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Cardiovascular morbidity and mortality in gout: is gout an independent risk factor?

Jasvinder A Singh1,2,3, Jagat Narula4

  • 1Medicine Service, Michael E. Debakey VA Medical Center, Houston, TX, USA.

Expert Opinion on Pharmacotherapy
|November 30, 2025
PubMed

Insights

Gout increases cardiovascular disease risk. Treatments like allopurinol and colchicine, especially with a treat-to-target approach, can lower this risk in gout patients.

Area of Science:

  • Rheumatology and Cardiology
  • Systemic Inflammation and Cardiovascular Health

Background:

  • Gout is a prevalent inflammatory arthritis globally, disproportionately affecting men.
  • Cardiometabolic diseases frequently co-occur with gout, highlighting a significant comorbidity.
  • Gout is recognized as an independent risk factor for various cardiovascular diseases (CVD) and mortality.

Purpose of the Study:

  • To review evidence on the cardiovascular disease (CVD) risk and mortality in individuals with gout.
  • To examine the impact of gout treatments on reducing cardiovascular risk.

Main Methods:

  • Review of existing evidence on gout and cardiovascular outcomes.
  • Analysis of the role of urate-lowering therapies (ULT) and other medications in mitigating cardiovascular risk.
  • Examination of the treat-to-target (T2T) approach for managing serum urate levels.

Main Results:

  • Gout is an independent risk factor for coronary artery disease, myocardial infarction (AMI), and atrial fibrillation (AF).
  • Urate-lowering therapy (ULT), particularly allopurinol, is linked to a reduced risk of AMI, AF, and other cardiovascular outcomes in gout patients.
  • Colchicine use is associated with decreased acute cardiovascular events in both gout patients and the general population with coronary artery disease (CAD).

Conclusions:

  • Gout, as a systemic inflammatory condition, significantly elevates cardiovascular risk.
  • Effective management of gout with therapies like allopurinol, guided by a treat-to-target strategy, can potentially lower cardiovascular risk.
  • Further research into the cardiovascular benefits of gout management strategies is warranted.
Abstract

Keywords:
Goutallopurinolcardiovascular diseasecolchicinefebuxostathyperuricemiamajor adverse cardiovascular eventsmyocardial infarctionurate-lowering therapy

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