Gout flareups may precede heart attack, stroke, study says

British researchers say the risk of heart attack and stroke temporarily increases in the four months after a gout flare. Photo by cnick/
British researchers say the risk of heart attack and stroke temporarily increases in the four months after a gout flare. Photo by cnick/

Aug. 2 (UPI) -- The risk of heart attacks and strokes temporarily increases in the four months after a gout flareup, a British study released Tuesday suggests.

Gout is a common, painful form of inflammatory arthritis that often affects the big toe joint.


According to the research, gout patients who had a heart attack or stroke were twice as likely to have had a gout flare in the 60 days before the event, and one and one-half times more likely to have had a gout flare in the previous 61 to 120 days.

The study was published in JAMA, the Journal of the American Medical Association.

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Gout flares begin suddenly and can last for days or weeks, according to the Centers for Disease Control and Prevention. Flareups are followed by long periods of remission, sometimes adding up to years without symptoms before another flare begins.


By some estimates, gout affects more than 8 million American adults. CDC's latest data show roughly 58.5 million U.S. adults, or 22.7%, have been told by a doctor that they have some form of arthritis, rheumatoid arthritis, lupus, fibromyalgia or gout.

According to the Cleveland Clinic, gout occurs when excess uric acid leaves the bloodstream, forms needle-shaped urate crystals and settles into other parts of the body, particularly the joints, causing severe inflammation.

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Genetics likely is the cause, and overindulging in foods high in purines, such as red meat, seafood and alcohol that break down to uric acid, can cause a flare.

The British researchers said inflammation also is a risk factor for heart attack and stroke, and people with gout tend to have more cardiovascular risk factors.

But they said no previous studies exist about whether gout flares are linked to an increased risk of heart attack and stroke.

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"People with recurrent gout flares should be considered for long-term treatment with urate-lowering treatments such as allopurinol," which is a reliable way of removing urate crystal deposits and avoiding flares, Abhishek Abhishek, the study's lead author, said in a news release.

Gout 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 Abhishek, professor of rheumatology at the University of Nottingham School of Medicine in England.


Abhishek said that people with gout should be "encouraged to adopt a healthy lifestyle" and get appropriate treatment for conditions such as high blood pressure, high cholesterol, obesity and diabetes, to "minimize their background risk" of heart attack and stroke.

Abhishek is honorary consultant rheumatologist at the Nottingham University Hospitals NHS Trust, a major health system in the region.

For the study, the investigators used data from 62,574 patients with gout treated in the National Health Service in the United Kingdom. Of these, 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 researchers evaluated the association between heart attacks or strokes and recent gout flares, making adjustments "for comorbidities, socioeconomic deprivation, lifestyle factors and prescribed medications among other things," the release said.

The study found that the increased odds and rates persisted when people who had pre-existing heart disease or stroke before their gout diagnosis were excluded, and when shorter exposure periods prior to heart attack or stroke were considered.

Gout patients who died from a heart attack or stroke had more than four times the odds of experiencing a gout flare in the preceding 0 to 60 days and over twice the odds of gout flare in the preceding 61 to 120 days, the researchers said.


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