A new study looks to find the relationship between gout, a disease that often impacts the big toe, and cardiovascular disease.

In recent years, gout has been demonstrated to be an independent cardiovascular (CV) risk factor, which means that the arthritic disease itself increases CV risk. But understandings of what that risk entails have varied widely.

“No prior study had focused on individual patients from clinics, rather than analyzing large databases. This is a major strength of our work,” says Mariano Andrés, of Spain’s Hospital General Universitario de Alicante, and lead author of the paper “Cardiovascular risk of patients with gout seen at rheumatology clinics following a structured assessment,” published last month in Annals of the Rheumatic Diseases. The biggest lesson that patients should take away from this research, according to Dr. Andrés, is the danger of underestimating gout and confusing it with a minor condition. “We have a really effective treatment for the disease,” he says. “This high cardiovascular risk can likely be controlled easily.” Physicians, he says, should avoid the same pitfall. “When they have patients suffering from gout, they have to focus on all of the cardiovascular risk factors and manage them properly,” Dr. Andrés says.

In the study, Dr. Andrés and his colleagues used carotid ultrasound to detect subclinical atherosclerosis — the lesion that occurs immediately prior to a cardiovascular event. That helped them accurately classify their patients. “Following this, around two out of three patients would be at very high risk,” he says. Of 237 new patients with gout, 95 (or 40.1 percent) showed very high and 72 (30.5 percent) had moderate risk levels for CV. After carotid ultrasound (cUS) was performed in the 142 patients who weren’t very high risk, the number of very high risk classifications rose by more than half — from 40.1 percent to 67.9 percent.

“CV preventive strategies are less costly than treating the complications, especially on subjects at risk, which support efforts to identify high-risk populations through risk prediction tools or subclinical atherosclerosis screening,” Dr, Andrés and his colleagues write in the study, as quoted in Medscape. Future research projects will address the crucial need to demonstrate what impact dissolving uric acid crystals and curing gout will have on cardiovascular risk, and will focus on understanding what makes gout increase CV risk, Dr. Andrés says.