Achieving target sUA levels ‘should be a principal goal’ in hyperuricemic patients with gout
medwireNews: People with gout and hyperuricemia who achieve guideline-recommended serum uric acid (sUA) levels below 0.36 mmol/L (6.0 mg/dL) have lower risks for overall and cardiovascular (CV) mortality than those who do not meet this target, researchers report.
Therefore, “[t]argeting sUA levels of <0.36 mmol/L should be a principal goal in these high-risk patients in order to reduce CV events and to extend patient survival,” say Fernando Pérez-Ruiz, from Hospital Universitario Cruces in Barakaldo, Spain, and team.
The study included 1193 patients (92% men) with gout and sustained hyperuricemia (>0.41 mmol/L sUA for >1 year), who had an average age of 60 years and mean sUA levels of 9.1 mg/dL at baseline. All participants achieved remission of gout flares during the study period, most commonly after treatment with allopurinol (62.2%), followed by benzbromarone (17.9%).
In all, 13.2% of patients died over an average follow-up of 48.6 months, while 6.9% of the total study population died due to CV events. Median sUA levels at baseline were significantly higher among patients who later died compared with those who were alive at the end of the study, at 9.3 versus 8.7 mg/dL.
When patients were categorized according to whether they did or did not achieve target sUA levels, mortality rates were 25.7 per 1000 person–years for those with levels below 0.36 mmol/L, compared with 80.9 per 1000 person–years for those with higher levels.
And in a multivariate analysis, patients who did not meet target sUA levels were more than twice as likely to die as those who did meet the target, with a hazard ratio of 2.33 for overall mortality and 2.03 for CV mortality after accounting for factors such as age, baseline sUA, and prior CV disease.
These findings “add credence to the hypothesis that elevated UA concentrations above 6 mg/dL contribute substantially to mortality and to shortened life spans,” write Pérez-Ruiz and colleagues in RMD Open.
They add: “The adoption and implementation of [urate-reducing] strategies that lower sUA levels to <0.36 mmol/L [6 mg/dL] are likely to confer a survival advantage beyond gout control.”
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