A new study led by experts at the University of Nottingham has found that medications used to treat gout can reduce the risk of heart attack and stroke in individuals with the condition. The research, published in JAMA Internal Medicine, indicates that treating gout to achieve specific blood urate levels also helps prevent cardiovascular events.
Study Overview
Gout is a common form of arthritis characterized by high blood urate levels and urate crystal deposits in joints, leading to severe pain and swelling. It affects one in 40 adults in the UK and EU and is associated with an increased cardiovascular risk. Medications like allopurinol reduce blood urate levels and dissolve these crystal deposits.
While achieving serum urate levels below 360 micromol/L (6 mg/dL) with urate-lowering drugs reduces gout flares, the impact on heart attack and stroke risk was less understood prior to this study.
Research Methodology
The research team investigated whether achieving a target serum urate level of less than 360 micromol/L (6 mg/dL) with urate-lowering drugs, primarily allopurinol, would reduce the risk of heart attack and stroke in people with gout.
They utilized primary care data from the Clinical Practice Research Datalink Aurum, linked to hospital and mortality records from January 2007 to March 2021. Patients included were aged 18 or above, diagnosed with gout, and had pre-treatment serum urate levels exceeding 360 micromol/L (6 mg/dL). An emulated target trial framework was employed for analysis.
Patients were assigned to either a 'treat-to-target' (T2T) urate-lowering treatment (ULT) arm if they achieved a serum urate level lower than 360 micromol/L within 12 months of starting treatment, or a 'non-T2T ULT' arm if they did not.
Key Findings
The study assessed the occurrence of a major adverse cardiovascular event (defined as heart attack, stroke, or death due to cardiovascular disease) within five years of the first prescription for a urate-lowering drug.
Of nearly 110,000 patients included, those in the T2T ULT arm demonstrated a higher five-year survival rate and a lower risk of a major adverse cardiovascular event compared to those in the non-T2T ULT arm. The association was more pronounced for individuals at high and very high cardiovascular risk.
Patients who achieved an even lower serum urate target of less than 300 micromol/L (5 mg/dL) experienced a greater risk reduction.
Additionally, patients in the T2T ULT arm reported fewer gout flares.
Expert Commentary
Professor Abhishek from the University of Nottingham stated:
"The findings indicate patients with gout who achieved serum urate levels below 360 micromol/L within 12 months had a significantly lower risk of heart attack or stroke over the subsequent five years. This study provides an added benefit of reduced risk of heart attack, stroke, and death due to these diseases, in addition to preventing gout flares as shown in previous research."