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Li L, Chang Y, Li F, Yin Y. Relationship between serum uric acid levels and uric acid lowering therapy with the prognosis of patients with heart failure with preserved ejection fraction: a meta-analysis. Front Cardiovasc Med 2024; 11:1403242. [PMID: 38938653 PMCID: PMC11210376 DOI: 10.3389/fcvm.2024.1403242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 05/29/2024] [Indexed: 06/29/2024] Open
Abstract
Aims This meta-analysis aimed to explore the association between serum uric acid levels and the efficacy of uric acid-lowering therapies on clinical outcomes among patients with heart failure with preserved ejection fraction (HFpEF). Methods A comprehensive literature search was conducted through October 21, 2023, across PubMed, Embase, Cochrane Library, and Web of Science databases. The pooled effect sizes were estimated and presented with their respective 95% confidence intervals (CI). Subgroup analyses were conducted based on various factors, including sample size (<1,000 vs. ≥1,000), follow-up duration (<2 years vs. ≥2 years), study quality (assessed by a score of <7 vs. ≥7), ethnicity (Non-Asian vs. Asian), study design (prospective vs. retrospective), type of heart failure (HF) (acute vs. chronic), presence of hyperuricemia (yes or no), left ventricular ejection fraction (LVEF) thresholds (≥45% vs. ≥50%), and the type of uric acid-lowering therapy (traditional vs. novel). Results The analysis included a total of 12 studies. Elevated serum uric acid levels were significantly linked to an increased risk of all-cause mortality [relative risk (RR): 1.21, 95% CI: 1.06-1.37, P = 0.004] and cardiovascular (CV) mortality (RR: 1.71, 95% CI: 1.42-2.04, P < 0.001) in HFpEF patients. Subgroup analyses confirmed this association, particularly in non-Asian populations, those with chronic HFpEF, and studies with a follow-up duration of two years or more. Additionally, higher uric acid levels were associated with an increased risk of HF-related hospitalization [hazard ratio (HR): 1.61, 95% CI: 1.12-2.34, P = 0.011]. Regarding treatment, uric acid-lowering therapy did not show a significant effect on reducing mortality in HFpEF patients. However, it was associated with a decreased risk of hospitalization due to HF (RR: 0.85, 95% CI: 0.79-0.91, P < 0.001). Conclusion The findings of this study highlight the prognostic significance of serum uric acid levels in HFpEF and suggest that uric acid-lowering therapy may be beneficial in reducing the incidence of HF hospitalizations. Further research is warranted to elucidate the mechanisms by which uric acid-lowering therapy confers its potential benefits.
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Affiliation(s)
- Linzhi Li
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Department of Geriatrics, Chongqing General Hospital, Chongqing, China
| | - Ying Chang
- Department of Geriatrics, Chongqing General Hospital, Chongqing, China
| | - Fei Li
- Department of Geriatrics, Chongqing General Hospital, Chongqing, China
| | - Yuehui Yin
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Qin S, Xiang M, Gao L, Cheng X, Zhang D. Uric acid is a biomarker for heart failure, but not therapeutic target: result from a comprehensive meta-analysis. ESC Heart Fail 2024; 11:78-90. [PMID: 37816496 PMCID: PMC10804193 DOI: 10.1002/ehf2.14535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/17/2023] [Accepted: 09/08/2023] [Indexed: 10/12/2023] Open
Abstract
AIMS This systematic review and meta-analysis aimed to investigate the association between serum uric acid (SUA) levels and the incidence rate and prognosis of heart failure (HF), as well as the impact of uric acid-lowering treatment on HF patients. METHODS AND RESULTS PubMed and Embase were searched for original articles reporting on the association between SUA and HF incidence, adverse outcomes, and the effect of uric acid-lowering treatment in HF patients. Data were pooled using random effects or fixed effects models. Univariable meta-regression analysis assessed the influence of study characteristics on research outcomes. Statistical analyses were conducted using RevMan software and STATA software version 15.0. Eleven studies on HF incidence and 24 studies on adverse outcomes in HF patients were included. Higher SUA levels were associated with an increased risk of HF (RR: 1.81, 95% CI: 1.53-2.16), all-cause mortality (RR: 1.44, 95% CI: 1.25-1.66), cardiac death (RR: 1.56, 95% CI: 1.32-1.84), and HF rehospitalization (RR: 2.07, 95% CI: 1.37-3.13) in HF patients. Uric acid-lowering treatment was found to increase all-cause mortality in HF patients (RR: 1.15, 95% CI: 1.05-1.25). CONCLUSIONS Uric acid is an independent predictor of heart failure occurrence and adverse prognosis. Targeting uric acid lowering as a therapeutic intervention does not improve the prognosis of patients with heart failure. It may not be advisable to use traditional urate-lowering drugs in young patients with heart failure, and elderly patients should exercise caution when using them.
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Affiliation(s)
- Shiwei Qin
- Department of Cardiology, The First Affiliated HospitalChongqing Medical UniversityChongqingChina
| | - Meilin Xiang
- Department of Cardiology, The First Affiliated HospitalChongqing Medical UniversityChongqingChina
| | - Lei Gao
- Department of Cardiology, The First Affiliated HospitalChongqing Medical UniversityChongqingChina
| | - Xiaocheng Cheng
- Department of Respiratory and Critical Care Medicine, The First Affiliated HospitalChongqing Medical UniversityChongqingChina
| | - Dongying Zhang
- Department of Cardiology, The First Affiliated HospitalChongqing Medical UniversityChongqingChina
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Wang X, Fan X, Wu Q, Liu J, Wei L, Yang D, Bu X, Liu X, Ma A, Hayashi T, Guan G, Xiang Y, Shi S, Wang J, Fang J. Uric Acid Predicts Recovery of Left Ventricular Function and Adverse Events in Heart Failure With Reduced Ejection Fraction: Potential Mechanistic Insight From Network Analyses. Front Cardiovasc Med 2022; 9:853870. [PMID: 35911515 PMCID: PMC9334530 DOI: 10.3389/fcvm.2022.853870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 03/07/2022] [Indexed: 11/21/2022] Open
Abstract
Background and Aims Heart failure with reduced ejection fraction (HFrEF) still carries a high risk for a sustained decrease in left ventricular ejection fraction (LVEF) even with the optimal medical therapy. Currently, there is no effective tool to stratify these patients according to their recovery potential. We tested the hypothesis that uric acid (UA) could predict recovery of LVEF and prognosis of HFrEF patients and attempted to explore mechanistic relationship between hyperuricemia and HFrEF. Methods HFrEF patients with hyperuricemia were selected from the National Inpatient Sample (NIS) 2016–2018 database and our Xianyang prospective cohort study. Demographics, cardiac risk factors, and cardiovascular events were identified. Network-based analysis was utilized to examine the relationship between recovery of LVEF and hyperuricemia, and we further elucidated the underlying mechanisms for the impact of hyperuricemia on HFrEF. Results After adjusting confounding factors by propensity score matching, hyperuricemia was a determinant of HFrEF [OR 1.247 (1.172–1.328); P < 0.001] of NIS dataset. In Xianyang prospective cohort study, hyperuricemia is a significant and independent risk factor for all-cause death (adjusted HR 2.387, 95% CI 1.141–4.993; P = 0.021), heart failure readmission (adjusted HR 1.848, 95% CI 1.048–3.259; P = 0.034), and composite events (adjusted HR 1.706, 95% CI 1.001–2.906; P = 0.049) in HFrEF patients. UA value at baseline was negatively correlated to LVEF of follow-ups (r = −0.19; P = 0.046). Cutoff UA value of 312.5 μmmol/L at baseline can work as a predictor of LVEF recovery during follow-up, with the sensitivity of 66.7%, the specificity of 35.1%, and the accuracy of 0.668 (95% CI, 0.561–0.775; P = 0.006). Moreover, gene overlap analysis and network proximity analysis demonstrated a strong correlation between HFrEF and Hyperuricemia. Conclusion Lower baseline UA value predicted the LVEF recovery and less long-term adverse events in HFrEF patients. Our results provide new insights into underlying mechanistic relationship between hyperuricemia and HFrEF.
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Affiliation(s)
- Xiqiang Wang
- Department of Cardiovascular Medicine, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Xiude Fan
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- Shandong Clinical Research Center of Diabetes and Metabolic Diseases, Jinan, China
- Shandong Key Laboratory of Endocrinology and Lipid Metabolism, Jinan, China
| | - Qihui Wu
- Science and Technology Innovation Center, Guangzhou University of Chinese Medicine, Guangzhou, China
- Clinical Research Center, Hainan Provincial Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Haikou, China
| | - Jing Liu
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Linyan Wei
- Department of General Practice, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Dandan Yang
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Xiang Bu
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xiaoxiang Liu
- Department of Cardiovascular Medicine, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Aiqun Ma
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Tomohiro Hayashi
- Center for Cardiovascular Research, Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO, United States
| | - Gongchang Guan
- Department of Cardiovascular Medicine, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Yu Xiang
- Department of Cardiovascular Medicine, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Shuang Shi
- Department of Cardiovascular Medicine, Shaanxi Provincial People's Hospital, Xi'an, China
- *Correspondence: Shuang Shi
| | - Junkui Wang
- Department of Cardiovascular Medicine, Shaanxi Provincial People's Hospital, Xi'an, China
- Junkui Wang
| | - Jiansong Fang
- Science and Technology Innovation Center, Guangzhou University of Chinese Medicine, Guangzhou, China
- Jiansong Fang
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The Relationship between Serum Uric Acid and Ejection Fraction of the Left Ventricle. J Clin Med 2021; 10:jcm10174026. [PMID: 34501474 PMCID: PMC8432558 DOI: 10.3390/jcm10174026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/09/2021] [Accepted: 09/03/2021] [Indexed: 11/29/2022] Open
Abstract
Study basis: As a byproduct of protein metabolism, serum uric acid is a controversial risk factor and is the focus of several recent studies in the field of cardiovascular disease. Whether serum uric acid is involved in the development of these pathologies alone or in conjunction with other factors is a matter of debate. Objective: The objective of this study is to assess the direct relationship between serum uric acid and the ejection fraction. Methods: A retrospective study of 303 patients with heart failure, classified according to the ESC guidelines, was conducted, and several parameters, along with the relationship between serum uric acid and ejection fraction, were characterized. Results: A direct relationship between the level of serum uric acid and the ejection fraction was established (p = 0.03); patients with higher uric acid had an increased risk of having a lower ejection fraction. Conclusions: Serum uric acid, even when asymptomatic, is linked with the level of the ejection fraction of the left ventricle.
