Lowering Uric Acid May Improve Prognosis in Patients With Hyperuricemia and Heart Failure With Preserved Ejection Fraction
Masami Nishino, Yasuyuki Egami, Shodai Kawanami, Hiroki Sugae, Kohei Ukita, Akito Kawamura, Hitoshi Nakamura, Yutaka Matsuhiro, Koji Yasumoto, Masaki Tsuda, Naotaka Okamoto, Yasuharu Matsunaga‐Lee, Masamichi Yano, Jun Tanouchi, Takahisa Yamada, Yoshio Yasumura, Shunsuke Tamaki, Takaharu Hayashi, Akito Nakagawa, Yusuke Nakagawa, Yohei Sotomi, Daisaku Nakatani, Shungo Hikoso, Yasushi Sakata, Taiki Sato, Masahiro Seo, Tetsuya Watanabe, Takahisa Yamada, Takaharu Hayashi, Yoshiharu Higuchi, Masaharu Masuda, Mitsutoshi Asai, Toshiaki Mano, Hisakazu Fuji, Daisaku Masuda, Shunsuke Tamaki, Yoshiyuki Nagai, Shizuya Yamashita, Masami Sairyo, Yusuke Nakagawa, Haruhiko Abe, Yasunori Ueda, Yasushi Matsumura, Kunihiko Nagai, Masamichi Yano, Masami Nishino, Jun Tanouchi, Yoh Arita, Shinji Hasegawa, Takamaru Ishizu, Minoru Ichikawa, Yuzuru Takano, Eisai Rin, Yukinori Shinoda, Koichi Tachibana, Shiro Hoshida, Masahiro Izumi, Hiroyoshi Yamamoto, Hiroyasu Kato, Kazuhiro Nakatani, Yuji Yasuga, Mayu Nishio, Keiji Hirooka, Takahiro Yoshimura, Yoshinori Yasuoka, Akihiro Tani, Yasushi Okumoto, Yasunaka Makino, Toshinari Onishi, Katsuomi Iwakura, Yoshiyuki Kijima, Takashi Kitao, Hideyuki Kanai, Wataru Shioyama, Masashi Fujita, Koichiro Harada, Masahiro Kumada, Osamu Nakagawa, Ryo Araki, Takayuki Yamada, Akito Nakagawa, Yoshio Yasumura, Taiki Sato, Akihiro Sunaga, Bolrathanak Oeun, Hirota Kida, Yohei Sotomi, Tomoharu Dohi, Kei Nakamoto, Katsuki Okada, Fusako Sera, Hidetaka Kioka, Tomohito Ohtani, Toshihiro Takeda, Daisaku Nakatani, Hiroya Mizuno, Shungo Hikoso, Yasushi Sakata
Abstract
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.