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Effect of urate-lowering therapy on all-cause and CVD-specific mortality in gout and hyperuricemia: a meta-analysis

Young Ho Lee1, Gwan Gyu Song2

  • 1Department of Rheumatology, Korea University Anam Hospital, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, 02841, Seoul, Korea (Republic of). lyhcgh@korea.ac.kr.

Zeitschrift Fur Rheumatologie
|December 5, 2024
PubMed

Insights

Urate-lowering therapy (ULT) significantly reduces all-cause mortality in patients with gout or hyperuricemia. While ULT benefits overall survival, allopurinol did not significantly impact cardiovascular disease-specific mortality in this meta-analysis.

Area of Science:

  • Rheumatology and Clinical Pharmacology
  • Cardiovascular Epidemiology
  • Public Health and Mortality Studies

Background:

  • Gout and hyperuricemia are associated with increased mortality risks, particularly from cardiovascular causes.
  • Urate-lowering therapy (ULT) aims to reduce serum uric acid levels, but its impact on long-term survival requires comprehensive evaluation.
  • Understanding the differential effects of ULT on all-cause versus cardiovascular disease (CVD)-specific mortality is crucial for patient management.

Purpose of the Study:

  • To investigate the association between urate-lowering therapy (ULT) and both all-cause and cardiovascular disease (CVD)-specific mortality in individuals with gout or hyperuricemia.
  • To synthesize evidence from existing literature to quantify the mortality risks associated with ULT use in these patient populations.

Main Methods:

  • A systematic meta-analysis was performed, including 11 comparative studies with a total of 38,396 ULT users and 47,530 controls.
  • Literature search was conducted across PubMed, Embase, and Cochrane databases to identify relevant hazard ratios (HRs) for all-cause and CVD-specific mortality.
  • Statistical analysis was employed to evaluate the pooled HRs and their corresponding confidence intervals (CIs) for mortality outcomes.

Main Results:

  • ULT significantly reduced the risk of all-cause mortality in patients with gout or hyperuricemia (HR = 0.783, 95% CI = 0.702-0.874).
  • Both ULT (HR = 0.651) and allopurinol (HR = 0.836) were associated with decreased all-cause mortality.
  • ULT significantly lowered CVD-specific mortality in hyperuricemia patients (HR = 0.872) but not in gout patients (HR = 0.676).

Conclusions:

  • Urate-lowering therapy (ULT) demonstrates a substantial benefit in reducing all-cause mortality for patients suffering from gout or hyperuricemia.
  • Allopurinol, a common ULT, did not show a significant impact on cardiovascular disease-specific mortality in this meta-analysis.
  • These findings highlight the significant potential of ULT in improving survival rates among specific patient groups with high uric acid levels.
Abstract

Keywords:
GoutMeta-analysisMortalityUrate-lowering therapy

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