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Mo R, Yu LT, Tan HQ, Wang Y, Yang YM, Liang Y, Zhu J. A new scoring system for predicting short-term outcomes in Chinese patients with critically-ill acute decompensated heart failure. BMC Cardiovasc Disord 2021; 21:228. [PMID: 33947350 PMCID: PMC8094523 DOI: 10.1186/s12872-021-02041-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 04/21/2021] [Indexed: 11/13/2022] Open
Abstract
Background Acute decompensated heart failure (ADHF) contributes millions of emergency department (ED) visits and it is associated with high in-hospital mortality. The aim of this study was to develop and validate a multiparametric score for critically-ill ADHF patients. Methods
In this single-center, retrospective study, a total of 1268 ADHF patients in China were enrolled and divided into derivation (n = 1014) and validation (n = 254) cohorts. The primary endpoint was any in-hospital death, cardiac arrest or utilization of mechanical support devices. Logistic regression model was preformed to identify risk factors and build the new scoring system. The assigning point of each parameter was determined according to its β coefficient. The discrimination was validated internally using C statistic and calibration was evaluated by the Hosmer-Lemeshow goodness-of-fit test. Results We constructed a predictive score based on six significant risk factors [systolic blood pressure (SBP), white blood cell (WBC) count, hematocrit (HCT), total bilirubin (TBIL), estimated glomerular filtration rate (eGFR) and NT-proBNP]. This new model was computed as (1 × SBP < 90 mmHg) + (2 × WBC > 9.2 × 109/L) + (1 × HCT ≤ 0.407) + (2 × TBIL > 34.2 μmol/L) + (2 × eGFR < 15 ml/min/1.73 m2) + (1 × NTproBNP ≥ 10728.9 ng/ml). The C statistic for the new score was 0.758 (95% CI 0.667–0.838) higher than APACHE II, AHEAD and ADHERE score. It also demonstrated good calibration for detecting high-risk patients in the validation cohort (χ2 = 6.681, p = 0.463). Conclusions The new score including SBP, WBC, HCT, TBIL, eGFR and NT-proBNP might be used to predict short-term prognosis of Chinese critically-ill ADHF patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-021-02041-2.
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Affiliation(s)
- Ran Mo
- Emergency and Intensive Care Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing, People's Republic of China
| | - Li-Tian Yu
- Emergency and Intensive Care Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing, People's Republic of China.
| | - Hui-Qiong Tan
- Emergency and Intensive Care Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing, People's Republic of China
| | - Yang Wang
- Emergency and Intensive Care Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing, People's Republic of China
| | - Yan-Min Yang
- Emergency and Intensive Care Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing, People's Republic of China
| | - Yan Liang
- Emergency and Intensive Care Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing, People's Republic of China
| | - Jun Zhu
- Emergency and Intensive Care Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing, People's Republic of China
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Clinical Implications of Uric Acid in Heart Failure: A Comprehensive Review. Life (Basel) 2021; 11:life11010053. [PMID: 33466609 PMCID: PMC7828696 DOI: 10.3390/life11010053] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 01/10/2021] [Accepted: 01/11/2021] [Indexed: 12/11/2022] Open
Abstract
Affecting more than 26 million people worldwide and with rising prevalence, heart failure (HF) represents a major global health problem. Hence, further research is needed in order to abate poor HF outcomes and mitigate significant expenses that burden health care systems. Based on available data, experts agree that there is an urgent need for a cost-effective prognostic biomarker in HF. Although a significant number of biomarkers have already been investigated in this setting, the clinical utility of adding biomarker evaluation to routine HF care still remains ambiguous. Specifically, in this review we focused on uric acid (UA), a purine metabolism detriment whose role as cardiovascular risk factor has been exhaustingly debated for decades. Multiple large population studies indicate that UA is an independent predictor of mortality in acute and chronic HF, making it a significant prognostic factor in both settings. High serum levels have been also associated with an increased incidence of HF, thus expanding the clinical utility of UA. Importantly, emerging data suggests that UA is also implicated in the pathogenesis of HF, which sheds light on UA as a feasible therapeutic target. Although to date clinical studies have not been able to prove the benefits of xanthine oxidase in HF patients, we discuss the putative role of UA and xanthine oxidase in the pathophysiology of HF as a therapeutic target.
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Tedeschi A, Agostoni P, Pezzuto B, Corra’ U, Scrutinio D, La Gioia R, Raimondo R, Passantino A, Piepoli MF. Role of comorbidities in heart failure prognosis Part 2: Chronic kidney disease, elevated serum uric acid. Eur J Prev Cardiol 2020; 27:35-45. [PMID: 33238740 PMCID: PMC7691631 DOI: 10.1177/2047487320957793] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 08/18/2020] [Indexed: 12/18/2022]
Abstract
Despite improvements in pharmacotherapy, morbidity and mortality rates in community-based populations with chronic heart failure still remain high. The increase in medical complexity among patients with heart failure may be reflected by an increase in concomitant non-cardiovascular comorbidities, which are recognized as independent prognostic factors in this population. Heart failure and chronic kidney disease share many risk factors, and often coexist. The presence of kidney failure is associated with incremented risk of cardiovascular and non-cardiovascular mortality in heart failure patients. Chronic kidney disease is also linked with underutilization of evidence-based heart failure therapy that may reduce morbidity and mortality. More targeted therapies would be important to improve the prognosis of patients with these diseases. In recent years, serum uric acid as a determinant of cardiovascular risk has gained interest. Epidemiological, experimental and clinical data show that patients with hyperuricaemia are at increased risk of cardiac, renal and vascular damage and cardiovascular events. Moreover, elevated serum uric acid predicts worse outcome in both acute and chronic heart failure. While studies have raised the possibility of preventing heart failure through the use of uric acid lowering agents, the literature is still inconclusive on whether the reduction in uric acid will result in a measurable clinical benefit. Available evidences suggest that chronic kidney disease and elevated uric acid could worsen heart failure patients' prognosis. The aim of this review is to analyse a possible utilization of these comorbidities in risk stratification and as a therapeutic target to get a prognostic improvement in heart failure patients.
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Affiliation(s)
- Andrea Tedeschi
- Cardiology Dept, Guglielmo da Saliceto Hospital, AUSL Piacenza
and University of Parma, Italy
| | - Piergiuseppe Agostoni
- Clinical Cardiology and Rehabilitation Unit, Università degli
Studi di Milano, Centro Cardiologico Monzino IRCCS, Italy
| | - Beatrice Pezzuto
- Clinical Cardiology and Rehabilitation Unit, Università degli
Studi di Milano, Centro Cardiologico Monzino IRCCS, Italy
| | - Ugo Corra’
- Centro Cardiologico di Veruno, Istituti Clinici Maugeri,
Italy
| | - Domenico Scrutinio
- Istituti Clinici Scientifici Maugeri-SPA SB. I.R.C.C.S.
Institute of Bari, Italy
| | - Rocco La Gioia
- Istituti Clinici Scientifici Maugeri-SPA SB. I.R.C.C.S.
Institute of Bari, Italy
| | - Rosa Raimondo
- Istituti Clinici Scientifici Maugeri-SPA SB. I.R.C.C.S.
Institute of Bari, Italy
| | - Andrea Passantino
- Istituti Clinici Scientifici Maugeri-SPA SB. I.R.C.C.S.
Institute of Bari, Italy
| | - Massimo F Piepoli
- Cardiology Dept, Guglielmo da Saliceto Hospital, AUSL Piacenza
and University of Parma, Italy
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Abstract
Coronary artery disease is a major underlying etiology for heart failure. The role of coronary microvascular disease, and endothelial dysfunction, in the pathophysiology of heart failure is poorly appreciated. Endothelial dysfunction, induced by oxidative stress, contributes to the development of heart failure. Alterations of endothelial function and nitric oxide-cyclic guanosine monophosphate (NO-cGMP) pathway are involved in the pathophysiology of heart failure with both reduced and preserved ejection fraction. Indeed, an altered endothelium dependent vasodilatation, causing repeated episodes of ischemia/reperfusion, can induce a chronic stunned myocardium with systolic dysfunction and an increased diastolic stiffness with diastolic dysfunction. Moreover, the altered NO-cGMP pathway directly affects myocardial homeostasis. Endothelial dysfunction is associated with worse prognosis and higher rate of cardiovascular events. Potential therapeutic strategies targeting the NO-cGMP pathway in patients with HF will be discussed in this review article. Although clinical data are still inconclusive, the NO-cGMP pathway represents a promising target for therapy.
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Network Meta-Analysis of Drug Therapies for Lowering Uric Acid and Mortality Risk in Patients with Heart Failure. Cardiovasc Drugs Ther 2020; 35:1217-1225. [PMID: 33095357 DOI: 10.1007/s10557-020-07097-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/11/2020] [Indexed: 12/29/2022]
Abstract
PURPOSE This network meta-analysis aimed to assess the current efficacy of decreasing the uric acid (UA) level with drugs to reduce mortality in patients with heart failure (HF). METHODS Electronic literature searches using EMBASE and MEDLINE of studies published from 1 Jan 1950 to 26 Dec 2019 were conducted for randomized controlled trials or non-randomized cohort studies that included at least one group of patients who took UA-lowering drugs and with a study outcome of all-cause mortality. A random-effects network meta-analysis was performed within a frequentist framework. Hierarchy of treatments was expressed as the surface under the cumulative ranking curve (SUCRA) value, which is in proportion to mean rank (best is 100%). RESULTS Nine studies, which included seven different types of groups, were eligible for analysis. The "untreated uricemia" group in which patients had hyperuricemia but without treatment had a significantly higher risk of mortality than the "no uricemia" group in which patients had no hyperuricemia (relative risk (RR)(95% confidence interval (CI), 1.43 (1.08-1.89)). The "start-allo" group wherein patients started to take allopurinol did not have a significantly lower risk of mortality than the "untreated uricemia" group (RR (95% CI), 0.68 (0.45-1.01)). However, in the "start-allo" group the SUCRA value was comparable to that in the "no uricemia" group (SUCRA: 65.4% for "start-allo"; 64.1% for "no uricemia"). CONCLUSIONS Results suggested that allopurinol therapy was not associated with a significantly improved prognosis in terms of mortality but could potentially counteract the adverse effects associated with longstanding hyperuricemia in HF patients.
