Gout increases the risk of a broad range of cardiovascular diseases

Gout is associated with an increased risk of a broad range of cardiovascular diseases, according to new research which looked at the health records of more than 860,000 people.

The study, which is published in the Lancet Rheumatology and led jointly by researchers from the Universities of Glasgow, Oxford and KU Leuven, reveals that having gout is linked with a 58% higher risk of cardiovascular disease, with even higher relative risks noted for females and those under the age 45 who have the condition.

Gout, an extremely painful condition that causes swelling and redness in joints, is one of the most common types of inflammatory arthritis in the world. It is more common in men and older individuals, but can impact women and younger people too, and is caused by a build-up of uric acid in the body leading to tiny crystals forming around joints.

Previous studies have linked gout to cardiovascular disease risk, but this is the first time researchers have looked at a broad range of diseases impacted in such a large-scale study. To carry out the work the team of UK and European researchers used electronic health records from the Clinical Practice Datalink, and analysed the data from more than 152,000 individuals with gout alongside more than 700,000 matched population controls.

The results show that people with gout had an overall higher risk of cardiovascular disease than those without the condition. In particular, women with gout had a 88% higher relative risk of cardiovascular disease compared to women without gout; for men with gout, the risk of cardiovascular disease was 49% higher compared to those without gout. Although the absolute risk of cardiovascular disease increases with age, this study shows that gout appears to amplify this risk to a greater extent in younger individuals (aged <45 years) than older individuals, such that a young person with gout has more than twice the risk of cardiovascular disease than a similarly aged person without gout.

This increased risk was seen across all 12 cardiovascular diseases studied in the research, including heart failure, ischaemic heart disease, arrythmias, valve diseases, and venous thromboembolism. In addition, patients with gout had a higher BMI than matched controls, and a notably higher prevalence of other health conditions, including chronic kidney disease and high blood pressure.

Researchers say these new findings suggest that identifying and implementing strategies to reduce cardiovascular risk in people with gout should now be a priority, for both further research and clinical practice.

Lead senior author of the paper Dr Nathalie Conrad, based at the KU Leuven in Belgium, and an Honorary Research Fellow at the University of Glasgow and the University of Oxford, said: “The present results complement a now large body of evidence of substantial cardiovascular risks associated with gout, as well as other immune­-mediated inflammatory conditions. To date, these conditions are less commonly considered in cardiovascular disease prevention guidelines and risk scores, nor are there specific prevention measures for these patients. These data suggest this might need to change, and the clinical community may need to consider cardiovascular disease screening and prevention as an integral part of the management of gout.”

First author of the paper Dr Lyn D Ferguson, Consultant and Honorary Senior Clinical Lecturer based at the University of Glasgow, said “This work highlights the importance of screening for and managing a range of cardiovascular diseases in people with gout. Gout could be considered a metabolic condition and management should include addressing the heart and body weight alongside joints”.

Co-lead author Professor Naveed Sattar, University of Glasgow, said: “High quality data used carefully are helping us determine common risk factors, such as obesity, for many conditions, as well future disease risks. Whether intentional weight loss helps prevent or reverse gout needs future research.”

The paper, ‘Gout and incidence of twelve cardiovascular diseases: A case-control study including 152,663 individuals with gout and 709,981 matched controls’ is published in the Lancet Rheumatology. The work was funded by the Research Foundation Flanders.