This common gout drug may slash heart attack and stroke risk

The findings, published in JAMA Internal Medicine, suggest that bringing blood urate levels down to recommended targets not only reduces gout symptoms but may also help prevent serious cardiovascular events. The research was led by Professor Abhishek from the University of Nottingham's School of Medicine, working with collaborators from Keele University and London School of Hygiene & Tropical Medicine in the UK, Gothenburg University in Sweden, and Polytechnic University of Marche in Italy.

What Is Gout and Why It Matters

Gout is a type of arthritis caused by elevated levels of urate in the blood, which can form sharp crystals in and around joints. This leads to sudden and intense episodes of pain, swelling, and inflammation. The condition affects about one in 40 adults across the UK and EU and has been linked to a higher risk of cardiovascular disease.

Medications such as allopurinol are widely used to lower urate levels in the blood. When taken at the appropriate dose, these drugs help dissolve crystal deposits and reduce the frequency of painful gout attacks.

Targeting Uric Acid Levels for Better Outcomes

Previous research has shown that patients who reduce their serum urate levels to below 360 micromol/L (6 mg/dL) experience fewer gout flares. However, it has remained unclear whether reaching this target could also lower the risk of heart attack and stroke.

To investigate this, researchers examined whether achieving a serum urate level below 360 micromol/L (6 mg/dL) through urate lowering therapy, primarily with allopurinol, would lead to improved cardiovascular outcomes.

Professor Abhishek said: "People with gout are at an increased risk of illnesses such as heart disease and stroke. This is the first study to find that medicines such as allopurinol that are used to treat gout reduce the risk of heart attack and stroke if they are taken at the right dose. The right dose varies from person to person and is the dose that gets the blood urate level to less than 360 micromol/L (6 mg/dL)."

Large Study Tracks Heart Risks Over Time

The research team analyzed data from primary care records in the Clinical Practice Research Datalink Aurum, which were linked to hospital and mortality data between January 2007 and March 2021. The study included adults aged 18 and older who had been diagnosed with gout and had pre-treatment serum urate levels above 360 micromol/L (6 mg/dL).

Using an emulated target trial approach, which relies on existing healthcare data rather than traditional clinical trials, the researchers were able to assess outcomes more quickly and efficiently.

Participants were divided into two groups. One group achieved the target urate level of below 360 micromol/L (6 mg/dL) within 12 months of starting urate lowering therapy. The other group did not reach this target within the same timeframe.

Lower Risk of Heart Attack, Stroke, and Death

The researchers then tracked whether participants experienced a major adverse cardiovascular event (i.e., heart attack, stroke or death due to cardiovascular disease) within five years of starting treatment.

Among nearly 110,000 patients, those who reached the target urate levels had higher survival rates and a lower likelihood of experiencing a major cardiovascular event compared to those who did not. The protective effect was even stronger in individuals who were already at high or very high cardiovascular risk.

Patients who achieved an even lower urate level of less than 300 micromol/L (5 mg/dL) saw greater reductions in risk. In addition, those in the target-treatment group experienced fewer gout flares overall.

Study Highlights Dual Benefits of Gout Therapy

"The findings of our study are very positive and show that patients with gout who were prescribed urate lowering drugs and achieved serum urate levels of lover than 360 micromol/L (6 mg/dL) within 12 months, had a much lower risk of a heart attack or stroke over the next five years. Previous research from Nottingham showed treat-to-target urate lowering treatment prevents gout flares. This current study provides an added benefit of reduced risk of heart attack, stroke, and death due to these diseases," said Professor Abhishek.

Overall, the results suggest that properly managing gout by reaching recommended urate targets may offer important benefits beyond joint health, including meaningful protection against serious heart conditions.