Many people who have gout also have cardiovascular disease, but whether gout actually causes heart disease has been unclear. After all, heart disease and gout — a chronic form of arthritis in which uric acid crystals deposit in the joints — share many common risk factors, including obesity, high blood pressure, and type 2 diabetes.
If gout does directly cause heart disease, at least in some patients, the assumption has been that systemic inflammation is to blame. While inflammation throughout the body (including in the joints and blood vessels) likely plays a strong role, a new case study suggests that it’s possible for uric acid crystals to actually deposit themselves in the heart muscle.
The case report, which was published in the journal Annals of Internal Medicine, describes a 49-year-old man who stopped taking his gout medications (allopurinol and colchicine) after experiencing gastrointestinal side effects. Several months later, he became short of breath, developed swelling in his legs, and was hospitalized. Doctors determined that uric acid crystals had settled into his heart muscle, causing it to become inflamed (a condition called myocarditis) and damaging it so that it could not pump efficiently (a condition called congestive heart failure).
Although this is a singular case — the authors say that no other cases like it have been reported to their knowledge — it highlights a possible connection between gout and heart disease.
“Many studies have found that [high uric acid] is associated with increased risk for coronary artery disease, heart failure, and sudden death,” the authors wrote. “On the basis of our experience with this patient, we conclude that gout can cause myocarditis with cardiac dilatation, cardiac dysfunction, and heart failure, particularly in patients with tophaceous and untreated gout.”
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Frustaci A, et al. Heart Failure From Gouty Myocarditis: A Case Report. Annals of Internal Medicine. December 2019. doi: https://doi.org/10.7326/L19-0486.
Singh JA. When gout goes to the heart: does gout equal a cardiovascular disease risk factor? Annals of the Rheumatic Diseases. April 2015. doi: http://dx.doi.org/10.1136/annrheumdis-2014-206432.