Common Gout Drug May Reduce Heart Attack and Stroke Risk

New research indicates that medications commonly used to treat gout may provide significant cardiovascular protection, specifically by reducing the risk of heart attacks and strokes in patients with cardiovascular disease.

Two distinct research findings highlight the potential of gout treatments to mitigate heart risks. One focus is on the anti-inflammatory drug colchicine, while another study emphasizes the role of urate-lowering therapies like allopurinol.

The Role of Low-Dose Colchicine

A Cochrane review analyzed 12 randomized controlled trials involving nearly 23,000 participants with a history of heart attack, stroke, or heart disease. The participants were monitored for at least six months while taking low doses of colchicine, specifically 0.5 mg administered once or twice daily.

The review found that those receiving low-dose colchicine were less likely to experience a heart attack or stroke. Statistically, for every 1,000 people treated, there were 9 fewer heart attacks and 8 fewer strokes compared to those who did not take the drug.

In a smaller sample of 200 people with cardiovascular disease, where seven heart attacks and four strokes would typically be expected, the use of low-dose colchicine could prevent approximately two of each event.

The effectiveness of colchicine is attributed to its anti-inflammatory properties. Cardiovascular disease is often driven by chronic low-grade inflammation, which contributes to the recurrence of heart attacks and strokes.

Urate-Lowering Therapy and Heart Health

Separate research led by Professor Abhishek from the University of Nottingham’s School of Medicine suggests that managing the underlying cause of gout also protects the heart. This study, published in JAMA Internal Medicine, examined the impact of medications such as allopurinol.

Gout is a form of arthritis caused by elevated urate levels in the blood, which create sharp crystals in and around the joints. This condition affects approximately one in 40 adults across the European Union and the United Kingdom and is linked to an increased risk of cardiovascular disease.

The University of Nottingham study found that patients who used medications to successfully lower their blood urate levels to recommended targets experienced a significantly reduced risk of strokes, heart attacks, and cardiovascular death over a five-year period.

Safety and Limitations

Regarding colchicine, the Cochrane review identified no increase in serious side effects. However, some patients reported stomach or digestive issues. These side effects were generally described as mild and short-lived.

While colchicine showed a benefit in reducing heart attacks and strokes, the review noted that it likely does not decrease the overall risk of death. The drug did not appear to have an impact on rates of coronary revascularization, the procedure used to reestablish blood supply to the heart.

The research involving colchicine focused on a demographic where the mean age ranged from 57 to 74 years, and approximately 80% of the participants were male.

Collaborative Research Efforts

The findings regarding urate-lowering therapies were the result of a large-scale collaboration. Professor Abhishek worked with partners from several institutions, including:

• Keele University and London School of Hygiene & Tropical Medicine in the UK
• Gothenburg University in Sweden
• Polytechnic University of Marche in Italy

Together, these findings suggest that both the anti-inflammatory action of colchicine and the urate-lowering action of drugs like allopurinol offer potential strategies for the prevention of serious cardiovascular events in high-risk populations.