Unseen but Impactful: Gout as a Neglected Comorbidity in Cardiovascular Care

• Many patients with gout and CVD did not achieve guideline urate targets after 2 years. • Tophaceous gout was linked to lower success in reaching recommended urate levels. • Treat-to-target implementation showed substantial room for improvement. Many patients with gout and CVD did not achieve guideline urate targets after 2 years. Tophaceous gout was linked to lower success in reaching recommended urate levels. Treat-to-target implementation showed substantial room for improvement. Cardiovascular diseases (CVD) affect about 6% of the global population and are a leading cause of death. Gout impacts approximately 3% of the population, and many do not receive adequate urate-lowering therapy to prevent disease progression. Gout is frequent in patients with CVD, and poorly managed gout is associated with cardiovascular complications, warranting proper gout treatment. This study assessed adherence to recommended gout treatment in patients with CVD. From a prospective cohort of gout patients confirmed by microscopy-identified urate crystals, we identified those with concomitant CVD (ischemic heart disease, atrial fibrillation, or heart failure). Patients were treated in real-life healthcare settings. The primary outcome was achieving recommended target serum urate levels 2 years postdiagnosis: <0.36 mmol/L for general gout management and <0.30 mmol/L for patients with tophi. Of 286 gout patients, 117 (41%) had CVD. The median age was 71 years, 76% were male, and most had multiple comorbidities. Recommended urate levels to prevent disease progression were achieved by 59%. However, 45% had tophi at diagnosis, and only 33% of these achieved levels sufficient to dissolve tophi. The mean prescribed dose of allopurinol was 253 mg/day, which was often insufficient to achieve target urate levels. Gout in patients with CVD is often inadequately managed, potentially increasing the risk of serious cardiovascular events. These findings reflect typical treatment settings. Optimizing allopurinol dosing and adherence to gout treatment guidelines may improve gout-related outcomes and could potentially have implications for cardiovascular risk. These findings highlight gout as a relevant comorbidity in patients with CVD and suggest that greater attention to gout management in cardiovascular care pathways may be warranted.