Gout may be an early warning sign of life-threatening heart disease, new research shows.
Drinking too much and being overweight increase gout risk
Dutch researchers found middle-aged patients with the painful joint condition were more likely to have high blood pressure, raised cholesterol levels and diabetes.
They said GPs should examine patients with gout to see if they have signs of cardiovascular disease.
The study does not suggest gout causes heart attacks.
But it does show it could be a marker for the disease in patients with no previous history of cardiac trouble.
"A gout attack should be an incentive to assess the cardiovascular risk profile when a patient seeks medical help," said researcher Dr Eloy van de Lisdonk, from the department of general practice at the University of Nijmegen.
Once dubbed 'the disease of Kings', gout has always been associated with high living, brought on partly by over-indulgence in certain foods and drink.
It is still mainly perceived as a disease of 17th, 18th and 19th centuries, an affliction confined to portly old men who enjoyed too much banqueting.
But in recent years the numbers of people affected has been rising, partly due to the increase in obesity.
It is now estimated there are a quarter of a million sufferers in the UK and it is the most common cause of inflammatory joint disease in men over 40 - usually affecting the big toe.
The condition, first described by Hippocrates in the fourth century BC, is caused by as build-up of uric acid in the blood and tissues.
In some sufferers, this is due to an inherited problem with the kidneys but many develop gout from drinking too much alcohol or eating high protein foods such as liver, kidneys, sardines and anchovies.
Treatment involves powerful painkillers and drugs to reduce uric acid levels in the joint.
Until now, gout has not been considered as a serious illness. But the latest research suggests it is linked with much more threatening ailments.
The Dutch researchers identified 261 patients who suffered a first attack of gout, most of whom had no record of heart disease, and compared them with 522 gout-free volunteers.
The results, published in the journal Family Practice, showed 43% of gout sufferers had high blood pressure, compared with just 18% in the non-gout group.
More than half of those in the group with gout were obese, compared to just a third in the other group.
Cholesterol rates were also higher in those with gout, and while one in 20 patients with the condition had signs of diabetes, in the healthy group, it was only one in a 100.
Dr van de Lisdonk said: "Gout was found to be associated with cardiovascular disease and with cardiovascular risk indicators."
The UK Gout Society says the risks can be reduced by cutting down on red meat, game, seafood - especially mussels, herrings and sardines - and drinking less beer, port and red wines.