Gout Flare Linked to Increased Risk of Heart Attack, Stroke

Among individuals with gout, the risk of heart attack or stroke temporarily increases in the 4 months after a gout flare, according to study findings published online today in JAMA.

Gout has already been associated with cardiovascular (CV) diseases, but the temporal relationship between gout flare and CV events has not yet been established.

To assess whether there is a temporary increase in CV event risk after a gout flare, researchers conducted a retrospective observational study using UK electronic health records from between January 1997 and December 2020. Data from 62,574 patients with diagnosed gout was collected. Their mean age was 76.5 years and 69.3% of the patients were male.

Of this group, 10,475 patients experienced a heart attack or stroke after receiving a gout diagnosis. The authors found that age, sex, and duration of gout were not factors, as other patients with similar characteristics did not experience a heart attack or stroke. The association between gout flare and either of the 2 CV events was also adjusted for other factors, including other comorbidities, socioeconomic status, lifestyle factors, and medication use.

Patients with gout who experienced a heart attack or stroke were twice as likely to have experienced a gout flare in the 60 days prior to the CV event and 1.5 times more likely to have experienced a flare between 61 and 120 days prior compared with patients with gout who did not experience a CV event. After excluding patients who had a preexisting heart disease or who experienced a stroke prior to receiving a gout diagnosis, and considering shorter time periods between flare and CV event, the authors found these increased odds persisted.

Additionally, there was no significant increase in odds of gout flare between the 121 and 180 days prior to a CV event.

Patients who experienced either CV event also had higher rates of current smoking (12.6% vs 8.9%), prior CV disease (52.0% vs 20.7%), a high or very high CV risk (98.5% vs 66.9%), and a higher mean Charlson Comorbidity Index (3.23 vs 2.52) compared with those who did not.

According to the authors, these results suggest gout flares are associated with a temporary increased risk of CV events in the months following the flare, warranting additional research and adjustments in treatment.

“People with recurrent gout flares should be considered for long-term treatment with urate-lowering treatments such as allopurinol,” said Abhishek Abhishek, PhD, lead author of the study and professor of rheumatology at the University of Nottingham, United Kingdom, according to a news release about these findings. “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.”

He also noted that clinicians should advise patients with gout to adopt a healthy lifestyle in general and encourage treatment for conditions such as high blood pressure, high cholesterol, obesity, and diabetes to minimize risk of heart attack and stroke.

Reference

Cipolletta E, Tata LJ, Nakafero G, Avery AJ, Mamas MA, Abhishek A. Association between gout flare and subsequent cardiovascular events among patients with gout. JAMA. Published online August 2, 2022. doi:10.1001/jama.2022.11390