Screen gout patients for heart disease: expert

Risk factors

20 Apr 2017

High levels of uric acid significantly increase the risk for cardiovascular events among people with gout say rheumatologists in Western Australia who are now pushing for routine cardiovascular risk screening in patients who have the condition.

“In addition to treating hyperuricemia in our patients with gout, we need to be aware that it is a risk factor for cardiovascular disease – taking that into account may well lead to reduced cardiovascular mortality in certain patients,” says rheumatologist Professor Johannes Nossent, talking to the limbic about his research published in BMC Cardiovascular Disorders.

In a prospective analysis of the The Busselton Health Survey – one of WA’s longest-running population health research programs – Professor Nossent, Chair of Rheumatology and Musculoskeletal Medicine at the University of Western Australia, and colleagues found that an increase of 0.1 mmol/L in uric acid was independently associated with a more than two-fold increased risk of cardiovascular mortality among patients with gout and a history of cardiovascular events.

The findings are based on baseline serum uric acid measurements taken from over 4,000 participants who were tracked using hospital records over 15 years.

While it’s not currently recommended in Australian guidelines Professor Nossent argues that the findings strongly support the proposal to screen all patients with gout for cardiovascular disease.

“That’s an absolute – there is no discussion about it, any patient with gout needs to be assessed for all risk factors for cardiovascular disease and they need to be managed optimally.”

According to Professor Nossent, any chronic inflammatory systemic disease, whether it is primary joint disease or chronic tissue disease, incurs an increased risk of cardiovascular events regardless of the inflammatory pathway.

“It doesn’t seem to matter how the inflammation comes about – it’s more the fact that the inflammation exists.”

“It’s a bit like the treatment of hypertension,” he added.

“Gout may add on to the existing cholesterol atheroma with uric acid deposits and increase the risk for serious cardiovascular events so it is crucial to focus on managing CV comorbidities, such as high blood pressure, in addition to proper gout management,” he told the limbic.

‘There is absolute evidence that as soon as gout occurs you need to intervene and reduce uric acid load. We have good drugs that can lower uric acid levels very effectively and, in doing so, not only treat joint pain, but also reduce the risk of heart disease.”

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