Lowering uric acid by ≥1.0 mg/dL for 1 year in patients with hyperuricemia and HFpEF was associated with decreased all-cause mortality compared to nonlowering (HR 1.71; 95% CI 1.02-2.86; P=0.041).
Observational (n=464)
Yes
Does lowering uric acid reduce the composite of all-cause mortality and heart failure rehospitalization in patients with hyperuricemia and HFpEF?
Hazard Ratio: 1.71 (95% CI 1.02–2.86)
p-value: p=0.041
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.
Nishino et al. (Wed,) conducted a observational in Hyperuricemia and Heart Failure With Preserved Ejection Fraction (HFpEF) (n=464). Lowering uric acid (≥1.0 mg/dL) vs. Nonlowering uric acid was evaluated on All-cause mortality (HR 1.71, 95% CI 1.02-2.86, p=0.041). Lowering uric acid by ≥1.0 mg/dL for 1 year in patients with hyperuricemia and HFpEF was associated with decreased all-cause mortality compared to nonlowering (HR 1.71; 95% CI 1.02-2.86; P=0.041).