Key result
In patients with hyperuricemia and heart failure with preserved ejection fraction, higher serum uric acid was an independent predictor of the composite of all-cause death and heart failure rehospitalization (HR 1.15).
Why the study?
Whether uric acid is a causal risk factor for heart failure is controversial, and the prognostic value of lowering uric acid in patients with HFpEF remains unclear.
Does lowering uric acid improve the composite outcome of all-cause death and heart failure rehospitalization in patients with HFpEF and hyperuricemia?
Cohort (n=464)
Yes
Does lowering uric acid improve the composite outcome of all-cause death and heart failure rehospitalization in patients with HFpEF and hyperuricemia?
Higher uric acid levels independently predict worse outcomes in HFpEF, suggesting that managing hyperuricemia might be a viable therapeutic strategy to improve prognosis in this population.
Background An association between uric acid (UA) and cardiovascular diseases, including heart failure (HF), has been reported. However, whether UA is a causal risk factor for HF is controversial. In particular, the prognostic value of lowering UA in patients with HF with preserved ejection fraction (HFpEF) is unclear. Methods and Results We enrolled patients with HFpEF from the PURSUIT‐HFpEF (Prospective Multicenter Observational Study of Patients With Heart Failure With Preserved Ejection Fraction) registry. We investigated whether UA was correlated with the composite events, including all‐cause mortality and HF rehospitalization, in patients with hyperuricemia and HFpEF (UA >7.0 mg/dL). Additionally, we evaluated whether lowering UA for 1 year (≥1.0 mg/dL) in them reduced mortality or HF rehospitalization. We finally analyzed 464 patients with hyperuricemia. In multivariable Cox regression analysis, UA was an independent determinant of composite death and rehospitalization (hazard ratio [HR], 1.15 [95% CI, 1.03–1.27], P =0.015). We divided them into groups with severe and mild hyperuricemia according to median estimated value of serum UA (8.3 mg/dL). Cox proportional hazards models revealed the incidence of all‐cause mortality was significantly higher in the group with severe hyperuricemia than in the group with mild hyperuricemia (HR, 1.73 [95% CI, 1.19–2.25], P =0.004). The incidence of all‐cause mortality was significantly decreased in the group with lowering UA compared with the group with nonlowering UA (HR, 1.71 [95% CI, 1.02–2.86], P =0.041). The incidence of urate‐lowering therapy tended to be higher in the group with lowering UA than in the group with nonlowering UA (34.9% versus 24.6%, P =0.06). Conclusions UA is a predictor for the composite of all‐cause death and HF rehospitalization in patients with hyperuricemia and HFpEF. In these patients, lowering UA, including the use of urate‐lowering therapy, may improve prognosis.
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Nishino et al. (2022) conducted a cohort in Heart failure with preserved ejection fraction and hyperuricemia (n=464). Serum uric acid level was evaluated on Composite of all‐cause death and heart failure rehospitalization (HR 1.15, 95% CI 1.03-1.27, p=0.015). In patients with hyperuricemia and heart failure with preserved ejection fraction, higher serum uric acid was an independent predictor of the composite of all-cause death and heart failure rehospitalization (HR 1.15).
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