Gout and Cardiovascular Disease: Crystallized Confusion

Aryeh M. Abeles; Michael H. Pillinge


Curr Opin Rheumatol. 2019;31(2):118-124. 

In This Article


People with gout are at increased risk for cardiovascular disease, both because, and independent of the high rate of traditional cardiovascular risk factors they harbor (Figure 1). Less clear are the mechanisms through which gout independently promotes cardiovascular risk – the role of urate per se, oxidant load, gouty inflammation, crystal deposition in vascular tissues, and the intracellular metabolic states in patients with gout are all areas of active investigation. Although serum urate lowering is always an appropriate treatment for established gout, it is less clear whether serum urate lowering has a salutary effect on cardiovascular disease. Which approaches to serum urate lowering are most likely to be beneficial is also an important but unresolved question. Finally, some evidence suggests that at least some antigout, anti-inflammatory agents may offer benefit, but colchicine studies are small and the results need to be confirmed in larger, prospective trials.

Figure 1.

Possible interactions in the association between gout and cardiovascular disease. As indicated, gout may play a causative role in the development and/or severity of cardiovascular disease, but cardiovascular disease may also theoretically promote gout. Alternatively, comorbidities, such as kidney disease may be promoted by, or promote, gout, cardiovascular disease, or both. Finally, the role of hyperuricemia, vs. gout per se, remains not well clarified. These multiple potential interactions and directions of causality make it challenging to clarify the role of gout in cardiovascular disease.