Effect of Uric Acid-Lowering Agents on Cardiovascular Outcome in Patients With Heart Failure: A Systematic Review and Meta-Analysis of Clinical Studies. (April 2020)

• Record Type: Journal Article
• Authors: Kanbay, Mehmet; Afsar, Baris; Siriopol, Dimitrie; Dincer, Neris; Erden, Nihan; Yilmaz, Onur; Sag, Alan A.; Kuwabara, Masanari; Cherney, David; Rossignol, Patrick; Ortiz, Alberto; Covic, Adrian
• Is Part Of: Angiology. Volume 71:Number 4(2020)
• Page Start: 315
• Page End: 323
• Publication Date: 2020-04
• Subjects: allopurinol -- febuxostat -- heart failure -- uric acid -- cardiovascular mortality; Blood-vessels -- Diseases -- Periodicals; Cardiovascular system -- Diseases -- Periodicals; 616.13005
• DOI: 10.1177/0003319719897509
• Languages: English
• ISSNs: 0003-3197

Abstract

Several trials have been completed in patients with heart failure (HF) treated with uric acid (UA)-lowering agents with inconsistent results. We aimed to investigate whether lowering UA would have an effect on mortality and cardiovascular (CV) events in patients with HF in a systematic review and meta-analysis. The primary outcome measures were all-cause mortality, CV mortality, CV events, and CV hospitalization in patients with HF. We included 11 studies in our final analysis. Overall, allopurinol treatment was associated with a significant increase in the risk for all-cause mortality (hazard ratio [HR]: 1.24, 95% confidence interval [CI]: 1.04-1.49, P = .02). The trial heterogeneity is high (heterogeneity χ 2 = 37.3, I2 = 73%, P < .001). With regard to CV mortality, allopurinol treatment was associated with a 42% increased risk of CV mortality (HR: 1.42, 95% CI: 1.11-1.81, P = .005). There was a trend toward increased CV hospitalization in the same group (HR: 1.21, 95% CI: 0.95-1.53, P = .12). Uric acid-lowering treatments increase all-cause and CV mortality but did not increase CV hospitalization significantly in this study.