cardiovascular disorders are one of the the leading causes of mortality and morbidity today all over the world . they are endemic , and have been seen to increasingly affect a considerable number of people . they are also responsible for a major financial burden on the community and cause healthcare expenses . although ischemic heart disease can be seen in different age groups , usually it is a disease of the aging population in whom related or un - related systemic disorders may also co - exist . on the other hand , other than the well known risk factors such as genetic inheritance , hyperlipidemia , cigarette smoking etc , it is well known that some of these co - existing systemic medical problems may also presdispose to coronary artery disease . it is characterized with deposition of crystals of monosodium urate due to the increased circulating levels of uric acid in the blood . literature includes scant reports about the co - existance of gout arthritis and ischemic heart disease , or hyperuricemia related coronary artery disease.[1313 ] in this report , we present pre- , peri- , and post - operative strategies in a 63-year - old male patient with the history of gout disease , and who underwent a successful surgical treatment for coronary artery disease . the patient was a 63-year - old white turkish male living in istanbul , turkey who presented to the clinic with increasing chest pain on exertion , which had progressed in the last six months . he had been a smoker for more than 45 years , and on an average smoked 1 - 1.5 packs per day . he was not hypertensive ( blood pressure of 128/76 mmhg on left arm and 132/77 mmhg on right arm at rest ) and did not have diabetes mellitus ( overnight fasting blood glucose of 98 mg / dl , normal range : < 100 mg / dl ) . blood lipid profile indicated total cholesterol and low density lipoprotein levels of 193 mg / dl ( normal range : < 200 mg / dl ) and 124 mg / dl ( normal range : < 130mg / dl ) , respectively . cardiologic check up protocol was considered and the patient underwent stress electrocardiography which resulted positive . myocardial thallium perfusion scintigraphy indicated ischemic zones at the inferior , inferolateral and inferoapical zones of the heart . according to the results , coronary angiography was performed and it revealed triple vessel disease with subtotal occlusion of left anterior descending artery ( lad ) at the midportion , midportion 80% stenosis at the circumflex coronary artery ( cx ) and 70% stenosis at the right coronary artery ( rca ) . echocardiography was normal with preserved left ventricular functions ( 65% ejection fraction ) and left ventricular hypertrophy . following the consent of the patient , coronary artery bypass grafting ( cabg ) was planned . during the preparatory phase for surgery , the patient complained of acute first toe pain . laboratory findings including complete blood count , blood lipid profile , renal and hepatic enzymes , clotting times , were normal except increased serum uric acid levels ( 10.74 mg / dl , normal : 3.4 - 7 mg / dl ) and slighly elevated c - reactive protein ( 6.72 mg / l , normal : 0 - 5 mg / l ) . he was prescribed allopurinol 300 mg twice daily and scheduled for surgery when the circulating uric acid levels returned to normal . following four days of treatment , uric acid levels returned to normal limits , and he underwent triple vessel cabg ( left internal mammarian artery to lad , aorta - first obtuse marginal artery and aorta - posterior descending branch of the right coronary artery bypasses with separate saphenous veins ) with the use of cardiopulmonary bypass on arrested heart at 33 - 34c . cross clamp and cardiopulmonary bypasses were 35 minutes and 47 minutes , respectively . after the operation , the patient was transferred to the intensive care unit and extubated there on the post - operative 4 hour . he was taken to the ward the next day and discharged on the 6th day . blood and blood product usage was 1 units of erythrocyte suspension and 2 units of fresh frozen plasma in total . immediately after the surgery , there was a slight increase in serum uric acid levels ( 7.4 mg / dl ) detected in the blood drawn in the intensive care unit . as soon as the patient was extubated and oral intake was started , allopurinol was initiated at the same pre - operative dosage , and this returned the serum uric acid levels to normal . he has been followed symptom free for more than 9 months and is on allopurinol treatment in addition to anti - aggregant ( aspirin , 100 mg daily ) , anti - lipidemic ( atorvastatin , 20 mg daily ) and low dose beta - blocker ( metoprolol 25 mg daily ) medications and a low calori diet . coronary artery disease is the leading cause of mortality and morbidity worldwide in the current decade . with the advances in medical knowledge about the different pathophysiologic events leading to ischemic heart disease , diagnostic methods and treatment strategies , various therapeutic measures are now - a - day performed to prevent , diagnose , treat and obtain deeper knowledge about the disease . it is very well known that there are certain risk factors such as genetic susceptibility , hypertension , hyperlipidemia , smoking , and diabetes mellitus , which may predispose an individual to coronary artery disease . additionally , hyperhomocysteinemia and metabolic syndromes have been identified as other risk factors for the disease as well as predictors of the success of the treatment and survival of the patients . recently , elevated serum uric acid level is identified as an independent risk factor for cardiovascular diseases.[1313 ] several prospective studies have shown an association between hyperuricemia and cardiovascular diseases and death.[1571011 ] in our case , the patient only had smoking as a major cardiovarcular risk factor , and otherwise he was not hypertensive , hyperlipidemic , or diabetic , and did not define positive family history . we may speculate that in addition to the over 45 years of cigarettes smoking history , increased serum uric acid levels might have increased the risk of coronary artery disease or have exacerbated the symptoms of the patient in our case study . gout is a kind of acute inflammatory arthritis , and characterized by recurrent painful attacks . in more than half of the patients , the metatarsophalangeal joint is the most commonly affected region as well as the presenting symptom of the patients in the clinic . the pathology is caused by the crystalization , accumulation and deposition of elevated levels of uric acid of monosorium urate character in the blood , at the joints , tendons , cartilages , and the surrounding tissues . additionally , the disease may also present as tophi , kidney stones , or urate nephropathy . it has been shown that chronic inflammatory disorders such as systemic lupus erythematosus , rheumatiod arthritis , ankylosing spondilitis , diabetes mellitus , etc are associated with shorter life expectancy in affected individuals as compared to the general population . on the other hand , hyperuricemia is associated with reduced survival due to increased tendency to obesity , hypertension , insulin resistance , diuretic usage and renal disease . the national health and nutrition examination survey i follow - up study reported that serum uric acid was an independent predictor of cardiovascular mortality in subjects above 45 years of age regardless of race , menopausal status , diuretic use , or presence of cardiovascular disease . the framingham study showed that serum urate levels were not independently associated with the risk of coronary heart disease ; however , gout was associated with a 60% increased risk of coronary artery disease . a recent study , based on the multiple risk factor intervention trial reports that gout may lead to upto 26% increased risk of acute myocardial infarction . choi et al . , in their 12 years health professionals follow - up study , which included 51,297 male participants , strongly support the link between hyperuricemia , gout , and cardiovascular diseases . although a clear mechanism indicating the consequences of hyperuricemia on cardiovascular diseases and decreased survival could not be identified , a recent novel rodent model showed that that uric acid could cause renal afferent arteriolopathy and tubulointerstitial disease , which leads to hypertension . when the serum uric acid levels are reversed , the renal lesions and hypertension were prevented . another explanation for the increased cardiovascular disease rate in the presence of gout may be the ongoing and relapsing inflammation due to hyperuricemia among patients with the disease , which might enhance and promote atherogenesis and thrombogenesis , as seen in other inflammatory rheumatic disorders . in conclusion , patients with gout have higher risks of cardiovascular disorders , myocardial infarction and death due to increased blood uric acid levels . as sson as hyperuricemia has been diagnosed , strict control of gout should be aimed for , to prevent any systemic complications as well as cardiovascular consequences . this can be achieved with a multidisciplinary approach through the usage of well known cardioprotective medications such as aspirin , statins , beta - blockers when needed , and angiotensin converting enzyme inhibitors following coronary artery bypass grafting .