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Siemińska E, Sobczak P, Skibińska N, Sikora J. The differential role of uric acid - The purpose or cause of cardiovascular diseases? Med Hypotheses 2020; 142:109791. [PMID: 32434129 DOI: 10.1016/j.mehy.2020.109791] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 03/19/2020] [Accepted: 04/24/2020] [Indexed: 02/07/2023]
Abstract
For 40 years many studies have been conducted to verify the connection between serum uric acid concentration and cardiovascular diseases, such as myocardial infarction. Unfortunately, it remains unclear which form of uric acid - prooxidant or antioxidant - could be a predictive marker of cardiovascular disease, especially in patients after myocardial infarction. It is well-known that uric acid is an organic compound and the water-soluble final product of purine catabolism, which is catalysed by xanthine oxidoreductase and excreted by kidneys. An increased concentration of UA in human plasma leads to diseases like tumours, renal disorders, atherosclerosis, hypertension, diabetes, metabolic syndrome, polycythaemia vera, haemolytic anaemias, ischemia, oxidative stress, and rare genetic disorders connected with UA degradation. Epidemiological studies have shown that UA might be a marker of oxidative stress, progression of inflammation, or renal disease. A fortiori, it is possible that could also be a predictor for short/long-term survival of patients with CVD. Evidence provided by multiple studies is controversial and mutually exclusive. Among 71 studies the most of them found an independent association between SUA and CVD risk. Some of those studies confirm that CVD risk is higher in women who had elevated SUA levels. On the other hand, many studies reached the opposite conclusion and did not find any relationship between SUA and CVD mortality and morbidity.
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Affiliation(s)
- Emilia Siemińska
- Department of Transplantology and General Surgery, Collegium Medicum in Bydgoszcz, 85-092 Bydgoszcz, Poland.
| | - Przemysław Sobczak
- Department of Cardiology and Internal Medicine, Collegium Medicum in Bydgoszcz, 85-092 Bydgoszcz, Poland
| | - Natalia Skibińska
- Department of Cardiology and Internal Medicine, Collegium Medicum in Bydgoszcz, 85-092 Bydgoszcz, Poland
| | - Joanna Sikora
- Department of Transplantology and General Surgery, Collegium Medicum in Bydgoszcz, 85-092 Bydgoszcz, Poland
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Obstructive sleep apnea and the risk of gout: a population-based case-control study. Arthritis Res Ther 2020; 22:92. [PMID: 32334617 PMCID: PMC7183677 DOI: 10.1186/s13075-020-02176-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 03/31/2020] [Indexed: 02/08/2023] Open
Abstract
Background Patients with obstructive sleep apnea (OSA) might be at risk of gout because of pathophysiological mechanisms that can lead to hyperuricemia and eventually gout or because of shared risk factors between both diseases. The objective of the present study was to investigate the risk of gout in patients with OSA. Methods A population-based case-control study using the UK Clinical Practice Research Datalink GOLD including all patients aged 40 years and older with a first diagnosis of gout between 1987 and 2014. Gout cases were matched by year of birth, sex, and practice to non-gout controls. Conditional logistic regression estimated the risk of gout with an earlier diagnosis of OSA. Analyses were adjusted for lifestyle factors, comorbidities, and recent drug use. Results One hundred eleven thousand five hundred nine cases were matched with 210,241 controls. Patients with OSA were at increased risk of gout (OR 1.86; 95%CI (1.71–2.02). However, this association disappeared (OR 1.05; 95% CI 0.96–1.16) after adjustment for smoking status, body mass index (BMI), alcohol use, a history of heart failure, diabetes mellitus, renal function, and recent use of diuretics and other medications. Among females with OSA and patients with OSA associated with heart failure, renal impairment, or higher BMI, the risk of gout was however still increased when compared to the total control population. Conclusion This study showed that the observed association between OSA and gout disappeared after adjustment.
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12
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Hung PH, Lin CH, Hung KY, Muo CH, Chung MC, Chang CH, Chung CJ. Clinical burden of autosomal dominant polycystic kidney disease. Aging (Albany NY) 2020; 12:3899-3910. [PMID: 32096480 PMCID: PMC7066921 DOI: 10.18632/aging.102858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 02/08/2020] [Indexed: 11/25/2022]
Abstract
There are no specific therapies for autosomal dominant polycystic kidney disease (ADPKD), and clinical data evaluating the effects of non-specific therapies on ADPKD patients are scarce. We therefore evaluated those effects using data from a longitudinal health insurance database collected from 2000-2010. We individually selected patients with and without ADPKD from inpatient data files as well as from the catastrophic illness registry in Taiwan based on 1:5 frequency matching for sex, age, and index year. The hazard ratios (HR) of all-cause mortality, ischemic stroke, hemorrhagic stroke and end-stage renal disease (ESRD) in ADPKD inpatients were elevated as compared to the controls. Similarly, ADPKD patients from the catastrophic illness registry had an increased risk of hemorrhagic stroke and ESRD. Allopurinol users also had an increased risk of all-cause mortality. The HR for developing ESRD after medication exposure was 0.47-fold for statin and 1.93-fold for pentoxifylline. These results reveal that patients with ADPKD (either inpatient or from the catastrophic illness registry) are at elevated risk for hemorrhagic stroke and ESRD, and suggest that allopurinol and pentoxifylline should not be prescribed to ADPKD patients due to possible adverse effects.
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Affiliation(s)
- Peir-Haur Hung
- Department of Internal Medicine, Ditmanson Medical Foundation Chiayi Christian Hospital, Chia-Yi, Taiwan.,Department of Applied Life Science and Health, Chia-Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Chien-Hung Lin
- Division of Pediatric Immunology and Nephrology, Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Pediatrics, Zhongxing Branch, Taipei City Hospital, Taipei, Taiwan.,College of Science and Engineering, Fu Jen Catholic University, New Taipei, Taiwan
| | - Kuan-Yu Hung
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chih-Hsin Muo
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Mu-Chi Chung
- Division of Nephrology, Department of Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chao-Hsiang Chang
- Department of Urology, China Medical University Hospital, Taichung, Taiwan
| | - Chi-Jung Chung
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.,Department of Public Health, China Medical University, Taichung, Taiwan
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13
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Kanbay M, Afsar B, Siriopol D, Dincer N, Erden N, Yilmaz O, Sag AA, Kuwabara M, Cherney D, Rossignol P, Ortiz A, Covic A. Effect of Uric Acid-Lowering Agents on Cardiovascular Outcome in Patients With Heart Failure: A Systematic Review and Meta-Analysis of Clinical Studies. Angiology 2020; 71:315-323. [PMID: 32000517 DOI: 10.1177/0003319719897509] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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 χ2 = 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.
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Affiliation(s)
- Mehmet Kanbay
- Department of Medicine, Division of Nephrology, Koc University School of Medicine, Istanbul, Turkey
| | - Baris Afsar
- Division of Nephrology, Department of Internal Medicine, Suleyman Demirel University School of Medicine, Isparta Turkey
| | - Dimitrie Siriopol
- Nephrology Clinic, Dialysis and Renal Transplant Center, 'C.I. PARHON' University Hospital, 'Grigore T. Popa' University of Medicine, Iasi, Romania
| | - Neris Dincer
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Nihan Erden
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Onur Yilmaz
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Alan A Sag
- Division of Vascular and Interventional Radiology, Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | | | - David Cherney
- Toronto General Hospital Research Institute, UHN, Toronto, Canada.,Departments of Physiology and Pharmacology and Toxicology, University of Toronto, Ontario, Canada
| | - Patrick Rossignol
- Université de Lorraine, INSERM CIC-P 1433, CHRU de Nancy, INSERM U1116, FCRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France
| | - Alberto Ortiz
- Dialysis Unit, School of Medicine, IIS-Fundacion Jimenez Diaz, Universidad Autónoma de Madrid, Madrid, Spain
| | - Adrian Covic
- Nephrology Clinic, Dialysis and Renal Transplant Center, 'C.I. PARHON' University Hospital, 'Grigore T. Popa' University of Medicine, Iasi, Romania
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14
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Pavlusova M, Jarkovsky J, Benesova K, Vitovec J, Linhart A, Widimsky P, Spinarova L, Zeman K, Belohlavek J, Malek F, Felsoci M, Kettner J, Ostadal P, Cihalik C, Spac J, Al-Hiti H, Fedorco M, Fojt R, Kruger A, Malek J, Mikusova T, Monhart Z, Bohacova S, Pohludkova L, Rohac F, Vaclavik J, Vondrakova D, Vyskocilova K, Bambuch M, Dostalova G, Havranek S, Svobodová I, Dusek L, Spinar J, Miklik R, Parenica J. Hyperuricemia treatment in acute heart failure patients does not improve their long-term prognosis: A propensity score matched analysis from the AHEAD registry. Clin Cardiol 2019; 42:720-727. [PMID: 31119751 PMCID: PMC6671780 DOI: 10.1002/clc.23197] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 05/22/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Hyperuricemia is associated with a poorer prognosis in heart failure (HF) patients. Benefits of hyperuricemia treatment with allopurinol have not yet been confirmed in clinical practice. The aim of our work was to assess the benefit of allopurinol treatment in a large cohort of HF patients. METHODS The prospective acute heart failure registry (AHEAD) was used to select 3160 hospitalized patients with a known level of uric acid (UA) who were discharged in a stable condition. Hyperuricemia was defined as UA ≥500 μmoL/L and/or allopurinol treatment at admission. The patients were classified into three groups: without hyperuricemia, with treated hyperuricemia, and with untreated hyperuricemia at discharge. Two- and five-year all-cause mortality were defined as endpoints. Patients without hyperuricemia, unlike those with hyperuricemia, had a higher left ventricular ejection fraction, a better renal function, and higher hemoglobin levels, had less frequently diabetes mellitus and atrial fibrillation, and showed better tolerance to treatment with angiotensin-converting enzyme inhibitors/angiotensin receptor blockers and/or beta-blockers. RESULTS In a primary analysis, the patients without hyperuricemia had the highest survival rate. After using the propensity score to set up comparable groups, the patients without hyperuricemia had a similar 5-year survival rate as those with untreated hyperuricemia (42.0% vs 39.7%, P = 0.362) whereas those with treated hyperuricemia had a poorer prognosis (32.4% survival rate, P = 0.006 vs non-hyperuricemia group and P = 0.073 vs untreated group). CONCLUSION Hyperuricemia was associated with an unfavorable cardiovascular risk profile in HF patients. Treatment with low doses of allopurinol did not improve the prognosis of HF patients.
