Treating Gout to SU Target Lowers Risk of Cardiovascular Events

Treating gout to target serum urate (SU) level was associated with a reduced risk of cardiovascular events in people with gout, according to a new study.¹

“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),” lead investigator Abhishek Abhishek, MD, PhD, Professor, Professor of Rheumatology at the University of Nottingham, United Kingdom, said in a statement.²

Abhishek and colleagues conducted a new-user cohort study using emulated target trial framework with up to 5 years of follow-up using primary care data from the Clinical Practice Research Datalink Aurum, which is linked to hospitalization and mortality records, from January 1, 2007, to March 29, 2021. Included patients were 18 years or older with gout and a pretreatment serum urate level higher than 6 mg/dL who were newly prescribed urate lowering therapy (ULT). Investigators analyzed data from May 2024 to January 2025.

“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 (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,” Abhishek said.²

The study included 109,504 patients with a mean age of 62.9 years (standard deviation [SD], 15.2), 22.2% of which were female, and who had a mean disease duration of 2.5 years (SD, 3.6) years. Patients were assigned to the treat-to-target (T2T) ULT arm (27.3%) or the non–T2T ULT arm depending on whether they achieved a serum urate level lower than 6 mg/dL within 12 months of their first ULT prescription.

Abhishek and colleagues found that patients in the T2T ULT arm had a higher 5-year survival (weighted survival difference, 1.0% [95% CI, 0.5-1.6]) and lower risk of major adverse cardiovascular events (weighted hazard ratio, 0.91 [95% CI, 0.89-0.92]) than those in the non–T2T ULT arm.

Furthermore, there was a statistically significantly greater association for people at high and very high cardiovascular risk than those with moderate risk. Substantially fewer gout flares were ascertained in the T2T ULT arm, with a weighted incidence rate ratio of 0.97 (95% CI, 0.95-0.99). Patients who achieved an SU level lower than 5 mg/dL had an even larger cardiovascular risk reduction (weighted event-free survival difference, 2.6% [95% CI, 0.9-3.6]; weighted HR, 0.77 [95% CI, 0.72-0.81]). No differences were observed for negative control outcomes.

“We report that T2T ULT resulting in SU levels lower than 6 mg/dL was associated with lower risk of MACE. Although the absolute risk reduction was modest, the potential population-level benefit is substantial, as 55.8 million people globally had gout in 2020, and this is expected to rise to 95.8 million by 2050,” Abhishek and colleagues wrote.¹

“We believe that the observed association is likely to be mediated by fewer gout flares, as the control of hyperuricemia by itself is not expected to prevent cardiovascular diseases given the findings of several genetic studies and the ALL-HEART trial, although in a population without gout,” they wrote.¹

References

1. Edoardo Cipolletta, Sandström TZ, Davide Rozza, et al. Treat-to-Target Urate-Lowering Treatment and Cardiovascular Outcomes in Patients With Gout. JAMA Internal Medicine. Published online January 26, 2026. doi: 10.1001/jamainternmed.2025.7453

2. Gout medication can reduce the risk of heart attack and stroke, finds new study. News release. University of Nottingham. January 26, 2026. https://www.eurekalert.org/news-releases/1113714