ACR 2010: Aggressive Therapy Reduces Risk of CVD in People with Gout

Early treatment with urate-lowering therapy not only prevents gout, it also may reduce cardiovascular disease and stroke mortality.

The use of urate-lowering therapy might successfully prevent death from cardiovascular disease in people with gout, according to research presented this week at the American College of Rheumatology Annual Scientific Meeting in Atlanta.

Hyperuricemia is an abnormally high level of uric acid in the blood that can lead to gout — a painful and potentially disabling form of arthritis that has been recognized since ancient times. Initial symptoms of gout usually consist of intense episodes of painful swelling in single joints, most often in the feet (especially the big toe). Gout occurs when excess uric acid (a normal waste product) accumulates in the body, and needle%u2010like crystals deposit in the joints. This may happen because uric acid production increases or, more often, the kidneys are unable to remove uric acid from the body adequately.

Previous studies have confirmed that there is an association between elevated serum uric acid levels and cardiovascular disease. Based on this information, researchers recently evaluated whether controlling serum acid levels with urate-lowering therapy—drugs that also reduce gout flare ups and joint damage and deformity from gout—could help prevent the development of, and death from, cardiovascular disease in people with gout.

The researchers examined medical data on 45,215 participants—of whom 20,677 were men and 24,538 were women—from the MJ Health Clinical Center in Taiwan, the National Health Insurance database, and the National Mortality Registry for Cardiovascular Death to look for links between high levels of uric acid, urate-lowering therapies and cardiovascular disease. While completing their comparison of information, the researchers took into account a number of other factors that could contribute to the development of and death from cardiovascular disease including age, gender, high blood sugar, high blood pressure, kidney disease, heart disease, arthritis, high cholesterol, and several drugs used to treat these conditions. Additionally, they considered if a person was overweight, had a history of cigarette smoking, and his or her level of alcohol consumption, level of exercise, education, occupation and work load.

Over an average of 11.3 years follow up, 519 subjects died of cardiovascular disease, including 308 men and 211 women. Urate-lowering therapy reduced the risk of cardiovascular disease by 44 percent and reduced death from a stroke by 58 percent. Urate-lowering therapy was also associated with a reduction in death from hemorrhagic stroke and high blood pressure of 88 percent and 71 percent, respectively.

Additionally, these researchers found that subjects who continued treatment for hyperuricemia for more than one year had a much lower risk of developing cardiovascular disease when compared to those who had been treated for less than two months.

"There is potential benefit of urate-lowering therapy on reducing total cardiovascular disease and stroke mortality," says Jiunn-Horng Chen, MD, PhD; assistant professor of medicine at China Medical University and lead investigator of the study. "Patients with hyperuricemia should be treated more aggressively and persistently than previously thought. This is not only for preventing incident gout, but also for the sake of cardiovascular disease prevention."

Source: American College of Rheumatology