Pharmacologic Management of Gout in Patients with Cardiovascular Disease and Heart Failure

AbstractGout is the most common inflammatory arthritis and is often comorbid with cardiovascular disease (CVD). Hyperuricemia and gout are also independent risk factors for cardiovascular events, worsening heart failure (HF), and death. The recommended treatment modalities for gout have important implications for patients with CVD because of varying degrees of cardiovascular and HF benefit and risk. Therefore, it is critical to both manage hyperuricemia with urate-lowering therapy (ULT) and treat acute gout flares while minimizing the risk of adverse cardiovascular events. In this review, the evidence for the safety of pharmacologic treatment of acute and chronic gout in patients with CVD and/or HF is reviewed. In patients with CVD or HF who present with an acute gout flare, colchicine is considered safe and potentially reduces the risk of myocardial infarction. If patients cannot tolerate colchicine, short durations of low-dose glucocorticoids are efficacious and may be safe. Nonsteroidal anti-inflammatory drugs should be avoided in patients with CVD or HF. The use of canakinumab and anakinra for acute gout flares is limited by the high cost, risk of serious infection, and relatively modest clinical benefit. For long-term ULT, allopurinol, and alternatively probenecid, should be considered first-line treatments in patients with CVD or HF given their safety and potential for reducing cardiovascular outcomes. An increased risk of cardiovascular death and HF hospitalization lim...
Source: American Journal of Cardiovascular Drugs - Category: Cardiology Source Type: research

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Conclusions: Approximately, one-fourth of patients developed hyperkalaemia during follow-up which was associated with a lower MRA dose during follow-up. Discontinuation of MRA, but not hyperkalaemia itself, was associated with an increased risk of all-cause mortality and heart failure admission in HFrEF patients. PMID: 32264757 [PubMed - as supplied by publisher]
Source: Acta Cardiologica - Category: Cardiology Tags: Acta Cardiol Source Type: research
Publication date: Available online 8 April 2020Source: Journal of Clinical Orthopaedics and TraumaAuthor(s): V. Adukia, J. Mangwani, R. Issac, S. Hussain, L. Parker
Source: Journal of Clinical Orthopaedics and Trauma - Category: Orthopaedics Source Type: research
People with stiff and aching knees due to arthritis get better relief from physical therapy than from cortisone injections, according to a one-year military study comparing the two treatments.Reuters Health Information
Source: Medscape Medical News Headlines - Category: Consumer Health News Tags: Rheumatology News Source Type: news
Background: Even with antiretroviral therapy (ART), persons with HIV (PWH) experience increased morbidity and mortality. Cytomegalovirus (CMV) and Epstein--Barr virus (EBV) co-infections likely exacerbate inflammatory-related diseases. Objective: To determine if presence of detectable CMV or EBV DNA in peripheral blood mononuclear cells (PBMC) is associated with non-AIDS events among PWH receiving modern ART. Design: We performed a case--control study of PWH starting ART and HIV-suppressed at year 1 and thereafter, 140 cases who experienced non-AIDS events and 305 matched controls. Events included myocardial infarc...
Source: AIDS - Category: Infectious Diseases Tags: CLINICAL SCIENCE Source Type: research
Conclusion: ART may reduce the risk of NCIs in HIV-infected patients in general. Further research to investigate NCIs on specific antiretroviral regimens and comorbidities may provide insights regarding the long-term clinical care of these patients.
Source: AIDS - Category: Infectious Diseases Tags: EPIDEMIOLOGY AND SOCIAL Source Type: research
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Source: Diabetologia - Category: Endocrinology Source Type: research
AbstractThe paper by Stamp and colleagues (1) contributes to confirming the deleterious role of gout in patients with established cardiovascular (CV) disease. Here this is shown as a shorter time to readmission, mainly for heart failure, but an increased risk of subsequent myocardial infarction, CV ‐related and all‐cause death has also been reported (2). Of interest, these poor outcomes occurred despite appropriate CV management. Gout is a disease with variable levels of inflammation (3), driven by the deposition of monosodium urate crystals.
Source: Arthritis and Rheumatology - Category: Rheumatology Authors: Tags: LETTER TO THE EDITOR Source Type: research
This study shows that mRNA levels of the aging related lamin A splice variant progerin, associated with premature aging in HGPS, were significantly upregulated in subjects with BMI ≥ 25 kg/m2. Moreover, our data revealed a significantly positive correlation of BMI with progerin mRNA. These data provide to our knowledge for the first-time evidence for a possible involvement of progerin in previously observed accelerated aging of overweight and obese individuals potentially limiting their longevity. Our results also showed that progerin mRNA was positively correlated with C-reactive protein (CRP). This might suggest an as...
Source: Fight Aging! - Category: Research Authors: Tags: Newsletters Source Type: blogs
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Source: Journal of Rheumatology - Category: Rheumatology Tags: J Rheumatol Source Type: research
(Reuters Health) - Sleep apnea may increase the risk of developing gout and experiencing flare-ups, according to a new study. The intense pain and swelling of a joint, often a big toe, that marks gout is caused by the deposition of uric acid crystals in joints and tissues. Sleep apnea, the study team notes, causes periods of oxygen deprivation during the night when people stop breathing, which triggers overproduction of uric acid in the bloodstream. But little was known about the relationship between the two conditions, the study team writes in Arthritis and Rheumatology.  In 2007-2008, almost six percent of men and t...
Source: Healthy Living - The Huffington Post - Category: Consumer Health News Source Type: news
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