Achieving Serum Urate Target Linked to Lower Cardiovascular Risk in Gout

Patients with gout who achieved serum urate levels below 6 mg/dL within 12 months of starting urate-lowering therapy (ULT) had a lower 5-year risk of major adverse cardiovascular events compared with those who did not reach target, according to a large population-based cohort study using an emulated target trial framework.

The analysis included 109,504 adults with gout from UK primary care records who were newly prescribed ULT between 2007 and 2021. Patients were categorized as treat-to-target (T2T) if they achieved a serum urate level lower than 6 mg/dL within one year, or non-T2T if they did not. The primary outcome was the first major adverse cardiovascular event over five years of follow-up.

Overall, 27.3% of patients achieved the T2T goal. Compared with non-T2T patients, those who reached the target had a higher weighted 5-year event-free survival and a lower risk of cardiovascular events (weighted hazard ratio 0.91). The association was stronger among patients at high or very high baseline cardiovascular risk.

A more intensive urate target was associated with greater benefit. Patients achieving serum urate levels below 5 mg/dL experienced a larger reduction in cardiovascular risk (weighted hazard ratio 0.77). As expected, T2T patients also had fewer gout flares. No differences were observed for negative control outcomes, supporting the specificity of the findings.

The authors concluded that “achieving serum urate levels lower than 6 mg/dL within 12 months was associated with a lower 5-year risk of major adverse cardiovascular events.” These results address a longstanding question regarding whether biochemical target attainment translates into broader systemic benefit.

Reference
Cipolletta E, Zverkova Sandström T, Rozza D, et al. Treat-to-target urate-lowering treatment and cardiovascular outcomes in patients with gout. JAMA Intern Med. Published online January 26, 2026. doi:10.1001/jamainternmed.2025.7453