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Affiliation(s)
- Marie Pavlusova
- Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech Republic.,Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jiri Jarkovsky
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Klara Benesova
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jiri Vitovec
- Faculty of Medicine, Masaryk University, Brno, Czech Republic.,First Department of Internal Medicine, Cardiology and Angiology, St Anne's University Hospital Brno, Brno, Czech Republic
| | - Ales Linhart
- Second Department of Internal Medicine, Department of Cardiology and Angiology, First Faculty of Medicine of the Charles University, Prague, and General University Hospital in Prague, Czech Republic
| | - Petr Widimsky
- University Hospital Kralovske Vinohrady and the Third Faculty of Medicine of the Charles University, Prague, Czech Republic
| | - Lenka Spinarova
- Faculty of Medicine, Masaryk University, Brno, Czech Republic.,First Department of Internal Medicine, Cardiology and Angiology, St Anne's University Hospital Brno, Brno, Czech Republic
| | - Kamil Zeman
- Department of Internal Medicine, Hospital Frydek-Mistek, Frydek-Mistek, Czech Republic
| | - Jan Belohlavek
- Second Department of Internal Medicine, Department of Cardiology and Angiology, First Faculty of Medicine of the Charles University, Prague, and General University Hospital in Prague, Czech Republic
| | - Filip Malek
- Department of Cardiology, Hospital Na Homolce, Prague, Czech Republic
| | - Marian Felsoci
- Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech Republic.,Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jiri Kettner
- Department of Cardiology, Institute of Clinical and Experimental Medicine, Prague, Czech Republic
| | - Petr Ostadal
- Department of Cardiology, Hospital Na Homolce, Prague, Czech Republic
| | - Cestmir Cihalik
- Department of Internal Medicine, University Hospital Olomouc, Olomouc, Czech Republic
| | - Jiri Spac
- Faculty of Medicine, Masaryk University, Brno, Czech Republic.,Second Department of Internal Medicine, St Anne's University Hospital Brno, Brno, Czech Republic
| | - Hikmet Al-Hiti
- Department of Cardiology, Institute of Clinical and Experimental Medicine, Prague, Czech Republic
| | - Marian Fedorco
- Department of Internal Medicine, University Hospital Olomouc, Olomouc, Czech Republic
| | - Richard Fojt
- University Hospital Kralovske Vinohrady and the Third Faculty of Medicine of the Charles University, Prague, Czech Republic
| | - Andreas Kruger
- Department of Cardiology, Hospital Na Homolce, Prague, Czech Republic
| | - Josef Malek
- Department of Internal Medicine, Hospital Havlickuv Brod, Havlickuv Brod, Czech Republic
| | - Tereza Mikusova
- First Department of Internal Medicine, Cardiology and Angiology, St Anne's University Hospital Brno, Brno, Czech Republic
| | - Zdenek Monhart
- Department of Internal Medicine, Hospital Znojmo, Znojmo, Czech Republic
| | - Stanislava Bohacova
- Department of Cardiology, Tomas Bata Regional Hospital, Zlin, Czech Republic
| | - Lidka Pohludkova
- Department of Internal Medicine, Hospital Frydek-Mistek, Frydek-Mistek, Czech Republic
| | - Filip Rohac
- University Hospital Kralovske Vinohrady and the Third Faculty of Medicine of the Charles University, Prague, Czech Republic
| | - Jan Vaclavik
- Department of Internal Medicine, University Hospital Olomouc, Olomouc, Czech Republic
| | - Dagmar Vondrakova
- Department of Cardiology, Hospital Na Homolce, Prague, Czech Republic
| | - Klaudia Vyskocilova
- First Department of Internal Medicine, Cardiology and Angiology, St Anne's University Hospital Brno, Brno, Czech Republic
| | - Miroslav Bambuch
- Department of Cardiology, Tomas Bata Regional Hospital, Zlin, Czech Republic
| | - Gabriela Dostalova
- Second Department of Internal Medicine, Department of Cardiology and Angiology, First Faculty of Medicine of the Charles University, Prague, and General University Hospital in Prague, Czech Republic
| | - Stepan Havranek
- Second Department of Internal Medicine, Department of Cardiology and Angiology, First Faculty of Medicine of the Charles University, Prague, and General University Hospital in Prague, Czech Republic
| | - Ivana Svobodová
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Ladislav Dusek
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jindrich Spinar
- Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech Republic.,Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Roman Miklik
- Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech Republic.,Department of Internal Medicine, Military Hospital Brno, Brno, Czech Republic
| | - Jiri Parenica
- Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech Republic.,Faculty of Medicine, Masaryk University, Brno, Czech Republic
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15
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Spinar J, Spinarova L, Malek F, Ludka O, Krejci J, Ostadal P, Vondrakova D, Labr K, Spinarova M, Pavkova Goldbergova M, Benesova K, Jarkovsky J, Parenica J. Prognostic value of NT-proBNP added to clinical parameters to predict two-year prognosis of chronic heart failure patients with mid-range and reduced ejection fraction - A report from FAR NHL prospective registry. PLoS One 2019; 14:e0214363. [PMID: 30913251 PMCID: PMC6435170 DOI: 10.1371/journal.pone.0214363] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 03/12/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND According to guidelines, the prognosis of patients with chronic heart failure can be predicted by determining the levels of natriuretic peptides, the NYHA classification and comorbidities. The aim our work was to develop a prognostic score in chronic heart failure patients that would take account of patients' comorbidities, NYHA and NT-proBNP levels. METHODS AND RESULTS A total of 1,088 patients with chronic heart failure with reduced ejection fraction (HFrEF) (LVEF<40%) and mid-range EF (HFmrEF) (LVEF 40-49%) were enrolled consecutively. Two-year all-cause mortality, heart transplantation and/or LVAD implantation were defined as the primary endpoint (EP). The occurrence of EP was 14.9% and grew with higher NYHA, namely 4.9% (NYHA I), 11.4% (NYHA II) and 27.8% (NYHA III-IV) (p<0.001). The occurrence of EP was 3%, 10% and 15-37% in patients with NT-proBNP levels ≤125 ng/L, 126-1000 ng/L and >1000 ng/L respectively. Discrimination abilities of NYHA and NT-proBNP were AUC 0.670 (p<0.001) and AUC 0.722 (p<0.001) respectively. The predictive value of the developed clinical model, which took account of older age, advanced heart failure (NYHA III+IV), anaemia, hyponatraemia, hyperuricaemia and being on a higher dose of furosemide (>40 mg daily) (AUC 0.773; p<0.001) was increased by adding the NT-proBNP level (AUC 0.790). CONCLUSION The use of prediction models in patients with chronic heart failure, namely those taking account of natriuretic peptides, should become a standard in routine clinical practice. It might contribute to a better identification of a high-risk group of patients in which more intense treatment needs to be considered, such as heart transplantation or LVAD implantation.
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Affiliation(s)
- Jindrich Spinar
- Department of Cardiology, University Hospital Brno, Brno, Czech Republic
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Lenka Spinarova
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
- First Department of Internal Medicine, Cardiology and Angiology, St Anne’s University Hospital Brno, Brno, Czech Republic
| | - Filip Malek
- Department of Cardiology, Hospital Na Homolce, Prague, Czech Republic
| | - Ondrej Ludka
- Department of Cardiology, University Hospital Brno, Brno, Czech Republic
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jan Krejci
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
- First Department of Internal Medicine, Cardiology and Angiology, St Anne’s University Hospital Brno, Brno, Czech Republic
| | - Petr Ostadal
- Department of Cardiology, Hospital Na Homolce, Prague, Czech Republic
| | - Dagmar Vondrakova
- Department of Cardiology, Hospital Na Homolce, Prague, Czech Republic
| | - Karel Labr
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
- First Department of Internal Medicine, Cardiology and Angiology, St Anne’s University Hospital Brno, Brno, Czech Republic
| | - Monika Spinarova
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
- First Department of Internal Medicine, Cardiology and Angiology, St Anne’s University Hospital Brno, Brno, Czech Republic
| | | | - Klara Benesova
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jiri Jarkovsky
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jiri Parenica
- Department of Cardiology, University Hospital Brno, Brno, Czech Republic
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
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16
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Shirakabe A, Okazaki H, Matsushita M, Shibata Y, Goda H, Uchiyama S, Tani K, Kiuchi K, Kobayashi N, Hata N, Asai K, Shimizu W. Hyperuricemia complicated with acute kidney injury is associated with adverse outcomes in patients with severely decompensated acute heart failure. IJC HEART & VASCULATURE 2019; 23:100345. [PMID: 31321285 PMCID: PMC6612750 DOI: 10.1016/j.ijcha.2019.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 02/23/2019] [Accepted: 03/12/2019] [Indexed: 12/28/2022]
Abstract
Background The relationship between the serum level of uric acid (UA) and the acute kidney injury on admission in patients with acute heart failure (AHF) remain unclear. Methods and results A total of 1326 AHF patients were screened, and data for 1047 patients who were admitted to the intensive-care unit were analyzed. The patients were assigned to a low-UA group (UA ≤ 7.0 mg/dl, n = 569) or a high-UA group (UA > 7.0 mg/dl, n = 478) according to their UA level at admission. Acute kidney injury (AKI) at admission was defined based on the ratio of the serum creatinine value recorded on admission to the baseline creatinine value: no-AKI (n = 736) or AKI (n = 311). The patients were therefore assigned to four groups: low-UA/no-AKI (n = 428), high-UA/no-AKI (n = 308), low-UA/AKI (n = 141) and high-UA/AKI (n = 170). The high-UA patients were significantly more frequent in the AKI group than in the non-AKI group among all patients and the non-chronic kidney injury (CKD) cohort. A Kaplan-Meier curve showed a significantly lower 365-day survival rate in the high-UA/AKI group than in the other groups. The multivariate Cox regression model identified only high-UA/AKI as an independent predictor of 365-day mortality (hazard ratio [HR]: 2.511, 95% confidence interval [CI] 1.671–3.772 in all AHF patients, HR: 1.884, 95% CI 1.022–3.473 in non-CKD patients and HR: 3.546, 95% CI 2.136–5.884 in CKD patients). Conclusion An elevated serum UA level complicated with AKI was an independent predictor of mortality in patients with severely decompensated AHF.
