Do drugs that lower uric acid levels decrease cardiovascular events in patients with chronic gout?

The existing data are largely limited to studies that lasted less than a year (many of which did not report any cardiovascular events), but it appears that urate-lowering therapy is not associated with a reduction in cardiovascular events. (LOE = 2a-)

Zhang T, Pope JE. Cardiovascular effects of urate-lowering therapies in patients with chronic gout: a systematic review and meta-analysis. Rheumatology (Oxford) 2017;56(7):1144-1153.  [PMID:28379501]

Meta-analysis (randomized controlled trials)

Self-funded or unfunded

Various (meta-analysis)

The association between gout and cardiovascular disease (CVD) has been taught since I was a medical student (which was a long time ago). To determine if urate-lowering therapy prevents CVD, these authors searched several databases and clinical trials registries to identify randomized trials of various agents (allopurinol, febuxostat, pegloticase, rasburicase, probenecid, benzbromarone, sulphinpyrazone, losartan, fenofibrate, and new sodium-glucose linked transporter 2 inhibitors) that reported the rate of CVD events. The authors don't describe if they independently assessed studies for inclusion or risk of bias. Ultimately, they included 18 studies with 7757 patients with follow-up of 2 weeks to 172 weeks. Four studies were of low risk of bias, the remainder had a variety of methodologic flaws such as lack of masking and incomplete or selective reporting. Most studies had very low rates of CVD events; several studies reported no CVD events. Overall, urate-lowering therapy was not associated with a reduction in CVD events. Although it appears that patients using allopurinol had fewer CVD events than patients using febuxostat, those data are not very robust and were not statistically significant. Since only 4 of the studies lasted as long as a year, the overall data are inadequate to tell for certain. Certainly a trial of 2 weeks is not long enough to see a change in CVD events!