American Heart Month – Linking Gout and Heart Disease
Gout and heart disease

Featuring Dr Ambrose Panico, DO Electrophysiologist

“Dear heart, please stop getting involved in everything. Your job is to pump blood, that’s it.” – Anonymous

February has been named American Heart Month, and just like the heart is involved in everything, you are now going to notice hearts, heart memes, and heart images everywhere this month.

The heart is especially important in the whole-body approach to how we view autoimmune conditions, and now we have even realized that gout and heart disease may be connected.

Dr. Ambrose Panico, DO is an Electrophysiologist in Mesa, AZ and refers to himself as a heart electrician. He specializes in the diagnosis and treatment of complex arrhythmias or electrical conduction abnormalities in the heart, and has become one of the premier physicians in the greater Phoenix area that provides state-of-the-art treatment for heart rhythm disorders. He is our guest contributor this month to help answer questions about how gout and heart disease can be related.

“Over the past several years, the medical community is seeing more and more patients, especially younger ones, being diagnosed with A fib. We know there are certain risk factors like obesity, alcohol use, and heart failure that make a person more likely to have an arrhythmia or irregular heart rate,” states Dr Panico. “Now we are learning that so can high uric acid levels, chronic inflammation, and viruses.”

Rheumatology helps to integrate the link between inflammation in the body and how it can affect organ function. There were not many conditions that were known to affect the heart about 10 years ago, outside of rheumatoid arthritis, lupus, and certain infections like coxackie virus or rheumatic fever. Now, we have evidence that shows a much clearer connection between a state of high inflammation and the stress that takes on the heart.

What Is Heart Disease?

Heart Disease can broadly be defined as any disease effecting the heart or circulatory system. This includes blood vessels that supply every inch of our bodies. But mainly, we refer to:

  • Coronary artery disease in which blockages in the arteries of the heart can lead to heart attacks.
  • Peripheral arterial disease where blockages in other major arteries can lead to strokes, or blood clots in the arteries that stop blood flow.
  • Cardiomyopathy and Congestive Heart Failure (CHF) where the heart pumping strength is decreased and weaker
  • Valvular Heart Disease where one of the four heart valves does not function properly
  • Arrhythmias, or abnormalities with the electrical system of the heart that make the heart beat too slow or too fast

So, as you can see, the heart really is involved in everything! And when the heart is not functioning properly, the rest of the body suffers too.

How is Gout and Heart Disease Related?

According to Dr. Ambrose Panico,

“More and more evidence is supporting that high levels of inflammation over a long period of time (weeks to months or years) can lead to changes in the heart tissue itself or within the blood vessels of the heart and the rest of the body. This has recently been shown with high levels of uric acid, in which gout can crystalize in the heart blood vessels right alongside the cholesterol deposits that we know contribute to heart attacks.”

A recent study out of Sweden showed a “significant increase of new-onset atrial fibrillation in patients with elevated serum uric acid levels,” states Dr. Ambrose Panico. “But what was most alarming about these results, was that these patients did not have other traditional risk factors for afib or heart disease that we know about. This means that patients with undiagnosed or uncontrolled gout can do everything else to have a heathy heart but will still be higher risk for heart disease and afib.”

Research surrounding gout and heart disease is still ongoing. The Annals of Rheumatic Disease published a study that cited patients with gout were higher risk for developing blockages in major arteries—this can lead to strokes and heart attacks. Another study estimated that this risk was almost twice as high in these very same patients.

How Can Heart Disease or Arrhythmias be prevented?

Unfortunately, not all heart disease can be prevented. There are however several ways we can minimize the risk of developing, or at least slow down the progression of cardiovascular disease, by risk factor modification. These are factors that we may control.

What is a Modifiable Risk Factor?

These risk factors are anything we can change or treat, with medication, lifestyle adjustments, and awareness. For example, controlling blood pressure is important to help the heart pump effectively and to keep the inside lining of our blood vessels (called the endothelium) healthy.

Other actions like treating sleep apnea, managing diabetes, and treating high cholesterol can be modified to help decrease the risk of heart disease. Maintaining a healthy weight, minimizing alcohol consumption, avoiding tobacco products, eating a well-balanced diet, and getting our hearts pumping with regular exercise are all within our control and may help reduce the risk of gout and heart disease.

Often the first step to modifying your risk factors starts with regular visits with your healthcare team and understanding your diagnosis so that you can empower yourself to make changes for the better. When we understand what is at stake, we are more likely to invest in behaviors that change our habits.

What are Non-modifiable Risk Factors?

These are things that we cannot change entirely but can still take steps to minimize their overall impact. A great example of this is genetics. For example, a number of patients have genetic predisposition to high cholesterol. While we cannot modify your individual genetic code, we can still recognize this risk and treat the condition with medications, diet changes, and exercise to lower the genetic impact.

How does diet impact cardiovascular health?

Diet is an important step to recognize in the overall prevention and treatment of cardiovascular disease. And unsurprisingly, diet is also a major player when it comes to preventing gout and heart disease. The American Heart Association recommends a diet that emphasizes a variety of fruits and vegetables, whole grains, low-fat dairy products, skinless poultry and fish, nuts, legumes and (non-tropical) vegetable oils. This is similar to the anti-inflammatory approach that we often talk about in rheumatology, and these features also help with managing gout symptoms. So just like the heart is involved in everything, our diet also impacts every health condition.

There is more and more research being done to learn about the effect of our gut bacteria and our overall health. “This is an exciting revelation for the field of cardiology because we may start to see changes reverse in more people as they pay more attention to their diet specifically. Changes that may be even more powerful than medications in some instances,” states Dr. Ambrose Panico.

Why is exercise so important for heart health?

Exercise and increasing blood flow through our bodies is equally important. The CDC recommends 150 minutes of moderate-intensity physical activity and 2 days of muscle strengthening exercises per week. That is about 30 minutes per day on average of increased physical activity. This does not need to be 30 minutes all at once, but can be broken up throughout the day.

These recommendations align with the American College of Rheumatology, who recently published recommendations for exercise to be a part of the treatment plan for patients with RA. Weight-bearing exercise is important for maintaining bone health in patients at risk for or who have a diagnosis of osteoporosis. Dr. Panico emphasizes that it is important to discuss these recommendations with your health care provider prior to beginning any dedicated plan.

How can you find Dr. Ambrose Panico?

Ambrose Panico, DO is an Electrophysiologist at Cardiovascular Associates of Mesa. His office phone is (480) 641-5400 and is accepting new patients. He can be found on Twitter and Instagram @AZ_EP_DOC .

For more on gout and heart disease, visit The American Heart Association.

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