Gout may increase susceptibility of atrial fibrillation (AF) patients to ischaemic stroke, according to new research.
Analysis of data from the nationwide registry-linkage FinACAF* study showed that the incidence of ischaemic stroke was 12 percent higher among AF patients with gout than among their counterparts without gout (incidence rate ratio [IRR], 1.12, 95 percent confidence interval [CI], 1.02–1.24). [Stroke 2026;doi:10.1161/STROKEAHA.126.055194]
The increased incidence of ischaemic stroke in the presence of gout persisted in analyses restricted to AF patients without prior stroke (IRR, 1.14, 95 percent CI, 1.02–1.27) and in analyses restricted to follow-up without anticoagulation (IRR, 1.26, 95 percent CI, 1.09–1.46).
Nonanticoagulated crude stroke rates were 1.5, 1, and 4.8 per 100 patient-years for gout patients with CHA2DS2-VA scores of 0, 1, and ≥2, respectively.
Notably, time-dependent exposure to urate-lowering therapy was associated with a 30-percent lower stroke rate (IRR, 0.70, 95 percent CI, 0.57–0.85), and AF patients with gout who were receiving urate-lowering therapy had a similar stroke risk as those without gout.
“The 12-percent to 26-percent higher stroke risk associated with gout in the current study is clinically meaningful and comparable in magnitude to that observed for several established stroke risk factors in patients with AF, such as diabetes, hypertension, vascular disease, and heart failure,” the investigators said. [Diabetes Res Clin Pract 2023;203:110875; Eur J Prev Cardiol 2024;31:2135-2137; Atherosclerosis 2024;399:118590; J Am Heart Assoc 2025;14:e040758]
“Moreover, our study provides some evidence supporting a potential causal dose–response relationship between gout and stroke, as AF patients with gout requiring hospital-level treatment had a higher stroke risk than those with gout recorded only in primary care registries,” they added.
A modifiable risk factor
Current AF guidelines do not recognize gout as an established stroke risk factor, but more and more studies provide evidence of improved cardiovascular outcomes with the management of gout, according to the investigators.
The elevated stroke risk observed in AF patients in this study may be attributed to hyperinflammation and thrombogenic processes associated with gout and its flares, they explained. This inflammation hypothesis is supported by the positive results of colchicine prophylaxis for gout flares, which simultaneously decreases the risk of cardiovascular events. [Lancet Rheumatol 2025;7:e197-e207]
“In summary, although residual confounding by indication bias cannot be excluded in observational studies, our results suggest that gout may represent a modifiable stroke risk factor in patients with AF, and its consideration may help refine stroke prevention strategies,” the investigators said.
“Gout could be considered in stroke risk stratification in addition to the conventional scores, particularly for patients classified as low risk who might otherwise not be considered for oral anticoagulant therapy,” they added.
FinACAF population
The study included 229,565 patients with new-onset AF (mean age 72.7 years, 50 percent female). Of these, 6,910 (3 percent) had a history of gout, with diagnosis established at the hospital level for 3,796 (1.7 percent) and only in primary care for 3,114 (1.4 percent). Among those with gout, 2,978 (43.1 percent) had purchased urate-lowering therapies within a year before the first AF diagnosis. None of the patients in the cohort used colchicine at baseline.
Over a mean follow-up of 4 years, patients with vs without gout were more likely to initiate oral anticoagulant therapy (73.7 percent vs 70.4 percent) and had higher mortality (35 percent vs 33.2 percent). Ischaemic stroke occurred in 16,296 (7.1 percent) patients.
Based on the CHA2DS2-VA score, stroke risk was classified as low in 103 (1.5 percent), moderate in 443 (6.4 percent), and high in 6,364 (92.1 percent) patients with gout.