#3-74E. Beyond Flare Prevention: Treat-to-Target Urate-Lowering Therapy and Cardiovascular Risk in Gout (JAMA Intern Med, 2026)

Managing the elevated cardiovascular risk inherently associated with gout remains a pervasive and critical challenge in daily clinical practice. In this episode, we review a large-scale, new-user cohort study utilizing an emulated target trial framework to evaluate patients newly prescribed urate-lowering treatment (ULT). The research specifically investigated whether achieving a serum urate target of less than 6 mg/dL within 12 months impacted cardiovascular outcomes over a 5-year follow-up period. The most vital finding from this study suggests that successfully achieving this urate target is associated with a significantly lower risk of major adverse cardiovascular events (MACE). However, when critically appraising these promising results, it is crucial to recognize that due to the observational design, this association could be influenced by residual confounding. Specifically, achieving the urate target might simply reflect better overall systemic patient management, healthcare engagement, and medication adherence rather than a direct biological effect of the urate reduction itself. For physicians, this paper is highly significant as it reinforces the clinical imperative of a rigorous "treat-to-target" strategy. It highlights that strict urate control is essential not just for eliminating gout flares, but potentially for mitigating the broader cardiometabolic burden in our gout patients.

Citation: Cipolletta E, Abhishek A. Treat-to-Target Urate-Lowering Treatment and Cardiovascular Outcomes in Patients With Gout. JAMA Internal Medicine. 2026. DOI: 10.1001/jamainternmed.2025.7453

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