Over 9 million Americans suffer from gout. This inflammatory condition is associated with high levels of uric acid in the bloodstream. When crystals precipitate into joints they cause extreme pain. That’s not all, though. A study published in JAMA (Aug. 2, 2022) shows that gout attacks seemingly increase the risk for cardiovascular events such as heart attacks and strokes.
Gout Attacks Really, Really Hurt!
One person wrote to us after she was switched to a different generic formulation of the gout medicine allopurinol.
After starting this product she:
“…started having breakthrough pains. Then one morning I woke with excruciating pain. My right big toe was red, swollen twice its size and very painful. I couldn’t get my shoe on.”
Betty shared this story about diet and gout:
“I could not get gout; I was not as old as my parents were when they both got gout. Well, haha. Then I had a lot of dental work done and I could not chew for several weeks. I bought liver sausage, which I love. I ate it daily, and surprise! I got gout.
“Wow, it is painful!! Could the liver sausage cause gout? I Googled, and sure enough, it could! I stopped the liver sausage and in a few days I had no more gout.”
Jack suffered gout flares after an indiscretion:
“I just got gout for first time. The pain was out of this world!
“I delayed going to doctor for few days which was a big mistake. I got a prescription for colchichine, which knocked out the intense pain in my toe but did nothing for the swelling. Prednisone fixed that.
“It is crucial that you figure out for yourself what your triggers are. Many of the usual suspects that doctors will cite are not your problem. For me, I had a few vodka and cranberries one night. I hadn’t had one in 15 years. That was my trigger, the fruit juice probably more so than the vodka.”
Gout Flares and Cardiovascular Complications!
The pain of a gout attack is enough to get most peoples’ attention. This is the kind of pain that cannot be ignored!
Pain and joint damage are not the only complications of gout.
The authors of the study in JAMA (Aug. 2, 2022) introduce their article this way:
“Gout is a common inflammatory condition that affected approximately 4% of the US general population in 2016 and is particularly prevalent in older people. Gout is characterized by recurrent episodes of acute inflammatory arthritis. Patients with gout have higher rates of cardiovascular diseases, independent of traditional cardiovascular risk factors.”
Be Especially Vigilant After Gout Attacks!
The study published in JAMA included more than 60,000 patients with gout. The vulnerable period lasted up to four months after a gout attack.
Here are the findings:
“In the nested case-control study of patients with newly diagnosed gout, patients with cardiovascular events had significantly increased odds of a gout flare during the preceding 120 days compared with patients who did not experience cardiovascular events. These findings suggest that gout flares are associated with a transient increase in cardiovascular events following flares. The increased odds persisted when people with preexisting cardiovascular diseases were excluded and when shorter exposure periods prior to the cardiovascular event (eg, within 0-15 and 16-30 days of cardiovascular event) were considered.”
Why Would Gout Flares Trigger Heart Attacks and Strokes?
Without getting into the weeds on the possible mechanisms, consider the inflammatory nature of gout. There is oxidative stress to various tissues throughout the body.
The authors of the JAMA study suggest that this in turn can:
“…contribute to plaque destabilization. This may explain the association between cardiovascular events and recent prior gout flares.”
Preventing Gout Attacks That May Lead to Heart Attacks and Strokes:
An editorial accompanying the research report suggests that health care providers be especially vigilant for cardiovascular complications after gout flares JAMA, Aug. 2, 2022).
Here is the summary:
“The findings of the study by Cipolletta et al should alert clinicians and patients to the increased cardiovascular risk in the weeks beginning after a gout flare and should focus attention on optimizing preventive measures. Patients should be alert to the signs and symptoms of unstable angina, MI [heart attack], and ischemic stroke so that medical care can be emergently sought. Clinicians should emphasize the importance of optimizing lifestyle measures and standard risk factor control, including adherence to diet, statins, anti-inflammatory drugs (eg, aspirin, colchicine), smoking cessation, diabetic and blood pressure control, and antithrombotic medications as indicated.”
Preventing gout attacks through diet, adequate fluid intake and appropriate uric acid-lowering medications might be the best way of avoiding these cardiovascular complications. You may find our article about “How to Avoid a Painful Gout Attack” of interest at this link.
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