Association of Gout and Hypertriglyceridemia

Epidemiological Association

The European League Against Rheumatism (EULAR) guidelines are based on evidence that hypertriglyceridemia is strongly associated with gout, representing a key component of the metabolic syndrome cluster that increases gout risk and requires treatment in its own right, as demonstrated by hospital-based case-control studies showing gout patients have significantly elevated triglyceride and apolipoprotein B levels compared to controls 1, 2, 3
The American College of Rheumatology recommends considering the association between gout and hypertriglyceridemia, with prospective data showing hazard ratios of 1.38 for men with hyperuricemia and 1.40 for men without hyperuricemia, although the exact mechanism is not fully understood 1, 2, 3

The American Heart Association notes that both gout and hypertriglyceridemia are integral components of metabolic syndrome, clustering with obesity, hyperglycemia, and hypertension, which have contributed to rising gout prevalence 4

EULAR guidelines strongly recommend (strength 93, 95% CI 88-98) that all patients with gout undergo assessment for metabolic syndrome features, including hyperlipidemia, as these represent the most prevalent and impactful comorbidities 1, 2, 3
The American College of Cardiology suggests screening for hypertriglyceridemia, hypertension, diabetes mellitus, obesity, and chronic kidney disease in gout patients, as these conditions frequently coexist 1

The European Society of Cardiology recommends eliminating or drastically reducing alcohol consumption, particularly beer and spirits, which raise both uric acid and triglycerides, with complete abstinence mandatory during active gout flares 5
The Academy of Nutrition and Dietetics suggests restricting purine-rich meats and seafood, while encouraging low-fat dairy products, which have protective effects, and achieving weight loss in overweight/obese patients through daily exercise and caloric restriction 5

The American College of Rheumatology recommends fenofibrate as the preferred agent for hypertriglyceridemia in gout patients, providing dual benefits: triglyceride reduction and additional uric acid lowering, with dosing starting at 54-160 mg daily and titrating based on lipid response 5
EULAR guidelines suggest reducing fenofibrate to 54 mg daily in patients with mild-to-moderate renal impairment and avoiding it entirely in severe renal impairment, a critical consideration since chronic kidney disease frequently coexists with gout 1

The American Heart Association advises against assuming that treating hypertriglyceridemia alone will adequately control gout, as both conditions require specific targeted therapy, and recommends avoiding thiazide or loop diuretics for hypertension management in gout patients with hypertriglyceridemia 5
The National Institute on Alcohol Abuse and Alcoholism notes that not all alcohol is equal, with wine consumption not increasing serum uric acid levels, unlike beer and spirits, and recommends monitoring renal function closely when using fenofibrate, especially in elderly patients or those with baseline kidney disease 5, 6

Type 2 diabetes is recognized as one of the comorbidities that has contributed to the rising prevalence of gout in many countries, including the USA, over the last few decades, according to the American College of Rheumatology 7, 8
Diabetes is part of the metabolic syndrome cluster that is commonly associated with hyperuricemia and gout, as stated by the European League Against Rheumatism 9, 10

Associated comorbidities and risk factors such as hyperlipidemia, hypertension, hyperglycemia, and obesity should be addressed as an important part of gout management, as recommended by the European League Against Rheumatism 11, 12, 13
Some treatments for comorbidities may benefit both conditions, such as losartan for hypertension and fenofibrate for hyperlipidemia, which can also reduce serum urate levels, according to the European League Against Rheumatism 12, 13