Gout Drugs Linked to Lower Heart Attack and Stroke Risk

A new study, led by experts at the University of Nottingham, has found that medicines used to treat gout can also reduce the risk of heart attack and stroke in people with gout.

The new research, which is published in JAMA Internal Medicine, shows that treating gout to target blood urate levels also prevents heart attacks and stroke. The study is led by Professor Abhishek from the School of Medicine at the University along with colleagues at Keele University and London School of Hygiene & Tropical Medicine in the UK, Gothenburg University in Sweden, and Polytechnic University of Marche in Italy.

Gout is a common form of arthritis where people have high levels of urate in their blood and urate crystals deposited inside and around their joints. It causes sudden flares of severe joint pain and swelling. It affects one in 40 adults across the UK and EU and is associated with an increased cardiovascular risk. Tablets such as allopurinol, taken at the right dose, reduce blood urate levels and dissolve urate crystal deposits.

People with gout who achieve serum urate levels below 360 micromol/L (6 mg/dL) with urate lowering drugs such as allopurinol experience fewer gout flares, but little is known about whether this would also reduce the risk of heart attack and stroke.

Study design and methodology

In this new study, the team set out to find if achieving a target serum urate level of lower than 360 micromol/L (6 mg/dL) with urate lowering drugs, mainly allopurinol, would also reduce the risk of heart attack and stroke in people with gout.

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).”

The team conducted a large study using primary care data from the Clinical Practice Research Datalink Aurum linked to hospital and mortality records from January 2007 to March 2021.

Patients were aged 18 years and above, had been diagnosed with gout, and had a pre-treatment serum urate level higher than 360 micromol/L (6 mg/dL). They used an emulated target trial framework in which routinely collected health care data are analyzed. This is faster than traditional clinical trials which are costly and take time.

Key findings and implications

Patients were assigned to the treat-to-target (T2T) urate lowering treatment (ULT) arm or the non-T2T ULT arm if they achieved or did not achieve a serum urate level lower than 360 micromol/L (6 mg/dL) within 12 months of their first treatment with a urate lowering drug.

The team looked at whether there was a major adverse cardiovascular event (i.e., heart attack, stroke, or death due to cardiovascular disease) within five years of the first prescription for a urate lowering drug.

Of the nearly 110,000 patients included, patients in the T2T ULT arm had a higher five-year survival and lower risk of a major adverse cardiovascular event than those in the non-T2T ULT arm. There was a greater association for people at high risk and very high cardiovascular risk than those with moderate risk.

Patients who achieved a lower serum urate target of less than 300 micromol/L (5 mg/dL) had a larger risk reduction. Patients in the T2T ULT arm had fewer gout flares.

“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 lower 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.