Urate-lowering therapy in cardiovascular pharmacotherapy: from Mendelian randomization data to cardio–renal–metabolic risk modulation
An erratum to this article was published (Eur Heart J Cardiovasc Pharmacother, 17 Aug 2026 ↗)
Authors' conclusion
Serum uric acid is a cardio-renal-metabolic biomarker and a plausible therapeutic target in selected cardio-renal-metabolic phenotypes. However, evidence does not support routine ULT for CV prevention in asymptomatic hyperuricaemia. Urate-lowering therapy should remain focused on gout and symptomatic hyperuricaemia, with phenotype-guided strategies to identify patients with asymptomatic hyperuricemia most likely to benefit.
Study context
- Population
- Studies of serum uric acid, hyperuricaemia and urate-lowering therapy in cardiovascular risk
- Outcome
- Prevalence of hyperuricaemia
Main finding
As reported in the abstract
- Hyperuricaemia is prevalent and rising, often closely accompanying obesity, hypertension, diabetes, and chronic kidney disease (CKD)
Further findings
Serum uric acid (SUA) and cardiovascular (CV) outcomes
- Higher SUA correlates with coronary artery disease, heart failure, stroke, cardio-renal-metabolic syndromes, and mortality, with non-linear risk relationships and sex- and age-specific thresholds
Mendelian randomization
- Modest causal contribution of genetically elevated SUA to blood pressure, coronary disease, and advanced CKD
CV events with urate-lowering therapy (ULT)
- No consistent reduction in CV events when ULT is added to guideline-directed therapy in asymptomatic hyperuricaemia, stable ischaemic heart disease, chronic heart failure, or CKD
- Observational data suggest long-term, adequately dosed xanthine oxidase inhibitors (XOIs) and high cumulative uricosuric exposure may reduce coronary risk
Original publication
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