Adults with gout who reduced blood urate to guideline targets within a year of starting urate-lowering therapy had a lower risk of heart attack, stroke or cardiovascular death over the next five years, according to an analysis of more than 109,000 patients in UK electronic health records published in JAMA Internal Medicine.
Researchers using UK primary-care records linked to hospital admissions and death registrations found that gout patients who achieved recommended blood-urate targets after starting urate-lowering therapy had fewer major cardiovascular events over the subsequent five years.
The study, published in JAMA Internal Medicine, analyzed data from the Clinical Practice Research Datalink (CPRD) Aurum database linked to hospitalization and mortality records from January 1, 2007, to March 29, 2021. Adults 18 and older with a diagnosis of gout were included if they were newly prescribed urate-lowering therapy and had a pretreatment serum urate level above 6 mg/dL (about 360 micromol/L).
Using an “emulated target trial” approach, patients were categorized based on whether they did or did not achieve a serum urate level below 6 mg/dL within 12 months of their first urate-lowering prescription. The primary outcome was a first major adverse cardiovascular event within five years—defined as nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death.
Among 109,504 patients (mean age 62.9 years; 22.2% female), those who reached the urate target within 12 months had a lower risk of major cardiovascular events over five years than those who did not (weighted hazard ratio 0.91, 95% CI 0.89–0.92) and a modestly higher estimated five-year event-free survival.
The association was stronger in people categorized as having high or very high cardiovascular risk compared with those at moderate risk. Patients who achieved a more stringent urate level—below 5 mg/dL (about 300 micromol/L)—had a larger reduction in cardiovascular risk (weighted hazard ratio 0.77, 95% CI 0.72–0.81) and also experienced fewer gout flares.
In a statement accompanying the research, Professor Abhishek of the University of Nottingham said people with gout have an increased risk of cardiovascular illnesses and that the findings suggest urate-lowering medicines such as allopurinol, when dosed to reach target urate levels, are linked to reduced risks of heart attack and stroke in this observational analysis.
The research team included collaborators from institutions in the United Kingdom, Sweden and Italy, including the University of Nottingham, the Polytechnic University of Marche, the University of Gothenburg, the London School of Hygiene & Tropical Medicine, and Keele University.
