Objective:

To evaluate the association between achieving guideline-recommended serum urate targets and the risk of major adverse cardiovascular events in patients with gout.

Key Findings:

• Patients achieving serum urate targets had a weighted hazard ratio of 0.91 for major adverse cardiovascular events compared to those who did not.
• An absolute 5-year event-free survival difference of about 1 percentage point was observed.
• The association was stronger for patients achieving serum urate levels <5 mg/dL, with a hazard ratio of 0.77 and a 3 percentage point survival difference.
• 27% of patients reached serum urate levels <6 mg/dL within 12 months, with 80% achieving this within 6 months.
• Secondary outcomes showed lower risks of myocardial infarction, stroke, and hospitalization among those achieving serum urate targets.

Interpretation:

The findings suggest a potential link between achieving serum urate targets and reduced cardiovascular risk, particularly in high-risk patients, though causation cannot be established.

Limitations:

• Residual confounding may still exist despite adjustments.
• Possible exposure misclassification and incomplete capture of gout flares managed outside the healthcare system.
• Some patients in the non-treat-to-target group may have achieved targets after the 12-month window.
• Less than one-third of patients achieved target serum urate levels within the first year, indicating gaps in routine care.

Conclusion:

Achieving serum urate targets may lower cardiovascular risk in gout patients, but further research is needed to clarify the relationship and address existing confounding factors.