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RISK FACTORS OF HEART DISEASE: GOUT
To the cartoonist gout is something of a joke, an affliction of the obese port-drinker; to the patient suffering brief but extremely painful attacks of arthritis, it is far from amusing. It has a tendency to run in families, and the cartoonists are right about one thing: it is certainly made worse by alcohol. The basis of the condition is an excessive amount of a rather insoluble substance, uric acid, in the blood. Crystals of this can form in spaces between joints, leading to bouts of arthritis. These can occur in any joint; the base of the great toe is a common site. The condition is both treatable and preventable. Hence it is a pity if- as can sometimes happen -the diagnosis is missed or delayed. It should be suspected whenever a man (or older woman) suddenly develops a painful, swollen, reddened and sensitive joint.
Gout has some major complications: chronic arthritis and kidney stones, heart attack and stroke. Today the first two can be averted, but we need to learn more about reducing the risk of heart disease. Patients with gout have a tendency to high blood-triglyceride levels, and are also prone to high blood pressure. Probably both of these factors contribute to the risk of heart attack; and fortunately both are readily corrected. Avoidance of obesity is important. It is well worth limiting the intake of alcohol, which raises the levels both of uric acid and of triglyceride. If the triglyceride is persistently high it often responds to a diet similar to that used for high cholesterol levels. Drug treatment is of course available for high blood pressure and for resistant high-tri-glyceride levels. We do not know whether increased blood uric acid is directly harmful to the heart and arteries. But it is normal practice today for the doctor to correct very high uric-acid levels by drug treatment; this is chiefly to prevent or reduce the frequency of attacks of arthritis, and to avoid kidney stones.
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