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It is well known that high cholesterol, elevated blood pressure and smoking increase the risk for heart disease. Now, researchers from the University of Pittsburgh School of Medicine say that having gout can further boost the chances of having a heart attack.

Gout is a form of arthritis marked by sudden attacks of painful, inflamed joints, usually the big toe, but feet, ankles, knees, hands and wrists can also be affected. More than half of those who have had a gout attack will have a recurrence within one year.

One in 30 Canadians has gout, with men four times more likely than women to develop the condition. It usually shows up between the ages of 40 and 50 in men and after menopause in women.

Gout results from too much uric acid in the body - either the body makes too much of it or doesn't excrete enough, causing uric acid crystals to form in the joints.

A new study published in the Archives of Internal Medicine suggests that having gout can do more than damage your joints - it may also cause heart problems if you already have risk factors for heart disease.

In the study, researchers followed 9,105 men aged 41 to 63 years who were at above-average risk for heart disease to assess the link between gout and death from heart disease. (The men in the study had high cholesterol, high blood pressure and were smokers.) After 17 years, men with gout were 30 per cent more likely to die of heart attack or another cardiovascular cause (such as a stroke) compared with their peers who didn't have gout.

This isn't the first study to find higher rates of heart problems such as angina (chest pain that occurs when the heart doesn't get enough blood and oxygen) and heart attack in men with gout and high uric acid levels.

A 2004 study of 1,423 middle-aged Finnish men found that those with excess uric acid in their bloodstream had more than a 2.5-fold greater risk of dying from cardiovascular disease than men with lower uric acid levels.The normal range for serum uric acid is 200 to 440 micromoles per litre for men and 140 to 340 for women. (Serum is the part of the blood left over after clotting factors have been removed.)

It is thought that having too much uric acid in the blood creates oxidative stress, a state that damages LDL cholesterol, causing it to become oxidized. (Oxidized LDL cholesterol is considered more dangerous because it causes hardening and narrowing of artery walls.) High uric acid is also associated with higher levels of C-reactive protein in the blood, an inflammatory compound linked to atherosclerosis and heart attack.

Not everyone with high uric acid develops gout. In the latest study, men who fell into this category did not have a greater risk of dying from heart disease.

The standard prescription for managing gout is medication and dietary changes to reduce uric acid in the blood. The following dietary strategies can help you reduce the risk of gout - and possibly keep heart disease at bay.

LIMIT PURINE-RICH FOODS

Purines, natural compounds found in certain foods, are broken down into uric acid in the body. They're found in organ meats, beef, pork, lamb, sardines, anchovies, canned tuna, mackerel, lobster, scallops, shrimp, clams, asparagus, mushrooms, spinach, green peas, cauliflower, beans and lentils.

In the past, people with gout were told to lay off all purine-rich foods. However, a 2004 study involving 47,150 men found that while high intakes of meat and seafood increased the odds of developing gout by as much as 50 per cent, eating purine-rich vegetables did not.

GO EASY ON MEAT

AND SEAFOOD

Each day, consume no more than two to three servings of meat, fish, poultry, eggs or meat alternatives such as soy and legumes. Eating larger portions may increase uric acid and the risk of gout. One serving is 75 grams (2.5 ounces) of meat, fish or poultry; two eggs, or 175 millilitres (¾ cup) of cooked legumes or tofu.

INCLUDE LOW-FAT DAIRY

The same study found that men who drank at least two 240-millilitre (8-ounce) servings of skim milk each day were 44 per cent less likely to develop gout than men who drank less than one serving per month. It is thought the proteins in dairy help reduce uric acid levels.

Reduce saturated fat

Choose lean cuts of meat, skinless poultry breast and low-fat dairy products to reduce saturated fat, the type that raises LDL cholesterol.

AVOID BEER

Alcoholic beverages, especially beer and spirits, prevent uric acid from leaving your body and may trigger gout. (A moderate intake of wine has not been shown to increase the risk of gout.) Beer, unlike wine and spirits, also contains purines. Alcohol may also interfere with gout medications. If you're unsure, speak to your doctor about alcohol consumption.

GET PLENTY OF FLUIDS

Drink two to three litres of fluids per day to help your body excrete uric acid. Avoid sugar-sweetened soft drinks and fruit juice, which have been linked to a higher risk of gout.

If you are a coffee drinker, research suggests you might have a lower risk of gout. Coffee drinking is associated with lower levels of uric acid, an effect probably caused by antioxidants in coffee rather than caffeine. (Skip the cream and sugar.)

LOSE EXCESS WEIGHT

If you are overweight, slimming down may help prevent gout attacks. Excess weight puts more stress on your joints and can boost uric acid levels.

Do it gradually at a rate of on to two pounds per week. Rapid weight loss and fasting can increase uric acid levels in the blood. Avoid low-carbohydrate, high-protein diets since they can elevate uric acid levels.

Leslie Beck, a Toronto-based dietitian at the Medcan Clinic, is on CTV's Canada AM every Wednesday. Her website is lesliebeck.com.