Urate-lowering therapy in patients with hyperuricemia and heart failure: A retrospective cohort study using the UK Clinical Practice Research Datalink.
Humans
Hyperuricemia
/ drug therapy
Male
Heart Failure
/ epidemiology
Female
Aged
United Kingdom
/ epidemiology
Retrospective Studies
Uric Acid
/ blood
Gout Suppressants
/ therapeutic use
Risk Factors
Middle Aged
Biomarkers
/ blood
Treatment Outcome
Gout
/ drug therapy
Time Factors
Databases, Factual
Follow-Up Studies
gout
heart failure
hyperuricemia
urate‐lowering therapy
Journal
Clinical cardiology
ISSN: 1932-8737
Titre abrégé: Clin Cardiol
Pays: United States
ID NLM: 7903272
Informations de publication
Date de publication:
Jun 2024
Jun 2024
Historique:
received:
16
04
2024
accepted:
15
05
2024
medline:
14
6
2024
pubmed:
14
6
2024
entrez:
14
6
2024
Statut:
ppublish
Résumé
Elevated serum uric acid (sUA) is associated with heart failure (HF). Urate-lowering therapy (ULT) in HF is associated with lower risk of HF hospitalization (hHF) and mortality. Data on patients with HF and gout or hyperuricemia in the Clinical Practice Research Datalink database linked to the Hospital Episode Statistics and the Office for National Statistics in the United Kingdom were analyzed. Risks of hHF and all-cause mortality or cardiovascular-related mortality by ULT exposure (ULT initiated within ≤6 months of gout or hyperuricemia diagnosis) were analyzed in a propensity score-matched cohort using adjusted Cox proportional hazards regression models. Of 2174 propensity score-matched pairs, patients were predominantly male, aged >70 years, with mean ± standard deviation sUA 9.3 ± 1.8 (ULT-exposed) and 9.4 ± 1.9 mg/dL (ULT-unexposed). At 5 years, ULT-exposed patients had a 43% lower risk of hHF or all-cause mortality (adjusted hazard ratio [HR]: 0.57; 95% confidence interval [CI]: 0.51-0.65) and a 19% lower risk of hHF or cardiovascular-related mortality (adjusted HR: 0.81; 95% CI: 0.71-0.92) versus no ULT exposure. ULT was associated with reduced risk of adverse clinical outcomes in patients with HF and gout or hyperuricemia over 5 years.
Sections du résumé
BACKGROUND
BACKGROUND
Elevated serum uric acid (sUA) is associated with heart failure (HF).
HYPOTHESIS
OBJECTIVE
Urate-lowering therapy (ULT) in HF is associated with lower risk of HF hospitalization (hHF) and mortality.
METHODS
METHODS
Data on patients with HF and gout or hyperuricemia in the Clinical Practice Research Datalink database linked to the Hospital Episode Statistics and the Office for National Statistics in the United Kingdom were analyzed. Risks of hHF and all-cause mortality or cardiovascular-related mortality by ULT exposure (ULT initiated within ≤6 months of gout or hyperuricemia diagnosis) were analyzed in a propensity score-matched cohort using adjusted Cox proportional hazards regression models.
RESULTS
RESULTS
Of 2174 propensity score-matched pairs, patients were predominantly male, aged >70 years, with mean ± standard deviation sUA 9.3 ± 1.8 (ULT-exposed) and 9.4 ± 1.9 mg/dL (ULT-unexposed). At 5 years, ULT-exposed patients had a 43% lower risk of hHF or all-cause mortality (adjusted hazard ratio [HR]: 0.57; 95% confidence interval [CI]: 0.51-0.65) and a 19% lower risk of hHF or cardiovascular-related mortality (adjusted HR: 0.81; 95% CI: 0.71-0.92) versus no ULT exposure.
CONCLUSION
CONCLUSIONS
ULT was associated with reduced risk of adverse clinical outcomes in patients with HF and gout or hyperuricemia over 5 years.
Substances chimiques
Uric Acid
268B43MJ25
Gout Suppressants
0
Biomarkers
0
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
e24297Subventions
Organisme : AstraZeneca
Informations de copyright
© 2024 The Authors. Clinical Cardiology published by Wiley Periodicals, LLC.
Références
Drozd M, Relton SD, Walker AMN, et al. Association of heart failure and its comorbidities with loss of life expectancy. Heart. 2021;107(17):1417‐1421.
Chen TY, Kao CW, Cheng SM, Chang YC. Uncertainty and depressive symptoms as mediators of quality of life in patients with heart failure. PLoS One. 2018;13(11):e0205953.
McDonagh TA, Metra M, Adamo M, et al. 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021;42(36):3599‐3726.
