Dapagliflozin reduces uric acid concentration, an independent predictor of adverse outcomes in DAPA‐HF. (6th February 2022)

• Record Type: Journal Article
• Authors: McDowell, Kirsty; Welsh, Paul; Docherty, Kieran F.; Morrow, David A.; Jhund, Pardeep S.; de Boer, Rudolf A.; O'Meara, Eileen; Inzucchi, Silvio E.; Køber, Lars; Kosiborod, Mikhail N.; Martinez, Felipe A.; Ponikowski, Piotr; Hammarstedt, Ann; Langkilde, Anna Maria; Sjöstrand, Mikaela; Lindholm, Daniel; Solomon, Scott D.; Sattar, Naveed; Sabatine, Marc S.; McMurray, John J.V.
• Is Part Of: European journal of heart failure. Volume 24:Number 6(2022)
• Page Start: 1066
• Page End: 1076
• Publication Date: 2022-02-06
• Subjects: Heart failure -- Uric acid -- Mortality -- Sodium–glucose cotransporter 2 -- Diabetes; Heart failure -- Periodicals; Heart Failure -- Periodicals; Insuffisance cardiaque -- Périodiques; Heart failure; Periodicals; 616.129005
• DOI: 10.1002/ejhf.2433
• Languages: English
• ISSNs: 1388-9842

Abstract

Abstract : Aims: Blood uric acid (UA) levels are frequently elevated in patients with heart failure and reduced ejection fraction (HFrEF), may lead to gout and are associated with worse outcomes. Reduction in UA is desirable in HFrEF and sodium–glucose cotransporter 2 inhibitors may have this effect. We aimed to examine the association between UA and outcomes, the effect of dapagliflozin according to baseline UA level, and the effect of dapagliflozin on UA in patients with HFrEF in the DAPA‐HF trial. Methods and results: The association between UA and the primary composite outcome of cardiovascular death or worsening heart failure, its components, and all‐cause mortality was examined using Cox regression analyses among 3119 patients using tertiles of UA, after adjustment for other prognostic variables. Change in UA from baseline over 12 months was also evaluated. Patients in tertile 3 (UA ≥6.8 mg/dl) versus tertile 1 (<5.4 mg/dl) were younger (66.3 ± 10.8 vs. 68 ± 10.2 years), more often male (83.1% vs. 71.5%), had lower estimated glomerular filtration rate (58.2 ± 17.4 vs. 70.6 ± 18.7 ml/min/1.73 m 2 ), and more often treated with diuretics. Higher UA was associated with a greater risk of the primary outcome (adjusted hazard ratio tertile 3 vs. tertile 1: 1.32, 95% confidence interval [CI] 1.06–1.66; p = 0.01). The risk of heart failure hospitalization and cardiovascular death increased by 7% and 6%, respectively per 1 mg/dl unit increase of UA ( p = 0.04 and p = 0.07). Spline analysis revealed a linear increase in risk above a cut‐off UA value of 7.09 mg/dl. Compared with placebo, dapagliflozin reduced UA by 0.84 mg/dl (95% CI −0.93 to −0.74) over 12 months ( p < 0.001). Dapagliflozin improved outcomes, irrespective of baseline UA concentration. Conclusion: Uric acid remains an independent predictor of worse outcomes in a well‐treated contemporary HFrEF population. Compared with placebo, dapagliflozin reduced UA and improved outcomes irrespective of UA concentration. Abstract : Importance of uric acid in patients with heart failure and reduced ejection fraction (EF) and effect of dapagliflozin. NYHA, New York Heart Association.