Gout may boost heart attack risk

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It is well known that high cholesterol, elevated blood pressure andsmoking increase the risk for heart disease. Now, researchers fromthe University of Pittsburgh School of Medicine say that havinggout can further boost the chances of having a heart attack.
Gout is a form of arthritis marked by sudden attacks of painful,inflamed joints, usually the big toe, but feet, ankles, knees,hands and wrists can also be affected. More than half of those whohave had a gout attack will have a recurrence within one year.
One in 30 Canadians has gout, with men four times more likely thanwomen to develop the condition. It usually shows up between theages of 40 and 50 in men and after menopause in women.
Gout results from too much uric acid in the body - either the bodymakes too much of it or doesn't excrete enough, causing uric acidcrystals to form in the joints.
A new study published in the Archives of Internal Medicine suggeststhat having gout can do more than damage your joints - it may alsocause heart problems if you already have risk factors for heartdisease.
In the study, researchers followed 9,105 men aged 41 to 63 yearswho were at above-average risk for heart disease to assess the linkbetween gout and death from heart disease. (The men in the studyhad high cholesterol, high blood pressure and were smokers.) After17 years, men with gout were 30 per cent more likely to die ofheart attack or another cardiovascular cause (such as a stroke)compared with their peers who didn't have gout.
This isn't the first study to find higher rates of heart problemssuch as angina (chest pain that occurs when the heart doesn't getenough blood and oxygen) and heart attack in men with gout and highuric acid levels.
A 2004 study of 1,423 middle-aged Finnish men found that those withexcess uric acid in their bloodstream had more than a 2.5-foldgreater risk of dying from cardiovascular disease than men withlower uric acid levels.The normal range for serum uric acid is 200to 440 micromoles per litre for men and 140 to 340 for women.(Serum is the part of the blood left over after clotting factorshave been removed.)
It is thought that having too much uric acid in the blood createsoxidative stress, a state that damages LDL cholesterol, causing itto become oxidized. (Oxidized LDL cholesterol is considered moredangerous because it causes hardening and narrowing of arterywalls.) High uric acid is also associated with higher levels ofC-reactive protein in the blood, an inflammatory compound linked toatherosclerosis and heart attack.
Not everyone with high uric acid develops gout. In the lateststudy, men who fell into this category did not have a greater riskof dying from heart disease.
The standard prescription for managing gout is medication anddietary changes to reduce uric acid in the blood. The followingdietary strategies can help you reduce the risk of gout - andpossibly keep heart disease at bay.
LIMIT PURINE-RICH FOODS
Purines, natural compounds found in certain foods, are broken downinto uric acid in the body. They're found in organ meats, beef,pork, lamb, sardines, anchovies, canned tuna, mackerel, lobster,scallops, shrimp, clams, asparagus, mushrooms, spinach, green peas,cauliflower, beans and lentils.
In the past, people with gout were told to lay off all purine-richfoods. However, a 2004 study involving 47,150 men found that whilehigh intakes of meat and seafood increased the odds of developinggout by as much as 50 per cent, eating purine-rich vegetables didnot.
GO EASY ON MEAT
AND SEAFOOD
Each day, consume no more than two to three servings of meat, fish,poultry, eggs or meat alternatives such as soy and legumes. Eatinglarger portions may increase uric acid and the risk of gout. Oneserving is 75 grams (2.5 ounces) of meat, fish or poultry; twoeggs, or 175 millilitres (¾ cup) of cooked legumes or tofu.
INCLUDE LOW-FAT DAIRY
The same study found that men who drank at least two 240-millilitre(8-ounce) servings of skim milk each day were 44 per cent lesslikely to develop gout than men who drank less than one serving permonth. It is thought the proteins in dairy help reduce uric acidlevels.
Reduce saturated fat
Choose lean cuts of meat, skinless poultry breast and low-fat dairyproducts to reduce saturated fat, the type that raises LDLcholesterol.
AVOID BEER
Alcoholic beverages, especially beer and spirits, prevent uric acidfrom leaving your body and may trigger gout. (A moderate intake ofwine has not been shown to increase the risk of gout.) Beer, unlikewine and spirits, also contains purines. Alcohol may also interferewith gout medications. If you're unsure, speak to your doctor aboutalcohol consumption.
GET PLENTY OF FLUIDS
Drink two to three litres of fluids per day to help your bodyexcrete uric acid. Avoid sugar-sweetened soft drinks and fruitjuice, which have been linked to a higher risk of gout.
If you are a coffee drinker, research suggests you might have alower risk of gout. Coffee drinking is associated with lower levelsof uric acid, an effect probably caused by antioxidants in coffeerather than caffeine. (Skip the cream and sugar.)
LOSE EXCESS WEIGHT
If you are overweight, slimming down may help prevent gout attacks.Excess weight puts more stress on your joints and can boost uricacid levels.
Do it gradually at a rate of on to two pounds per week. Rapidweight loss and fasting can increase uric acid levels in the blood.Avoid low-carbohydrate, high-protein diets since they can elevateuric acid levels.
Leslie Beck, a Toronto-based dietitian at the Medcan Clinic, is onCTV's Canada AM every Wednesday. Her website is lesliebeck.com.