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Affiliation(s)
- Akihiro Shirakabe
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
- Corresponding author at: ICU, Chiba Hokusoh Hospital, Nippon Medical School, 1715 Kamagari, Inzai, Chiba 270-1694, Japan.
| | - Hirotake Okazaki
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Masato Matsushita
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Yusaku Shibata
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Hiroki Goda
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Saori Uchiyama
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Kenichi Tani
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Kazutaka Kiuchi
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Nobuaki Kobayashi
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Noritake Hata
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Kuniya Asai
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School Hospital, Tokyo, Japan
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17
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Baydemir C, Ural D, Karaüzüm K, Balcı S, Argan O, Karaüzüm I, Kozdağ G, Ağır AA. Predictors of Long-Term Mortality and Frequent Re-Hospitalization in Patients with Acute Decompensated Heart Failure and Kidney Dysfunction Treated with Renin-Angiotensin System Blockers. Med Sci Monit 2017; 23:3335-3344. [PMID: 28690311 PMCID: PMC5515119 DOI: 10.12659/msm.902786] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Accepted: 01/02/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Assessment of risk for all-cause mortality and re-hospitalization is an important task during discharge of acute heart failure (AHF) patients, as they warrant different management strategies. Treatment with optimal medical therapy may change predictors for these 2 end-points in AHF patients with renal dysfunction. The aim of this study was to evaluate the predictors for long-term outcome in AHF patients with kidney dysfunction who were discharged on optimal medical therapy. MATERIAL AND METHODS The study was conducted retrospectively. The study group consisted of 225 AHF patients with moderate-to-severe kidney dysfunction, who were hospitalized at Kocaeli University Hospital Cardiology Clinic and who were prescribed beta-blockers and ACE-inhibitors or angiotensin II receptor blockers at discharge. Clinical, echocardiographic, and biochemical predictors of the composite of total mortality and frequent re-hospitalization (≥3 hospitalizations during the follow-up) were assessed using Cox regression and the predictors for each end-point were assessed by competing risk regression analysis. RESULTS Incidence of all-cause mortality was 45.3% and frequent readmissions were 49.8% in a median follow-up of 54 months. The associates of the composite end-point were age, NYHA class, respiration rate on admission, eGFR, hypoalbuminemia, mitral valve E/E' ratio, and ejection fraction. In competing risk regression analysis, right-sided HF, hypoalbuminemia, age, and uric acid appeared as independent associates of all-cause mortality, whereas NYHA class, NT-proBNP, mitral valve E/E' ratio, and uric acid were predictors for re-hospitalization. CONCLUSIONS Predictors for all-cause mortality in AHF with kidney dysfunction treated with optimal therapy are mainly related to advanced HF with right-sided dysfunction, whereas frequent re-hospitalization is associated with volume overload manifested by increased mitral E/E' ratio and NT-proBNP levels.
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Affiliation(s)
- Canan Baydemir
- Department of Biostatistics and Medical Informatics, Kocaeli University, School of Medicine, Kocaeli, Turkey
| | - Dilek Ural
- Department of Cardiology, Koç University, School of Medicine, Istanbul, Turkey
| | - Kurtuluş Karaüzüm
- Department of Cardiology, Derince Education and Research Hospital, Kocaeli, Turkey
| | - Sibel Balcı
- Department of Biostatistics and Medical Informatics, Kocaeli University, School of Medicine, Kocaeli, Turkey
| | - Onur Argan
- Department of Cardiology, Kocaeli State Hospital, Kocaeli, Turkey
| | - Irem Karaüzüm
- Department of Cardiology, Izmit Seka State Hospital, Kocaeli, Turkey
| | - Güliz Kozdağ
- Department of Cardiology, Kocaeli University, School of Medicine, Kocaeli, Turkey
| | - Ayşen A. Ağır
- Department of Cardiology, Kocaeli University, School of Medicine, Kocaeli, Turkey
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18
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Okafor ON, Farrington K, Gorog DA. Allopurinol as a therapeutic option in cardiovascular disease. Pharmacol Ther 2017; 172:139-150. [DOI: 10.1016/j.pharmthera.2016.12.004] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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19
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Immunopathogenesis and risk factors for allopurinol severe cutaneous adverse reactions. Curr Opin Allergy Clin Immunol 2016; 16:339-45. [DOI: 10.1097/aci.0000000000000286] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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20
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Okazaki H, Shirakabe A, Kobayashi N, Hata N, Shinada T, Matsushita M, Yamamoto Y, Shibuya J, Shiomura R, Nishigoori S, Asai K, Shimizu W. The prognostic impact of uric acid in patients with severely decompensated acute heart failure. J Cardiol 2016; 68:384-391. [PMID: 27261247 DOI: 10.1016/j.jjcc.2016.04.013] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 04/12/2016] [Accepted: 04/18/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND The serum level of uric acid (UA) is a well-known prognostic factor for heart failure (HF) patients. However, the prognostic impact of hyperuricemia and the factors that induce hyperuricemia in acute HF (AHF) patients are not well understood. METHODS AND RESULTS Eight hundred eighty-nine AHF patients were enrolled in this study. The patients were assigned into a low UA group (UA≤7.0mg/dl, n=495) or a high UA group (UA>7.0mg/dl, n=394) according to their UA level on admission. A Kaplan-Meier curve showed that the survival rate of the low UA group was significantly higher than that of the high UA group. A multivariate Cox regression model identified that a high UA level (HR: 1.192, 95%CI 1.112-1.277) was an independent predictor of 180-day mortality. A multivariate logistic regression model for a high serum UA level on admission indicated that chronic kidney disease (CKD) (OR: 2.030, 95%CI: 1.298-3.176, p=0.002) and the administration of loop diuretics before admission (OR: 1.556, 95%CI: 1.010-2.397, p=0.045) were independent factors. The prognosis, including all-cause death and HF events, was significantly poorer among patients who had a high UA level who had previously used loop diuretics and among CKD patients with a high UA level than among other patients. CONCLUSIONS The serum UA level was an independent predictor in patients who were hospitalized during an emergent situation for AHF. An elevated serum UA level on admission was associated with the presence of CKD and the use of loop diuretics. These factors were also associated with adverse outcomes in hyperuricemic patients with AHF.
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Affiliation(s)
- Hirotake Okazaki
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Akihiro Shirakabe
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan.
| | - Nobuaki Kobayashi
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Noritake Hata
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Takuro Shinada
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Masato Matsushita
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Yoshiya Yamamoto
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Junsuke Shibuya
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Reiko Shiomura
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Suguru Nishigoori
- Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Kuniya Asai
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
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21
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Huang WM, Hsu PF, Cheng HM, Lu DY, Cheng YL, Guo CY, Sung SH, Yu WC, Chen CH. Determinants and Prognostic Impact of Hyperuricemia in Hospitalization for Acute Heart Failure. Circ J 2015; 80:404-10. [PMID: 26597355 DOI: 10.1253/circj.cj-15-0964] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Hyperuricemia is a prognostic factor in patients with chronic heart failure, but whether uric acid level can predict clinical outcome of acute heart failure (AHF) remains to be elucidated. We therefore investigated the association of uric acid with mortality in patients hospitalized for AHF. METHODS AND RESULTS Data for patients hospitalized for AHF were drawn from an intramural registry. Biochemistry data, echocardiographic characteristics, and uric acid level were collected. National Death Registry was linked for the identification of mortality data. Among a total of 1,835 participants (age, 75 ± 13 years, 68% men), 794 patients died during follow-up. Patients who died were older, had lower hemoglobin and estimated glomerular filtration rate, and higher pulmonary artery systolic pressure, NT-proBNP, and uric acid. Uric acid was a significant predictor of mortality on univariate analysis (HR per 1 SD, 1.18; 95% CI: 1.11-1.26) and in multivariate Cox models (HR, 1.15; 95% CI: 1.02-1.29). Survival analysis showed an increasing risk of death along the quartile distribution of uric acid level. Given renal function, cardiac performance, and kidney perfusion as major determinants of hyperuricemia, the prognostic impact of uric acid level was diminished as renal function deteriorated. CONCLUSIONS Uric acid level was an independent predictor of mortality in patients hospitalized for AHF, but the prognostic impact of hyperuricemia was attenuated by worsening renal function.
