I love it when gout forum posts trigger new lines of research for me.

A recent discussion about uric acid and heart disease prompted me to take a look at current research. This also tied in with a little bit of reorganizing I am doing. An old post about lowering uric acid levels did not appear to have any relevance to heart disease, but one link led to another, and before I knew it, a whole host of other diseases seemed to connect with gout.

Interestingly, the link between many of these diseases is via new research into allopurinol. I will come back to that at a later date, but for a hint of what is involved, please search for discussions about gout with another disease using the box at the top of each page.

Lower Uric Acid

In an earlier post, I mentioned that Hershfield believed that lowering uric acid below 2mg/dL (0.12 mmol/L) would probably be safe [1]. On reviewing that report in more detail, I noticed that much of his evidence was based on other diseases. There are conditions where people have the opposite conditions to gout sufferers. I.e., they either cannot produce uric acid or they over-excrete it. The first case is because they do not produce xanthine oxidase, the second because they have genetic kidney defects that stop the kidney from reclaiming uric acid. In both these conditions, people have no known ill-effects with uric acid levels below 1mg/dL (0.6mmol/L)

When I followed this through to other investigations of lowering uric acid, I hit on a report that also looked at other benefits of lowering uric acid outside the world of gout.

Allopurinol For Other Diseases

Wei and colleagues investigation, Impact of allopurinol use on urate concentration and cardiovascular outcome [2], attracted me for several reasons. The investigation highlights the poor level of treatment generally, with only a small percentage of gout patients achieving safe uric acid levels. This is one of my pet topics that I will keep returning to, but the investigation also ties together the issue of lowering uric acid for gout sufferers with the advantages of such a regime for patients with other health problems.

This has set me on a path to investigate and summarize several other diseases. Mainly, I am hoping that the outcomes from helping other diseases through lowering uric acid, will bring a better understanding of how uric acid affects us beyond the obvious gout problems. But, that is for another day. For today, let me leave you with the conclusion:

In conclusion, more than half of the patients taking allopurinol did not reach the recommended target urate levels. High-dose allopurinol use was associated with a lower risk of cardiovascular events and all-cause mortality than low-dose allopurinol use, suggesting that higher doses of allopurinol may be of benefit by reducing cardiovascular disease or death.

Figure from third reference

Gout And Heart Disease Feedback

21 Feb 2017: Allopurinol and Heart Health in Diabetes

This article is now flagged for review. It’s time to investigate recent evidence showing the value of allopurinol in heart disease. Because I’ve just read “Effect of long-term and high-dose allopurinol therapy on endothelial function in normotensive diabetic patients.”[3]

Long-term and high-dose allopurinol therapy significantly improved endothelial function in diabetic normotensive patients.

Do you agree that information about allopurinol linked with heart disease is valuable? Please prompt me to update it by sharing your story on allopurinol and heart disease.

24 Nov 2019: Patricia’s Allopurinol Anxiety

With reference to Are Allopurinol Anxieties Helpful or Pointless?:

My doctor doesnt have concern. I’ve had a heart attack a few months ago. But not from gout medicine – it was blockage. I just went back on it. Most doctors dont go by findings. I’m concerned about the heart and death issues.

25 Nov 2019: Allopurinol Anxiety Response

Sorry Patricia, but this is way beyond my pay grade. I’ve always said that anyone with gout and another medical condition MUST see specialists. When you see such a specialist, I suggest you ask if there is any more relevant research that shows how allopurinol helps heart disease. Because there could be something useful stemming from the research I reported here. Anyhow, I will look for later research into allopurinol and heart disease.
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Gout And Heart Disease References

  1. Hershfield, Michael S. “Reassessing serum urate targets in the management of refractory gout: can you go too low?.” Current opinion in rheumatology 21, no. 2 (2009): 138. Can Uric Acid Go Too Low?
  2. Wei, Li, Isla S. Mackenzie, Yang Chen, Allan D. Struthers, and Thomas M. MacDonald. “Impact of allopurinol use on urate concentration and cardiovascular outcome.” British journal of clinical pharmacology 71, no. 4 (2011): 600-607. doi: 10.1111/j.1365-2125.2010.03887.x. Allopurinol Uric Acid And Cardiovascular Health
  3. Dogan, Ali, Mikail Yarlioglues, Mehmet Gungor Kaya, Zakir Karadag, Serap Dogan, Idris Ardic, Orhan Dogdu et al. “Effect of long-term and high-dose allopurinol therapy on endothelial function in normotensive diabetic patients.” Blood pressure 20, no. 3 (2011): 182-187. doi: 10.3109/08037051.2010.538977

Also see my link to more recent allopurinol and heart disease research, in the comment below.

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