A new large-scale study led by researchers at the University of Nottingham has found that a drug commonly used to treat gout may reduce the risk of heart attack and stroke in gout patients.
The survey results are JAMA Internal Medicinesuggest that lowering blood uric acid levels to recommended target levels 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, in collaboration with collaborators from Keele University and the London School of Hygiene and Tropical Medicine in the UK, the University of Gothenburg in Sweden and the Marche Institute of Technology in Italy.
What is gout and why is it important?
Gout is a type of arthritis caused by elevated levels of uric acid in the blood, which can cause sharp crystals to form in and around the joints. This causes sudden, severe pain, swelling, and inflammation. The condition affects around one in 40 adults in the UK and EU and is associated with an increased risk of cardiovascular disease.
Drugs such as allopurinol are widely used to lower uric acid levels in the blood. When taken in proper doses, these medications can help dissolve crystal deposits and reduce the frequency of painful gout attacks.
Target uric acid levels for better results
Previous studies have shown that patients who lower their serum uric acid levels to less than 360 micromol/L (6 mg/dL) have fewer gout flares. But it remains unclear whether meeting this goal will also reduce the risk of heart attack and stroke.
To investigate this, researchers investigated whether achieving serum uric acid levels below 360 micromol/L (6 mg/dL) through urate-lowering therapy, primarily with allopurinol, would lead to improved cardiovascular disease outcomes.
Professor Abhishek said: “Gouty patients are at increased risk of diseases such as heart disease and stroke. This is the first study to find that drugs such as allopurinol, used to treat gout, reduce the risk of heart attack and stroke when taken in the right doses. The right dose varies from person to person and is the dose that results in blood uric acid levels below 360 micromoles per liter (6 mg/dL).”
Large-scale study tracks heart risk over time
The research team analyzed data from the Clinical Practice Research Datalink Aurum primary care records linked to hospital and mortality data from January 2007 to March 2021. The study included adults 18 years and older who had been diagnosed with gout and had pretreatment serum uric acid levels greater than 360 micromol/L (6 mg/dL).
By using an emulated targeted testing approach that relies on existing medical data rather than traditional clinical trials, researchers were able to assess results more quickly and efficiently.
Participants were divided into two groups. One group achieved a target uric acid level of less than 360 micromol/L (6 mg/dL) within 12 months of starting urate-lowering therapy. The other group failed to achieve this goal within the same time period.
Lower risk of heart attack, stroke, and death
The researchers then tracked whether participants experienced any major adverse cardiovascular events (i.e., heart attack, stroke, or death from cardiovascular disease) within five years of starting treatment.
Of the approximately 110,000 patients, those who reached their uric acid target had better survival rates and were less likely to experience major cardiovascular events than those who did not. The protective effect was even stronger in people who were already at high or very high cardiovascular risk.
Patients who achieved even lower uric acid levels below 300 micromol/L (5 mg/dL) had a significantly reduced risk. Additionally, people in the targeted treatment group had fewer gout flares overall.
Research highlights dual benefits of gout treatment
“Our study results are very positive and show that gout patients who were prescribed urate-lowering drugs and whose significant other achieved a serum uric acid level of 360 micromol/L (6 mg/dL) or higher within 12 months had a much lower risk of heart attack or stroke over the next five years. Previous research in Nottingham showed that targeted uric acid-lowering treatment prevents flare-ups of gout, and this study offers the added benefit of reducing the risk of heart attack, stroke and death from these diseases,” Professor Abhishek said.
Overall, the results suggest that properly managing gout by achieving recommended uric acid targets may provide important benefits beyond joint health, including meaningful protection against serious heart disease.