Palazzuoli A, Ruocco G, De Vivo O, Nuti R, McCullough PA. Prevalence of hyperuricemia in patients with acute heart failure with either reduced or preserved ejection fraction. Am J Cardiol. 2017;120(7):1146‐1150.
Gu J, Fan YQ, Zhang HL, Zhang JF, Wang CQ. Serum uric acid is associated with incidence of heart failure with preserved ejection fraction and cardiovascular events in patients with arterial hypertension. J Clin Hypertens (Greenwich). 2018;20(3):560‐567.
Shimizu T, Yoshihisa A, Kanno Y, et al. Relationship of hyperuricemia with mortality in heart failure patients with preserved ejection fraction. Am J Physiol Heart Circ Physiol. 2015;309(7):H1123‐H1129.
Herrett E, Gallagher AM, Bhaskaran K, et al. Data resource profile: Clinical Practice Research Datalink (CPRD). Int J Epidemiol. 2015;44(3):827‐836.
Padmanabhan S, Carty L, Cameron E, Ghosh RE, Williams R, Strongman H. Approach to record linkage of primary care data from Clinical Practice Research Datalink to other health‐related patient data: overview and implications. Eur J Epidemiol. 2019;34(1):91‐99.
Dubreuil M, Zhu Y, Zhang Y, et al. Allopurinol initiation and all‐cause mortality in the general population. Ann Rheum Dis. 2015;74(7):1368‐1372.
Juraschek SP, Kovell LC, Miller, 3rd ER, Gelber AC. Gout, urate‐lowering therapy, and uric acid levels among adults in the United States. Arthritis Care Res (Hoboken). 2015;67(4):588‐592.
Wood R, Fermer S, Ramachandran S, Baumgartner S, Morlock R. Patients with gout treated with conventional urate‐lowering therapy: association with disease control, health‐related quality of life, and work productivity. J Rheumatol. 2016;43(10):1897‐1903.
Hatoum H, Khanna D, Lin SJ, Akhras KS, Shiozawa A, Khanna P. Achieving serum urate goal: a comparative effectiveness study between allopurinol and febuxostat. Postgrad Med. 2014;126(2):65‐75.
National Institute for Health and Care Excellence: Allopurinol Prescribing Information. 2022. Accessed July 07, 2023. https://cks.nice.org.uk/topics/gout/prescribing-information/allopurinol/.
O'Dell JR, Brophy MT, Pillinger MH, et al. Comparative effectiveness of allopurinol and febuxostat in gout management. NEJM Evidence. 2022;1(3). doi:10.1056/evidoa2100028
Schumacher Jr., HR, Becker MA, Wortmann RL, et al. Effects of febuxostat versus allopurinol and placebo in reducing serum urate in subjects with hyperuricemia and gout: A 28‐week, phase III, randomized, double‐blind, parallel‐group trial. Arthritis Rheum. 2008;59(11):1540‐1548.
Hughes JC, Wallace JL, Bryant CL, Salvig BE, Fourakre TN, Stone WJ. Monitoring of urate‐lowering therapy among US veterans following the 2012 American College of Rheumatology guidelines for management of gout. Ann Pharmacother. 2017;51(4):301‐306.
Sapankaew T, Thadanipon K, Ruenroengbun N, et al. Efficacy and safety of urate‐lowering agents in asymptomatic hyperuricemia: systematic review and network meta‐analysis of randomized controlled trials. BMC Nephrol. 2022;23(1):223.
Chen Q, Wang Z, Zhou J, et al. Effect of urate‐lowering therapy on cardiovascular and kidney outcomes: a systematic review and meta‐analysis. Clin J Am Soc Nephrol. 2020;15(11):1576‐1586.
Zhao L, Cao L, Zhao TY, et al. Cardiovascular events in hyperuricemia population and a cardiovascular benefit‐risk assessment of urate‐lowering therapies: a systematic review and meta‐analysis. Chin Med J (Engl). 2020;133(8):982‐993.
Abeles AM, Pillinger MH. Gout and cardiovascular disease: crystallized confusion. Curr Opin Rheumatol. 2019;31(2):118‐124.
Borghi C, Fiorini G. Gout, urate‐lowering drugs, and risk of cardiovascular disease: can we clinically trust in the adjusted real‐life data? Eur Heart J. 2021;42(44):4589‐4591.
Gupta MK, Singh JA. Cardiovascular disease in gout and the protective effect of treatments including urate‐lowering therapy. Drugs. 2019;79(5):531‐541.
Singh JA, Reddy SG, Kundukulam J. Risk factors for gout and prevention: a systematic review of the literature. Curr Opin Rheumatol. 2011;23(2):192‐202.