- Among 109,504 patients with gout, 27.3% achieved serum urate levels below 6 mg/dL within 12 months of starting urate-lowering therapy.
- Achieving target serum urate levels was associated with lower 5-year risk of major adverse cardiovascular events (weighted HR, 0.91; 95% CI, 0.89-0.92).
- Patients achieving serum urate levels below 5 mg/dL had a larger association with reduced cardiovascular risk (weighted HR, 0.77; 95% CI, 0.72-0.81).
- Associations were strongest among patients at high or very high baseline cardiovascular risk; no benefit was observed in the moderate-risk subgroup.
- Because the study was observational, the findings do not establish causality, and residual confounding remains possible despite extensive adjustment and sensitivity analyses.
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