Presence of Gouty Tophi Increases Risk of Cardiovascular Disease More Than Hypertension

The presence of tophi in people with gout was associated with increased risk for cardiovascular disease.

The presence of crystalized uric acid (tophi) in people with gout indicated a 3-times higher risk than that for hypertension for the development of thickened and stiffened carotid arteries, considered markers for increased risk of cardiovascular disease (CVD), according to research from Bulgaria presented at the 2015 annual meeting of the American College of Rheumatology in San Francisco.

Studies conducted over the past decade have suggested a role of elevated levels of uric acid as a predictor of mortality in patients diagnosed with heart failure or coronary artery disease, although the mechanisms are not well understood.1 “Analyzing these studies—and based on data that gouty tophi are not passive masses, but rather active granulomas—we decided to examine the different stages of gout and to compare the results,” reported lead author Rada Gancheva, MD, a resident in the  Rheumatology Clinic of the University Hospital, St. Iv. Rilski in Sofia, Bulgaria.

“More than half of the deaths in the world are cause by cardiovascular diseases, and chronic inflammation is a proven risk factor,” Dr Gancheva said.  She and her colleagues collected data on 170 individuals divided into 3 groups according to gout diagnosis: asymptomatic hyperuricemia (n=41), gout without tophi (n=52), and gout with tophi (n=42), plus a control group diagnosed with osteoarthritis but no gout (n=35).

The 4 groups were given multisystem evaluations using ultrasonography and echocardiography, with no differences reported between groups in the frequency of diabetes mellitus, arterial hypertension, cardiovascular events, chronic renal failure, and obesity. All patients with gout (with or without tophi) had hyperlipidemia.

“These data suggest that the presence of tophi may confer an independent risk for cardiovascular disease that is commensurable and even greater than that for hypertension,” Dr Gancheva said. “With more studies like this one, with such an integrated approach, we believe criteria for the assessment of cardiovascular risk in gout could be established and easily applied by physicians to better ensure quality of care for people with gout.”


Gancheva R, Kundurdjiev A, Ivanova M, Kundurzhiev T, Kolarov Z. How strong cardiovascular risk factor are gouty tophi?  Presentation at: 2015 ACR/ARHP Annual Meeting; San Francisco, CA; November 7-11, 2015. Abstract 3168.