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Hyperuricemia Is Associated With Higher Mortality in Non-diabetic Heart Failure Patients
Sergio Madureira1, Rita Gouveia1, Catarina Elias1
1Department of Internal Medicine, Unidade Local de Saúde de São João, Porto, PRT.
Insights
Hyperuricemia (HU) increases heart failure (HF) mortality risk, but only in patients without diabetes mellitus (DM). For HF patients with DM, high uric acid levels do not appear to impact survival outcomes.
Area of Science:
- Cardiology
- Metabolic Diseases
- Clinical Research
Background:
- Hyperuricemia (HU) is linked to increased heart failure (HF) risk and poorer outcomes.
- Patients with diabetes mellitus (DM) exhibit a higher prevalence of HU.
Purpose of the Study:
- To investigate the prognostic significance of HU in heart failure (HF) patients.
- To assess if the presence of diabetes mellitus (DM) modifies the impact of HU on HF outcomes.
Main Methods:
- Retrospective cohort study of 538 ambulatory HF patients with left ventricular systolic dysfunction (LVSD).
- Follow-up until January 2021, with all-cause mortality as the primary endpoint.
- Cox regression analysis stratified by DM status, with HU defined as uric acid (UA) > 8.2 mg/dL.
Main Results:
- 40% of patients had HU (UA > 8.2 mg/dL).
- HU was associated with a 75% increased risk of all-cause mortality (HR: 1.75; P=0.003).
- This association persisted in non-DM patients (HR: 1.70; P=0.007) but not in DM patients, where the interaction between DM and UA was significant (P=0.04).
Conclusions:
- Diabetes mellitus (DM) influences the prognostic impact of hyperuricemia (HU) in chronic heart failure (HF).
- In HF patients without DM, HU is associated with a 70% increased risk of all-cause mortality compared to those with normal UA levels.
- The prognostic value of HU in HF appears diminished or altered in the presence of DM.
Introduction:
Hyperuricemia (HU) is associated with an increased risk of incident heart failure (HF) and adverse HF outcomes. Patients with diabetes mellitus (DM) have a greater prevalence of HU.
Aims:
We evaluated the prognostic impact of HU in patients with HF according to the coexistence of DM.
Methods:
A retrospective cohort study of ambulatory patients with HF with left ventricular systolic dysfunction (LVSD) was conducted from January 2012 to May 2018. The end point was all-cause mortality; follow-up was until January 2021. A Cox regression analysis was used to assess the prognostic impact of elevated uric acid (UA) levels. The cut-off for HU was 8.2 mg/dL. A multivariate model was built accounting for confounders. The analysis was stratified according to DM, and interaction between DM and UA levels was tested.
Results:
We studied 538 patients, of whom 66% were males. Of the patients, 45% had ischemic HF, 41% had DM, and 11% were receiving urate-lowering therapies. The median (interquartile range (IQR)) admission UA was 5.5 (5.8-9.2) mg/dL, and 40% had UA > 8.2 mg/dL. During a median 46-month follow-up, 48.5% of patients died. Patients with UA > 8.2 mg/dL had a multivariate-adjusted hazard ratio (HR) (95% confidence interval (CI)) of all-cause mortality of 1.75 (1.20-2.55; p=0.003). The interaction between DM and UA levels was significant (p=0.04). The independent association of hyperuricemia with mortality persisted only in non-DM patients (HR: 1.70, 95% CI: 1.16-2.51; p=0.007). In those with DM, hyperuricemia portended no survival disadvantage.
Conclusion:
DM appears to influence the prognostic impact of HU in chronic HF. The risk of all-cause mortality in hyperuricemic HF patients without DM increases by 70% when compared with those with normal UA levels.
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