Urate Cardiovascular Risk — SCE Rheumatology MCQ

Correct answer: C — Higher serum urate is associated with cardiovascular and cardio-renal-metabolic disease, but causality remains uncertain and urate lowering has not consistently reduced cardiovascular events in randomised trials.

Higher serum urate is consistently associated observationally with hypertension, coronary disease, heart failure, CKD and related metabolic phenotypes. This does not by itself establish that urate is a clinically modifiable causal risk factor, because confounding and reverse causation remain important and genetic evidence is not wholly uniform. Crucially, urate-lowering trials have not shown consistent prevention of major cardiovascular events. In the UK ALL-HEART trial, allopurinol did not improve cardiovascular outcomes in patients with ischaemic heart disease, although participants did not have gout. Therefore ULT should be prescribed and titrated for gout indications, not intensified solely for cardiovascular prevention. B and E incorrectly deny established epidemiological associations; C overstates causality and trial benefit; D reverses the observed relationship.

Reference: Borghi C, Fogacci F, Cicero AFG. Urate-lowering therapy in cardiovascular pharmacotherapy: from Mendelian randomization data to cardio-renal-metabolic risk modulation. European Heart Journal – Cardiovascular Pharmacotherapy. 2026;12:410–420. https://pubmed.ncbi.nlm.nih.gov/36216006/