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Uric acid and heart failure

Masanari Kuwabara1, Arrigo F G Cicero2, Naoyuki Akashi3

  • 1Division of Public Health, Center for Community Medicine, Jichi Medical University, Tochigi, Japan; Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University Tochigi, Japan.

Journal of Cardiology
|July 21, 2026
PubMed

Insights

Hyperuricemia, common in heart failure patients, may worsen outcomes. While evidence is limited, uric acid-lowering agents like febuxostat show potential, but more research is needed to confirm benefits for heart failure management.

Area of Science:

  • Cardiology
  • Nephrology
  • Pharmacology

Background:

  • Heart failure and hyperuricemia are increasing globally.
  • Hyperuricemia is a poor prognostic indicator in heart failure.
  • Current evidence on treating hyperuricemia in heart failure is insufficient.

Purpose of the Study:

  • To review clinical trials on hyperuricemia in heart failure.
  • To assess the efficacy of uric acid-lowering agents in heart failure patients.
  • To explore the role of serum uric acid in heart failure severity and oxidative stress.

Main Methods:

  • Review of clinical trials and cohort studies.
  • Analysis of Medicare data from approximately 100,000 participants.
  • Examination of evidence on uric acid-lowering agents (e.g., febuxostat, allopurinol).

Main Results:

  • Febuxostat showed less heart failure aggravation than allopurinol in a US cohort.
  • Serum uric acid may indicate disease severity, xanthine oxidase activity, and oxidative stress.
  • Differential effects of uric acid-lowering agents suggest drug-specific cardiovascular impacts.

Conclusions:

  • Treating hyperuricemia in heart failure lacks consensus but may be considered if lifestyle changes fail.
  • Further large-scale, prospective studies are essential to establish treatment efficacy.
  • Drug-specific properties, not just uric acid reduction, might influence cardiovascular outcomes.

Keywords:
Heart failureHyperuricemiaUric acidUric acid-lowering agentsXanthine oxidase

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