Common Gout Medication Found To Slash Heart Attack and Stroke Risk

New research indicates that treating gout to specific blood urate targets may also reduce the risk of serious cardiovascular events.

A new study led by the University of Nottingham suggests that standard gout medications may do more than ease painful flare-ups. The researchers found that bringing blood urate down to recommended goals was linked with a lower risk of heart attack and stroke in people diagnosed with gout, raising the possibility that careful gout control could have wider health effects.

Reported in JAMA Internal Medicine, the work was led by Professor Abhishek and an international team. Instead of looking only at joint symptoms, the study focused on what happens when treatment is adjusted until a specific blood marker reaches its target. That approach, often called treat to target, is familiar in other long-term conditions where hitting a measurable goal can translate into better outcomes.

Gout develops when urate builds up in the blood and forms crystals that collect in and around joints, triggering sudden bouts of intense pain and swelling. It affects about one in 40 adults across the UK and EU and is associated with higher cardiovascular risk. Medicines such as allopurinol can lower urate and, at an effective dose, help dissolve existing crystal deposits over time.

Clinicians already know that patients who reach serum urate levels below 360 micromol/L (6 mg/dL) tend to have fewer gout flares. What has been far less clear is whether reaching that same threshold could also change the odds of major events like heart attack and stroke.

Investigating Treat-to-Target Therapy

To explore that gap, the researchers examined whether achieving a serum urate level lower than 360 micromol/L (6 mg/dL) using urate lowering drugs, mainly allopurinol, was associated with reduced heart attack and stroke risk in people with gout.

Professor 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. 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).”

The team conducted a large study using primary care data from the Clinical Practice Research Datalink Aurum linked to hospital and mortality records from January 2007 to March 2021. Patients were aged 18 years and above, had been diagnosed with gout, and had a pre-treatment serum rate level higher than 360 micromol/L (6 mg/dL). They used an emulated target trial framework in which routinely collected healthcare data are analyzed. This is faster than traditional clinical trials which are costly and take time.

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 (6 mg/dL) within 12 months of their first treatment with a urate-lowering drug.

Key Findings and Clinical Implications

The team looked at whether there was a major adverse cardiovascular event (i.e., heart attack, stroke or death 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.

“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 that 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,” said Professor Abhishek.

Reference: “Treat-to-Target Urate-Lowering Treatment and Cardiovascular Outcomes in Patients With Gout” by Edoardo Cipolletta, Tatiana Zverkova Sandström, Davide Rozza, Clemence Leyrat, Georgina Nakafero, Panagiota Drivelegka, Anthony J. Avery, Mamas A. Mamas, Laila J. Tata, Mats Dehlin and Abhishek Abhishek, 26 January 2026, JAMA Internal Medicine.
DOI: 10.1001/jamainternmed.2025.7453

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