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Gout patients are at increased risk of heart attack and stroke in the four months following a flare, finds new research published in the journal JAMA.
While people with gout (a common form of arthritis) tend to have more cardiovascular risk factors, no previous studies have looked at whether gout flares are linked to heart attack and stroke.
To fill this gap in research, experts at the University of Nottingham and Keele University analysed NHS data from more than 62,000 gout patients.
Heart attack and stroke patients twice as likely to have had a gout flare in the 60 days prior to the event
In total, 10,475 experienced heart attack or stroke after the diagnosis of gout, while others of similar age, sex, and duration of gout, did not experience such events.
The study evaluated the association between heart attacks or strokes and recent gout flares and adjusted these results for variables such as comorbidities, socioeconomic deprivation, lifestyle factors and prescribed medications.
They found that gout patients who suffered a heart attack or stroke were twice as likely to have had a flare in the 60 days prior to the event, and one and a half times more likely to have a flare in the preceding 61-120 days (two to four months).
Patients who died from a heart attack or stroke had over four times the odds of experiencing a flare
When the researchers looked at information from patients who had only consulted for a flare, but had also experienced either a heart attack or stroke, they found a similarly high rate of heart attack of stroke in the 0-60 and 61-120 days after flares compared with other time periods.
This further strengthened the finding that flares are associated with a transient increase in cardiovascular events following flares.
The increased odds and rates persisted when people with pre-existing heart disease or stroke before their gout diagnosis were excluded, and when shorter exposure periods such as 0-15 and 16-30 days prior to heart attack or stroke, were considered.
Gout patients who died from a heart attack or stroke had over four times the odds of experiencing a flare in the preceding 0-60 days and over twice the odds of flare in the preceding 61-120 days.
Long-term treatment with urate lowering medications
Since gout is caused by high levels of uric acid, the study’s authors say that people with recurrent flares should be considered for long-term treatment with urate lowering medications, such as allopurinol, as “this is a reliable way of removing urate crystal deposits and providing freedom from gout flares”.
“Patients should also be considered for concurrent treatment with anti-inflammatory medicines such as colchicine for the first few months because urate lowering treatments may trigger gout flares in the short term,” said Professor Abhishek, lead author of the study.
“People with gout should be encouraged to adopt a healthy lifestyle with appropriate treatment of conditions such as high blood pressure, high cholesterol, obesity and diabetes to minimise their background risk of heart attack and stroke,” he added.