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Association between urate-lowering therapy and cardiovascular events in patients with asymptomatic hyperuricemia

Hiroyuki Hashimoto1, Masato Takeuchi1, Koji Kawakami2

  • 1Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshida-Konoe-Cho, Sakyo-Ku, Kyoto, 606-8501, Japan.

Clinical Rheumatology
|July 24, 2023
PubMed

Insights

Urate-lowering therapy (ULT) did not prevent cardiovascular disease (CVD) in patients with asymptomatic hyperuricemia. This study found no significant difference in CVD risk between patients receiving ULT and those who did not.

Area of Science:

  • Cardiology
  • Nephrology
  • Pharmacology

Background:

  • Asymptomatic hyperuricemia, defined by elevated serum uric acid (sUA) levels (≥7.0 mg/dL), is a growing concern.
  • The potential benefits of urate-lowering therapy (ULT) in preventing cardiovascular disease (CVD) in these patients remain unclear.
  • Understanding the role of ULT in asymptomatic hyperuricemia is crucial for clinical decision-making.

Purpose of the Study:

  • To investigate the efficacy of urate-lowering therapy (ULT) in preventing cardiovascular disease (CVD) among individuals with asymptomatic hyperuricemia.
  • To analyze the association between ULT initiation and the incidence of composite CVD outcomes.
  • To evaluate the current treatment guidelines for ULT in this patient population.

Main Methods:

  • A retrospective cohort study utilizing the Japanese JMDC Claims Database (January 2007 - August 2021).
  • Inclusion criteria: patients aged ≥18 years with sUA ≥7.0 mg/dL and at least one medical check-up.
  • Primary outcome: composite CVD events (coronary artery disease, stroke, atrial fibrillation); analysis using Cox proportional hazards models with overlap weighting.

Main Results:

  • The study included 152,166 patients (5,270 ULT group, 146,896 control group).
  • A total of 7,703 composite CVD outcomes were recorded.
  • No significant difference in the risk of developing composite CVD outcomes was observed between the ULT and control groups (HR: 1.01, 95% CI: 0.89 to 1.13).

Conclusions:

  • Urate-lowering therapy (ULT) does not appear to prevent the development of cardiovascular disease (CVD) in patients with asymptomatic hyperuricemia.
  • The study suggests no established cutoff for initiating ULT or a target sUA level for preventing CVD in this population.
  • Further research is needed to clarify the role and optimal management of ULT in asymptomatic hyperuricemia.
Abstract

Keywords:
AllopurinolCardiovascular riskEpidemiologyFebuxostatGoutHyperuricemiaXanthine oxidase inhibitor

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