Prevention & lipidsCohort study
Treat-to-Target Urate-Lowering Treatment and Cardiovascular Outcomes in Patients With Gout
- new-user cohort study using emulated target trial framework
- up to 5-year follow-up
- primary care data from the Clinical Practice Research Datalink Aurum linked to hospitalization and mortality records
Authors' conclusion
In this cohort study among patients with gout who were newly prescribed ULT, 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.
Study context
- Population
- Patients 18 years or older, diagnosed with gout, with a pretreatment serum urate level higher than 6 mg/dL, newly prescribed urate-lowering treatment (ULT) (January 1, 2007, to March 29, 2021)patients included, 27.3% in the T2T ULT arm
- Participants
- 109,504 patients
- Exposure
- T2T ULT arm vs non-T2T ULT arm
- Outcome
- First major adverse cardiovascular event
- Follow-up
- Within 5 years of first ULT prescription
Main finding
As reported in the abstract
T2T ULT arm vs non-T2T ULT armWeighted survival difference (95% CI)
higher 5-year survival with T2T ULT arm
1.0%(0.5%–1.6%)
T2T ULT arm vs non-T2T ULT armWeighted hazard ratio (95% CI)
major adverse cardiovascular events
0.91(0.89–0.92)
Observational data: associations, not effects.
Further findings
Major adverse cardiovascular events by cardiovascular risk (subgroup)
- Greater association for people at high and very high cardiovascular risk than those with moderate risk
Major adverse cardiovascular events with serum urate target of less than 5 mg/dL
- weighted survival difference (95% CI)
- 2.6% (0.9%-3.6%)
- weighted HR (95% CI)
- 0.77 (0.72-0.81)
- larger risk reduction
Gout flare (positive control outcome)
- Fewer gout flares in the T2T ULT arm
Acute bronchitis, cataract, and appendicitis (negative control outcomes)
- No differences observed
Original publication
Treat-to-Target Urate-Lowering Treatment and Cardiovascular Outcomes in Patients With Gout. JAMA Intern Med. Published 1 March 2026. doi:10.1001/jamainternmed.2025.7453
Summarised from the published abstract; every number is checked against it