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Affiliation(s)
- Wei-Ming Huang
- Department of Medicine, Taipei Veterans General Hospital
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22
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Khambata RS, Ghosh SM, Ahluwalia A. "Repurposing" of Xanthine Oxidoreductase as a Nitrite Reductase: A New Paradigm for Therapeutic Targeting in Hypertension. Antioxid Redox Signal 2015; 23:340-53. [PMID: 25714611 DOI: 10.1089/ars.2015.6254] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
SIGNIFICANCE In contrast to nitric oxide (NO), which has well-established, important effects in regulation of cardiovascular homeostasis, its oxidative metabolite nitrite has, until recently, been considered to be of minor functional significance. RECENT ADVANCES However, this view of nitrite has been radically revised over the past 10 years with evidence now supporting a critical role for this anion as a storage form of NO. CRITICAL ISSUES Importantly, while hypoxia and acidosis have been shown to play a pivotal role in the generation of nitrite to NO, a number of mammalian nitrite reductases have been identified that facilitate the reduction of nitrite. Critically, these nitrite reductases have been demonstrated to operate under physiological pH conditions and in normoxia, extending the functional remit of this anion from an ischemic mediator to an important regulator of physiology. One particular nitrite reductase that has been shown to operate under a wide range of environmental conditions is the enzyme xanthine oxidoreductase (XOR). FUTURE DIRECTIONS In this review, we discuss the evidence supporting a role for XOR as a nitrite reductase while focusing particularly on its function in hypertension. In addition, we discuss the potential merit in exploiting this activity of XOR in the therapeutics of hypertension.
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Affiliation(s)
- Rayomand S Khambata
- The William Harvey Research Institute, Barts NIHR Cardiovascular Biomedical Research Unit, Barts & The London Medical School, Queen Mary University of London , London, United Kingdom
| | - Suborno M Ghosh
- The William Harvey Research Institute, Barts NIHR Cardiovascular Biomedical Research Unit, Barts & The London Medical School, Queen Mary University of London , London, United Kingdom
| | - Amrita Ahluwalia
- The William Harvey Research Institute, Barts NIHR Cardiovascular Biomedical Research Unit, Barts & The London Medical School, Queen Mary University of London , London, United Kingdom
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23
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Kuo CF, Grainge MJ, Mallen C, Zhang W, Doherty M. Effect of allopurinol on all-cause mortality in adults with incident gout: propensity score-matched landmark analysis. Rheumatology (Oxford) 2015; 54:2145-50. [PMID: 26170376 DOI: 10.1093/rheumatology/kev246] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE To examine the association between allopurinol use and all-cause mortality for patients with incident gout. METHODS We compared all-cause mortality in incident gout patients who received allopurinol for at least 6 months within the exposure window (1 year or 3 years) with those who did not, using the UK Clinical Practice Research Data-link. Landmark analysis was used to account for immortal time bias and propensity score matching was used to control for potential effects of known confounders. RESULTS Of 23 332 incident gout patients identified, the propensity score-matched cohorts contained 1016 patients exposed to allopurinol on the date 1 year from diagnosis (landmark date) and 1016 allopurinol non-users. Over a median follow-up period of 10 years after the landmark date, there were 437 allopurinol users and 443 allopurinol non-users who died during follow-up. Allopurinol users and non-users had similar risk for all-cause mortality (hazard ratio 0.99; 95% CI 0.87, 1.12). In the 3-year landmark analysis, 3519 allopurinol users (1280 died) were compared with 3519 non-users (1265 died). The hazard ratio for all-cause mortality was 1.01 (95% CI 0.92, 1.09). CONCLUSION This propensity score-matched landmark analysis in a population of incident gout patients in the UK primary care setting found a neutral effect on the risk of all-cause mortality. Our study provides reassurance about the prescription of allopurinol for gout patients early in their disease course to prevent untoward consequences of chronic uncontrolled hyperuricaemia. However, whether higher than the commonly used dose of allopurinol could influence mortality remains to be determined.
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Affiliation(s)
- Chang-Fu Kuo
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK, Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Matthew J Grainge
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham and
| | - Christian Mallen
- Arthritis Research UK Primary Care Centre, Keele University, Keele, UK
| | - Weiya Zhang
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK,
| | - Michael Doherty
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
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24
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Givertz MM, Anstrom KJ, Redfield MM, Deswal A, Haddad H, Butler J, Tang WHW, Dunlap ME, LeWinter MM, Mann DL, Felker GM, O'Connor CM, Goldsmith SR, Ofili EO, Saltzberg MT, Margulies KB, Cappola TP, Konstam MA, Semigran MJ, McNulty SE, Lee KL, Shah MR, Hernandez AF. Effects of Xanthine Oxidase Inhibition in Hyperuricemic Heart Failure Patients: The Xanthine Oxidase Inhibition for Hyperuricemic Heart Failure Patients (EXACT-HF) Study. Circulation 2015; 131:1763-71. [PMID: 25986447 PMCID: PMC4438785 DOI: 10.1161/circulationaha.114.014536] [Citation(s) in RCA: 221] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 03/05/2015] [Indexed: 01/06/2023]
Abstract
BACKGROUND Oxidative stress may contribute to heart failure (HF) progression. Inhibiting xanthine oxidase in hyperuricemic HF patients may improve outcomes. METHODS AND RESULTS We randomly assigned 253 patients with symptomatic HF, left ventricular ejection fraction ≤40%, and serum uric acid levels ≥9.5 mg/dL to receive allopurinol (target dose, 600 mg daily) or placebo in a double-blind, multicenter trial. The primary composite end point at 24 weeks was based on survival, worsening HF, and patient global assessment. Secondary end points included change in quality of life, submaximal exercise capacity, and left ventricular ejection fraction. Uric acid levels were significantly reduced with allopurinol in comparison with placebo (treatment difference, -4.2 [-4.9, -3.5] mg/dL and -3.5 [-4.2, -2.7] mg/dL at 12 and 24 weeks, respectively, both P<0.0001). At 24 weeks, there was no significant difference in clinical status between the allopurinol- and placebo-treated patients (worsened 45% versus 46%, unchanged 42% versus 34%, improved 13% versus 19%, respectively; P=0.68). At 12 and 24 weeks, there was no significant difference in change in Kansas City Cardiomyopathy Questionnaire scores or 6-minute walk distances between the 2 groups. At 24 weeks, left ventricular ejection fraction did not change in either group or between groups. Rash occurred more frequently with allopurinol (10% versus 2%, P=0.01), but there was no difference in serious adverse event rates between the groups (20% versus 15%, P=0.36). CONCLUSIONS In high-risk HF patients with reduced ejection fraction and elevated uric acid levels, xanthine oxidase inhibition with allopurinol failed to improve clinical status, exercise capacity, quality of life, or left ventricular ejection fraction at 24 weeks. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00987415.
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Affiliation(s)
- Michael M Givertz
- From Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.M.G.); Duke University Medical Center, Durham, NC (K.J.A., G.M.F., C.M.O., S.E.M., K.L.L., A.F.H.); Mayo Clinic, Rochester, MN (M.M.R.); Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.D.); Ottawa Heart Institute, Ontario, Canada (H.H.); Emory University, Atlanta, GA (J.B.); Cleveland Clinic, OH (W.H.W.T.); MetroHealth Campus of Case Western Reserve University, Cleveland, OH (M.E.D.); University of Vermont, Burlington (M.M.L.); Washington University, St. Louis, MO (D.L.M.); Hennepin County Medical Center, Minneapolis, MN (S.R.G.); Morehouse School of Medicine, Atlanta, GA (E.O.O.); Christiana Care Health System, Newark, DE (M.T.S.); University of Pennsylvania, Philadelphia (K.B.M., T.P.C.); Tufts Medical Center, Boston, MA (M.A.K.); Massachusetts General Hospital, Boston (M.J.S.); and National Heart, Lung, and Blood Institute, Bethesda, MD (M.R.S.).
| | - Kevin J Anstrom
- From Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.M.G.); Duke University Medical Center, Durham, NC (K.J.A., G.M.F., C.M.O., S.E.M., K.L.L., A.F.H.); Mayo Clinic, Rochester, MN (M.M.R.); Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.D.); Ottawa Heart Institute, Ontario, Canada (H.H.); Emory University, Atlanta, GA (J.B.); Cleveland Clinic, OH (W.H.W.T.); MetroHealth Campus of Case Western Reserve University, Cleveland, OH (M.E.D.); University of Vermont, Burlington (M.M.L.); Washington University, St. Louis, MO (D.L.M.); Hennepin County Medical Center, Minneapolis, MN (S.R.G.); Morehouse School of Medicine, Atlanta, GA (E.O.O.); Christiana Care Health System, Newark, DE (M.T.S.); University of Pennsylvania, Philadelphia (K.B.M., T.P.C.); Tufts Medical Center, Boston, MA (M.A.K.); Massachusetts General Hospital, Boston (M.J.S.); and National Heart, Lung, and Blood Institute, Bethesda, MD (M.R.S.)
| | - Margaret M Redfield
- From Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.M.G.); Duke University Medical Center, Durham, NC (K.J.A., G.M.F., C.M.O., S.E.M., K.L.L., A.F.H.); Mayo Clinic, Rochester, MN (M.M.R.); Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.D.); Ottawa Heart Institute, Ontario, Canada (H.H.); Emory University, Atlanta, GA (J.B.); Cleveland Clinic, OH (W.H.W.T.); MetroHealth Campus of Case Western Reserve University, Cleveland, OH (M.E.D.); University of Vermont, Burlington (M.M.L.); Washington University, St. Louis, MO (D.L.M.); Hennepin County Medical Center, Minneapolis, MN (S.R.G.); Morehouse School of Medicine, Atlanta, GA (E.O.O.); Christiana Care Health System, Newark, DE (M.T.S.); University of Pennsylvania, Philadelphia (K.B.M., T.P.C.); Tufts Medical Center, Boston, MA (M.A.K.); Massachusetts General Hospital, Boston (M.J.S.); and National Heart, Lung, and Blood Institute, Bethesda, MD (M.R.S.)
