I recently taught medical students about gout. It made me wonder how many people are aware of the connection between gout and heart health (cardiovascular risk). We began by discussing the various types of joint symptoms caused by gout. The most commonly affected joints are the toes, knees, ankles, and finger joints.

Gout attacks can be excruciatingly painful and incapacitating. Gout develops in four stages:

1. There are no symptoms, but your blood contains high uric acid levels.
2. Acute gout refers to a gout flare-up.
3. Inter-critical gout is characterised by no symptoms between flares but persistently high uric acid levels.
4. Chronic tophaceous gout is characterised by joint deformity and dysfunction caused by uric acid deposits near the joint, as well as joint deformity caused by recurrent flares, as illustrated below:

Who is at risk of gout?

You are at risk of gout if you suffer from the conditions below:

• Chronic kidney disease
• High blood pressure (hypertension)
• Diabetes mellitus
• High fats in the blood (hyperlipidaemia)
• Osteoarthritis
• Lymphoproliferative/myeloproliferative disorders
• Severe exfoliative psoriasis.
• Diet
• Obesity
• Family history of hyperuricaemia and gout
  Male sex
  Postmenopausal women
  Older Age
  Medicines (for example, diuretics, low-dose aspirin, ciclosporin).

 

Treatment for gout:

For sudden onset flares Gout can be treated with:

• A short course of colchicine (side effect diarrhoea)
• An anti-inflammatory like ibuprofen or naproxen (side effect gastric irritation, kidney impairment)
• A steroid orally such as prednisolone

Treatment is highly dependent on your personal medical history, so always consult with your healthcare provider before beginning treatment. When the flare has settled, your uric acid level can be measured to prevent gout, and allopurinol is the most commonly used daily tablet to prevent gout. Your uric acid level can be measured, and allopurinol should keep it under control. Unless you drastically change your lifestyle or are unable to tolerate the treatment, treatment is usually lifelong.

 

Other long term treatments for gout:

Febuxostat is especially useful in treating gout patients who are intolerant to allopurinol and patients with impaired kidney function. There has recently been some concern about the use of febuxostat in patients with cardiovascular problems, but newer research indicates that it may be safe to use in those with pre-existing heart conditions.

 

What lifestyle advice should I follow?

• To follow a healthy and balanced diet
• Lose weight
• Reduce alcohol consumption

 

So what?

Anyone who has had gout knows how excruciatingly painful and incapacitating an acute flare-up can be. However, there are some long-term effects that should be avoided, such as:

• Chronic arthritis
• Joint damage.
• Reduced health-related quality of life
• Renal stones
• Tophi

 

Heart Health and Gout

Gout sufferers have an increased risk of cardiovascular disease, which has been well established. High uric acid levels are linked to an increased risk of:

• Heart disease and cardiovascular mortality (Heart attacks and strokes)
• Chronic kidney disease (CKD) affects nearly 25% of gout patients. 3 to 5
• If you have gout, you should assess your risk factors and heart health. The QRISK3 score is one method.

 

QRISK 3 score why is it important to me?

The QRISK 3 score was developed by doctors and academics in the UK National Health Service and is based on routinely collected data from thousands of GPs across the country who have freely contributed data to the QResearch database for medical research (1).
In general practise, we use the QRISK score to assess your risk of having a heart attack or stroke within the next ten years.
It can only be used in people who have not previously experienced a heart attack, stroke, or mini-stroke/TIA (trans ischaemic attack)

 

Why is gout being recognised as a cardiovascular risk factor?

Some of the inflammatory processes associated with gout are thought to predispose an individual to an increased risk of heart disease. Many risk factors for Gout are also risk factors for heart attacks and strokes. As a result, if you have gout, you should have your cardiovascular risk factors assessed, monitored, and treated as needed.

These would be:

• Blood pressure
• Lipids (cholesterol and triglycerides)
• Kidney function
• Smoking status
• Alcohol intake
• Body mass index

It is possible to compute your QRISK3 score. This score estimates your risk of having a heart attack, stroke, or heart attack in the next ten years based on your characteristics. If your risk is greater than 10%, you may be offered additional treatment.

 

Finally, Three Key Questions to ask your healthcare provider:

 

• What aspects of my lifestyle should I address?
• Should I alter any of my medications to avoid future attacks?
• Do I need to start taking medication to prevent further attacks, and what are the potential side effects?