To evaluate the impact of achieving serum urate targets on cardiovascular risk in patients with gout.
Key Findings:
Fewer than one-third of patients achieved recommended serum urate targets within 12 months.
Achieving serum urate levels <6 mg/dL was associated with a 9% relative risk reduction for major adverse cardiovascular events (MACE).
Patients with high or very high baseline cardiovascular risk showed the strongest association.
Achieving serum urate levels <5 mg/dL was linked to a 23% relative risk reduction.
5-year cardiovascular event-free survival was 89% in the treat-to-target group vs. 88% in the non-treat-to-target group.
Interpretation:
The study suggests that a treat-to-target approach in managing serum urate levels in gout patients may significantly reduce cardiovascular risks, particularly in those with higher baseline risks.
Limitations:
Residual confounding cannot be fully excluded despite extensive adjustments.
Potential surveillance bias due to inclusion of patients with prior cardiovascular events.
Exposure misclassification possible as serum urate levels were not measured in all patients during the first 12 months.
Incomplete capture of gout flares in routine care data.
Conclusion:
The findings support the importance of a treat-to-target approach in urate-lowering therapy for gout, given its potential cardiovascular benefits.