| | - Anita Deswal
- From Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.M.G.); Duke University Medical Center, Durham, NC (K.J.A., G.M.F., C.M.O., S.E.M., K.L.L., A.F.H.); Mayo Clinic, Rochester, MN (M.M.R.); Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.D.); Ottawa Heart Institute, Ontario, Canada (H.H.); Emory University, Atlanta, GA (J.B.); Cleveland Clinic, OH (W.H.W.T.); MetroHealth Campus of Case Western Reserve University, Cleveland, OH (M.E.D.); University of Vermont, Burlington (M.M.L.); Washington University, St. Louis, MO (D.L.M.); Hennepin County Medical Center, Minneapolis, MN (S.R.G.); Morehouse School of Medicine, Atlanta, GA (E.O.O.); Christiana Care Health System, Newark, DE (M.T.S.); University of Pennsylvania, Philadelphia (K.B.M., T.P.C.); Tufts Medical Center, Boston, MA (M.A.K.); Massachusetts General Hospital, Boston (M.J.S.); and National Heart, Lung, and Blood Institute, Bethesda, MD (M.R.S.)
| | - Haissam Haddad
- From Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.M.G.); Duke University Medical Center, Durham, NC (K.J.A., G.M.F., C.M.O., S.E.M., K.L.L., A.F.H.); Mayo Clinic, Rochester, MN (M.M.R.); Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.D.); Ottawa Heart Institute, Ontario, Canada (H.H.); Emory University, Atlanta, GA (J.B.); Cleveland Clinic, OH (W.H.W.T.); MetroHealth Campus of Case Western Reserve University, Cleveland, OH (M.E.D.); University of Vermont, Burlington (M.M.L.); Washington University, St. Louis, MO (D.L.M.); Hennepin County Medical Center, Minneapolis, MN (S.R.G.); Morehouse School of Medicine, Atlanta, GA (E.O.O.); Christiana Care Health System, Newark, DE (M.T.S.); University of Pennsylvania, Philadelphia (K.B.M., T.P.C.); Tufts Medical Center, Boston, MA (M.A.K.); Massachusetts General Hospital, Boston (M.J.S.); and National Heart, Lung, and Blood Institute, Bethesda, MD (M.R.S.)
| | - Javed Butler
- From Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.M.G.); Duke University Medical Center, Durham, NC (K.J.A., G.M.F., C.M.O., S.E.M., K.L.L., A.F.H.); Mayo Clinic, Rochester, MN (M.M.R.); Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.D.); Ottawa Heart Institute, Ontario, Canada (H.H.); Emory University, Atlanta, GA (J.B.); Cleveland Clinic, OH (W.H.W.T.); MetroHealth Campus of Case Western Reserve University, Cleveland, OH (M.E.D.); University of Vermont, Burlington (M.M.L.); Washington University, St. Louis, MO (D.L.M.); Hennepin County Medical Center, Minneapolis, MN (S.R.G.); Morehouse School of Medicine, Atlanta, GA (E.O.O.); Christiana Care Health System, Newark, DE (M.T.S.); University of Pennsylvania, Philadelphia (K.B.M., T.P.C.); Tufts Medical Center, Boston, MA (M.A.K.); Massachusetts General Hospital, Boston (M.J.S.); and National Heart, Lung, and Blood Institute, Bethesda, MD (M.R.S.)
| | - W H Wilson Tang
- From Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.M.G.); Duke University Medical Center, Durham, NC (K.J.A., G.M.F., C.M.O., S.E.M., K.L.L., A.F.H.); Mayo Clinic, Rochester, MN (M.M.R.); Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.D.); Ottawa Heart Institute, Ontario, Canada (H.H.); Emory University, Atlanta, GA (J.B.); Cleveland Clinic, OH (W.H.W.T.); MetroHealth Campus of Case Western Reserve University, Cleveland, OH (M.E.D.); University of Vermont, Burlington (M.M.L.); Washington University, St. Louis, MO (D.L.M.); Hennepin County Medical Center, Minneapolis, MN (S.R.G.); Morehouse School of Medicine, Atlanta, GA (E.O.O.); Christiana Care Health System, Newark, DE (M.T.S.); University of Pennsylvania, Philadelphia (K.B.M., T.P.C.); Tufts Medical Center, Boston, MA (M.A.K.); Massachusetts General Hospital, Boston (M.J.S.); and National Heart, Lung, and Blood Institute, Bethesda, MD (M.R.S.)
| | - Mark E Dunlap
- From Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.M.G.); Duke University Medical Center, Durham, NC (K.J.A., G.M.F., C.M.O., S.E.M., K.L.L., A.F.H.); Mayo Clinic, Rochester, MN (M.M.R.); Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.D.); Ottawa Heart Institute, Ontario, Canada (H.H.); Emory University, Atlanta, GA (J.B.); Cleveland Clinic, OH (W.H.W.T.); MetroHealth Campus of Case Western Reserve University, Cleveland, OH (M.E.D.); University of Vermont, Burlington (M.M.L.); Washington University, St. Louis, MO (D.L.M.); Hennepin County Medical Center, Minneapolis, MN (S.R.G.); Morehouse School of Medicine, Atlanta, GA (E.O.O.); Christiana Care Health System, Newark, DE (M.T.S.); University of Pennsylvania, Philadelphia (K.B.M., T.P.C.); Tufts Medical Center, Boston, MA (M.A.K.); Massachusetts General Hospital, Boston (M.J.S.); and National Heart, Lung, and Blood Institute, Bethesda, MD (M.R.S.)
| | - Martin M LeWinter
- From Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.M.G.); Duke University Medical Center, Durham, NC (K.J.A., G.M.F., C.M.O., S.E.M., K.L.L., A.F.H.); Mayo Clinic, Rochester, MN (M.M.R.); Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.D.); Ottawa Heart Institute, Ontario, Canada (H.H.); Emory University, Atlanta, GA (J.B.); Cleveland Clinic, OH (W.H.W.T.); MetroHealth Campus of Case Western Reserve University, Cleveland, OH (M.E.D.); University of Vermont, Burlington (M.M.L.); Washington University, St. Louis, MO (D.L.M.); Hennepin County Medical Center, Minneapolis, MN (S.R.G.); Morehouse School of Medicine, Atlanta, GA (E.O.O.); Christiana Care Health System, Newark, DE (M.T.S.); University of Pennsylvania, Philadelphia (K.B.M., T.P.C.); Tufts Medical Center, Boston, MA (M.A.K.); Massachusetts General Hospital, Boston (M.J.S.); and National Heart, Lung, and Blood Institute, Bethesda, MD (M.R.S.)
| | - Douglas L Mann
- From Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.M.G.); Duke University Medical Center, Durham, NC (K.J.A., G.M.F., C.M.O., S.E.M., K.L.L., A.F.H.); Mayo Clinic, Rochester, MN (M.M.R.); Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.D.); Ottawa Heart Institute, Ontario, Canada (H.H.); Emory University, Atlanta, GA (J.B.); Cleveland Clinic, OH (W.H.W.T.); MetroHealth Campus of Case Western Reserve University, Cleveland, OH (M.E.D.); University of Vermont, Burlington (M.M.L.); Washington University, St. Louis, MO (D.L.M.); Hennepin County Medical Center, Minneapolis, MN (S.R.G.); Morehouse School of Medicine, Atlanta, GA (E.O.O.); Christiana Care Health System, Newark, DE (M.T.S.); University of Pennsylvania, Philadelphia (K.B.M., T.P.C.); Tufts Medical Center, Boston, MA (M.A.K.); Massachusetts General Hospital, Boston (M.J.S.); and National Heart, Lung, and Blood Institute, Bethesda, MD (M.R.S.)
| | - G Michael Felker
- From Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.M.G.); Duke University Medical Center, Durham, NC (K.J.A., G.M.F., C.M.O., S.E.M., K.L.L., A.F.H.); Mayo Clinic, Rochester, MN (M.M.R.); Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.D.); Ottawa Heart Institute, Ontario, Canada (H.H.); Emory University, Atlanta, GA (J.B.); Cleveland Clinic, OH (W.H.W.T.); MetroHealth Campus of Case Western Reserve University, Cleveland, OH (M.E.D.); University of Vermont, Burlington (M.M.L.); Washington University, St. Louis, MO (D.L.M.); Hennepin County Medical Center, Minneapolis, MN (S.R.G.); Morehouse School of Medicine, Atlanta, GA (E.O.O.); Christiana Care Health System, Newark, DE (M.T.S.); University of Pennsylvania, Philadelphia (K.B.M., T.P.C.); Tufts Medical Center, Boston, MA (M.A.K.); Massachusetts General Hospital, Boston (M.J.S.); and National Heart, Lung, and Blood Institute, Bethesda, MD (M.R.S.)
| | - Christopher M O'Connor
- From Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.M.G.); Duke University Medical Center, Durham, NC (K.J.A., G.M.F., C.M.O., S.E.M., K.L.L., A.F.H.); Mayo Clinic, Rochester, MN (M.M.R.); Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.D.); Ottawa Heart Institute, Ontario, Canada (H.H.); Emory University, Atlanta, GA (J.B.); Cleveland Clinic, OH (W.H.W.T.); MetroHealth Campus of Case Western Reserve University, Cleveland, OH (M.E.D.); University of Vermont, Burlington (M.M.L.); Washington University, St. Louis, MO (D.L.M.); Hennepin County Medical Center, Minneapolis, MN (S.R.G.); Morehouse School of Medicine, Atlanta, GA (E.O.O.); Christiana Care Health System, Newark, DE (M.T.S.); University of Pennsylvania, Philadelphia (K.B.M., T.P.C.); Tufts Medical Center, Boston, MA (M.A.K.); Massachusetts General Hospital, Boston (M.J.S.); and National Heart, Lung, and Blood Institute, Bethesda, MD (M.R.S.)
