Experts from the University of Nottingham and Keele University have found that in the four months after a gout flare, the risk of heart attacks and strokes temporarily goes up.

Those who had a heart attack or stroke were found to be more than twice as likely to have flared up their gout in the 60 days prior to the occurrence, and around one-and-a-half times as likely to have flared up in the 61-120 day period before.

The findings of the study, which was led by Professor Abhishek at the University of Nottingham School of Medicine, were released in the JAMA journal.

One in 40 persons in the UK suffers from the common form of arthritis known as gout. It is brought on by excessive concentrations of uric acid, a substance found in some meals and beverages and produced by the body as a result of tissue breakdown.

Urate crystals in the shape of needles are deposited in and around joints when uric acid levels are high. These crystals produce significant inflammation when they are freed from their deposits, which frequently lasts for 1-2 weeks and manifests as joint pain, swelling, redness, and tenderness. These episodes—known as gout flares—recur quite frequently. Heart attack and stroke risk factors include inflammation as well.

Although there have been no prior research on whether gout flares are associated with an increased risk of heart attack and stroke, people with gout tend to have greater cardiovascular risk factors. The researchers in this study looked at whether there was a brief rise in the risk of heart attack or stroke following a gout flare.

The group made use of anonymized data from 62,574 gout patients who were treated by the UK’s National Health Service. Of these, 10,475 had a heart attack or a stroke after being diagnosed with gout, while others of a comparable age, sex, and gout duration did not. They looked at the link between recent gout flares and heart attacks or strokes and adjusted the results for things like co-morbidities, socioeconomic deprivation, lifestyle factors, and prescribed medications. They discovered that gout patients who experienced a heart attack or stroke were twice as likely to have a gout flare in the 60 days prior to the incident and 1.5 times more likely to have one in the 61–120 days prior to the event.

When they analyzed data from just individuals who sought medical attention for a gout flare and also suffered from a heart attack or stroke, they discovered a comparable high rate of heart attack or stroke in the 0-60 and 61-120 days after gout flares compared with other time periods. According to this study, flare-ups of gouty arthritis are linked to a brief rise in cardiovascular events. When those with prior heart disease or stroke were eliminated and shorter exposure times, such as 0-15 and 16-30 days prior to heart attack or stroke, were taken into account, the higher odds and rates persisted.

People with gout who died of a heart attack or stroke were four times more likely to have had a gout flare in the last 0-60 days and twice as likely to have had a gout flare in the last 61-120 days.

“This is the first study of its kind to examine whether there is an association between recent gout flares and heart attacks and strokes,” said Professor Abhishek, the study’s lead author.

The findings indicate that, among gout patients, those who had a heart attack or stroke had significantly higher odds of experiencing a gout flare in the previous 120 days than those who hadn’t. “These findings suggest that gout flares are associated with a transient increase in cardiovascular events following flares.”

People who suffer from recurrent attacks of gout should be evaluated for long-term treatment with medications that reduce urate levels, such as allopurinol, according to the authors. 

“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,” they write.

People who suffer from gout should be urged to maintain a healthy lifestyle and treated appropriately for illnesses such as high blood pressure, high cholesterol, obesity, and diabetes in order to lower their overall risk of suffering from a heart attack or stroke.

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