Study shows gout medication can reduce risk of heart attack or stroke

By Stephen Beech

A gout medication can reduce the risk of a heart attack or stroke, according to new research.

The pioneering study found that drugs used to treat the common but painful form of arthritis can also cut the chances of a potentially deadly heart attack and stroke in people with gout.

The research, led by University of Nottingham scientists, shows that treating gout to target blood urate levels also prevents heart attacks and stroke.

People with gout 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.

Gout affects around one in 40 adults in the UK 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.

The research team explained that 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 flare-ups.

But little was known about whether it would also reduce the risk of a heart attack or stroke.

For the new study, published in the journal JAMA Internal Medicine, researchers 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.

Study leader Professor Abhishek 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.

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"The right dose varies from person to person and is the dose that gets the blood urate level to less than 360 micromol/L.”

Abhishek, from Nottingham University's School of Medicine, worked with colleagues from Keele University and London School of Hygiene and Tropical Medicine as well as Gothenburg University, Sweden, and Polytechnic University of Marche in Italy.

The team used primary care data linked to hospital and mortality records from January 2007 to March 2021.

Patients were aged 18 or older, had been diagnosed with gout, and had a pre-treatment serum rate level higher than 360 micromol/L.

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 within 12 months of their first treatment with a urate lowering drug.

The team looked at whether there was a major cardiovascular event - such as a heart attack, stroke or fatality 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.

Abhishek said: “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 within 12 months, had a much lower risk of a heart attack or stroke over the next five years."

He added: "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."