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gout and atrial fibrillation

The Link Between Gout and Atrial Fibrillation

What does a disease that inflames your joints have to do with an erratic heart rhythm? Quite a lot, it turns out. Researchers have discovered that people with gout are at increased risk for atrial fibrillation (AFib).

One recent study analyzed a sample of Medicare claims data from more than 1.6 million people ages 65 and older. Those with gout were up to 90 percent more likely to be diagnosed with AFib than those without gout. The risk was particularly high among elderly adults.

The potential link between the two conditions underscores the need for gout patients to pay attention to their heart health.

What’s Behind the Link?

The most obvious connection between gout and AFib is inflammation. Body-wide inflammation is a hallmark of both diseases. The two conditions also share a number of risk factors, including obesity, high blood pressure, and diabetes.

Uric acid is another factor AFib and gout have in common. Gout occurs when high uric acid levels in the blood cause hard crystals to form around joints. Uric acid is a marker for cardiovascular risk and inflammation, and increased levels have been independently linked to AFib.

Still, it’s been difficult for researchers to prove the exact cause of the gout-AFib connection. “Could inflammation be the underlying link? Sure. Could uric acid be the driver of that inflammation? Sure. Could other factors be involved? Sure,” says Jasvinder Singh, MD, MPH, the University of Alabama professor of medicine and epidemiology who co-authored the Medicare claims study. “We need to investigate all of these pathways to understand this better.”

Getting a Diagnosis

If you have gout, you need to think about your heart health. Having AFib can increase your risk for serious conditions like blood clots, heart failure, and stroke.

“I think the practical implication is that rheumatologists and primary care doctors should keep a heightened suspicion for arrhythmias [abnormal heart rhythms] in people with gout,” Dr. Singh says. Vigilance is particularly important for people who have other AFib risk factors, such as high blood pressure or coronary artery disease.

Your primary care doctor or cardiologist can diagnose AFib with an electrocardiogram (EKG), Holter monitor, and other tests. If you have the condition, treatments include medicines and devices to control your heart rate and rhythm, and drugs to prevent blood clots from forming.

Treating Gout to Protect Your Heart

The same medications that treat gout might do double duty by lowering your AFib risk. In a 2016 study Dr. Singh also co-authored, older adults who took allopurinol had a 17 percent lower risk of AFib. Among those who took the drug for more than 2 years, the risk dropped by 35 percent. Colchicine is also being investigated for lowering AFib risk.

The trouble is, less than half of people with gout stick to their treatment regimen, putting both their joints and heart at risk. “These studies are increasingly making the case that if patients have gout, they should get treatment for it. Treatment might also protect them from the cardiac condition,” Dr. Singh says.

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