| | - Steven R Goldsmith
- From Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.M.G.); Duke University Medical Center, Durham, NC (K.J.A., G.M.F., C.M.O., S.E.M., K.L.L., A.F.H.); Mayo Clinic, Rochester, MN (M.M.R.); Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.D.); Ottawa Heart Institute, Ontario, Canada (H.H.); Emory University, Atlanta, GA (J.B.); Cleveland Clinic, OH (W.H.W.T.); MetroHealth Campus of Case Western Reserve University, Cleveland, OH (M.E.D.); University of Vermont, Burlington (M.M.L.); Washington University, St. Louis, MO (D.L.M.); Hennepin County Medical Center, Minneapolis, MN (S.R.G.); Morehouse School of Medicine, Atlanta, GA (E.O.O.); Christiana Care Health System, Newark, DE (M.T.S.); University of Pennsylvania, Philadelphia (K.B.M., T.P.C.); Tufts Medical Center, Boston, MA (M.A.K.); Massachusetts General Hospital, Boston (M.J.S.); and National Heart, Lung, and Blood Institute, Bethesda, MD (M.R.S.)
| | - Elizabeth O Ofili
- From Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.M.G.); Duke University Medical Center, Durham, NC (K.J.A., G.M.F., C.M.O., S.E.M., K.L.L., A.F.H.); Mayo Clinic, Rochester, MN (M.M.R.); Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.D.); Ottawa Heart Institute, Ontario, Canada (H.H.); Emory University, Atlanta, GA (J.B.); Cleveland Clinic, OH (W.H.W.T.); MetroHealth Campus of Case Western Reserve University, Cleveland, OH (M.E.D.); University of Vermont, Burlington (M.M.L.); Washington University, St. Louis, MO (D.L.M.); Hennepin County Medical Center, Minneapolis, MN (S.R.G.); Morehouse School of Medicine, Atlanta, GA (E.O.O.); Christiana Care Health System, Newark, DE (M.T.S.); University of Pennsylvania, Philadelphia (K.B.M., T.P.C.); Tufts Medical Center, Boston, MA (M.A.K.); Massachusetts General Hospital, Boston (M.J.S.); and National Heart, Lung, and Blood Institute, Bethesda, MD (M.R.S.)
| | - Mitchell T Saltzberg
- From Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.M.G.); Duke University Medical Center, Durham, NC (K.J.A., G.M.F., C.M.O., S.E.M., K.L.L., A.F.H.); Mayo Clinic, Rochester, MN (M.M.R.); Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.D.); Ottawa Heart Institute, Ontario, Canada (H.H.); Emory University, Atlanta, GA (J.B.); Cleveland Clinic, OH (W.H.W.T.); MetroHealth Campus of Case Western Reserve University, Cleveland, OH (M.E.D.); University of Vermont, Burlington (M.M.L.); Washington University, St. Louis, MO (D.L.M.); Hennepin County Medical Center, Minneapolis, MN (S.R.G.); Morehouse School of Medicine, Atlanta, GA (E.O.O.); Christiana Care Health System, Newark, DE (M.T.S.); University of Pennsylvania, Philadelphia (K.B.M., T.P.C.); Tufts Medical Center, Boston, MA (M.A.K.); Massachusetts General Hospital, Boston (M.J.S.); and National Heart, Lung, and Blood Institute, Bethesda, MD (M.R.S.)
| | - Kenneth B Margulies
- From Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.M.G.); Duke University Medical Center, Durham, NC (K.J.A., G.M.F., C.M.O., S.E.M., K.L.L., A.F.H.); Mayo Clinic, Rochester, MN (M.M.R.); Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.D.); Ottawa Heart Institute, Ontario, Canada (H.H.); Emory University, Atlanta, GA (J.B.); Cleveland Clinic, OH (W.H.W.T.); MetroHealth Campus of Case Western Reserve University, Cleveland, OH (M.E.D.); University of Vermont, Burlington (M.M.L.); Washington University, St. Louis, MO (D.L.M.); Hennepin County Medical Center, Minneapolis, MN (S.R.G.); Morehouse School of Medicine, Atlanta, GA (E.O.O.); Christiana Care Health System, Newark, DE (M.T.S.); University of Pennsylvania, Philadelphia (K.B.M., T.P.C.); Tufts Medical Center, Boston, MA (M.A.K.); Massachusetts General Hospital, Boston (M.J.S.); and National Heart, Lung, and Blood Institute, Bethesda, MD (M.R.S.)
| | - Thomas P Cappola
- From Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.M.G.); Duke University Medical Center, Durham, NC (K.J.A., G.M.F., C.M.O., S.E.M., K.L.L., A.F.H.); Mayo Clinic, Rochester, MN (M.M.R.); Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.D.); Ottawa Heart Institute, Ontario, Canada (H.H.); Emory University, Atlanta, GA (J.B.); Cleveland Clinic, OH (W.H.W.T.); MetroHealth Campus of Case Western Reserve University, Cleveland, OH (M.E.D.); University of Vermont, Burlington (M.M.L.); Washington University, St. Louis, MO (D.L.M.); Hennepin County Medical Center, Minneapolis, MN (S.R.G.); Morehouse School of Medicine, Atlanta, GA (E.O.O.); Christiana Care Health System, Newark, DE (M.T.S.); University of Pennsylvania, Philadelphia (K.B.M., T.P.C.); Tufts Medical Center, Boston, MA (M.A.K.); Massachusetts General Hospital, Boston (M.J.S.); and National Heart, Lung, and Blood Institute, Bethesda, MD (M.R.S.)
| | - Marvin A Konstam
- From Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.M.G.); Duke University Medical Center, Durham, NC (K.J.A., G.M.F., C.M.O., S.E.M., K.L.L., A.F.H.); Mayo Clinic, Rochester, MN (M.M.R.); Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.D.); Ottawa Heart Institute, Ontario, Canada (H.H.); Emory University, Atlanta, GA (J.B.); Cleveland Clinic, OH (W.H.W.T.); MetroHealth Campus of Case Western Reserve University, Cleveland, OH (M.E.D.); University of Vermont, Burlington (M.M.L.); Washington University, St. Louis, MO (D.L.M.); Hennepin County Medical Center, Minneapolis, MN (S.R.G.); Morehouse School of Medicine, Atlanta, GA (E.O.O.); Christiana Care Health System, Newark, DE (M.T.S.); University of Pennsylvania, Philadelphia (K.B.M., T.P.C.); Tufts Medical Center, Boston, MA (M.A.K.); Massachusetts General Hospital, Boston (M.J.S.); and National Heart, Lung, and Blood Institute, Bethesda, MD (M.R.S.)
| | - Marc J Semigran
- From Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.M.G.); Duke University Medical Center, Durham, NC (K.J.A., G.M.F., C.M.O., S.E.M., K.L.L., A.F.H.); Mayo Clinic, Rochester, MN (M.M.R.); Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.D.); Ottawa Heart Institute, Ontario, Canada (H.H.); Emory University, Atlanta, GA (J.B.); Cleveland Clinic, OH (W.H.W.T.); MetroHealth Campus of Case Western Reserve University, Cleveland, OH (M.E.D.); University of Vermont, Burlington (M.M.L.); Washington University, St. Louis, MO (D.L.M.); Hennepin County Medical Center, Minneapolis, MN (S.R.G.); Morehouse School of Medicine, Atlanta, GA (E.O.O.); Christiana Care Health System, Newark, DE (M.T.S.); University of Pennsylvania, Philadelphia (K.B.M., T.P.C.); Tufts Medical Center, Boston, MA (M.A.K.); Massachusetts General Hospital, Boston (M.J.S.); and National Heart, Lung, and Blood Institute, Bethesda, MD (M.R.S.)
| | - Steven E McNulty
- From Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.M.G.); Duke University Medical Center, Durham, NC (K.J.A., G.M.F., C.M.O., S.E.M., K.L.L., A.F.H.); Mayo Clinic, Rochester, MN (M.M.R.); Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.D.); Ottawa Heart Institute, Ontario, Canada (H.H.); Emory University, Atlanta, GA (J.B.); Cleveland Clinic, OH (W.H.W.T.); MetroHealth Campus of Case Western Reserve University, Cleveland, OH (M.E.D.); University of Vermont, Burlington (M.M.L.); Washington University, St. Louis, MO (D.L.M.); Hennepin County Medical Center, Minneapolis, MN (S.R.G.); Morehouse School of Medicine, Atlanta, GA (E.O.O.); Christiana Care Health System, Newark, DE (M.T.S.); University of Pennsylvania, Philadelphia (K.B.M., T.P.C.); Tufts Medical Center, Boston, MA (M.A.K.); Massachusetts General Hospital, Boston (M.J.S.); and National Heart, Lung, and Blood Institute, Bethesda, MD (M.R.S.)
| | - Kerry L Lee
- From Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.M.G.); Duke University Medical Center, Durham, NC (K.J.A., G.M.F., C.M.O., S.E.M., K.L.L., A.F.H.); Mayo Clinic, Rochester, MN (M.M.R.); Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.D.); Ottawa Heart Institute, Ontario, Canada (H.H.); Emory University, Atlanta, GA (J.B.); Cleveland Clinic, OH (W.H.W.T.); MetroHealth Campus of Case Western Reserve University, Cleveland, OH (M.E.D.); University of Vermont, Burlington (M.M.L.); Washington University, St. Louis, MO (D.L.M.); Hennepin County Medical Center, Minneapolis, MN (S.R.G.); Morehouse School of Medicine, Atlanta, GA (E.O.O.); Christiana Care Health System, Newark, DE (M.T.S.); University of Pennsylvania, Philadelphia (K.B.M., T.P.C.); Tufts Medical Center, Boston, MA (M.A.K.); Massachusetts General Hospital, Boston (M.J.S.); and National Heart, Lung, and Blood Institute, Bethesda, MD (M.R.S.)
| | - Monica R Shah
- From Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.M.G.); Duke University Medical Center, Durham, NC (K.J.A., G.M.F., C.M.O., S.E.M., K.L.L., A.F.H.); Mayo Clinic, Rochester, MN (M.M.R.); Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.D.); Ottawa Heart Institute, Ontario, Canada (H.H.); Emory University, Atlanta, GA (J.B.); Cleveland Clinic, OH (W.H.W.T.); MetroHealth Campus of Case Western Reserve University, Cleveland, OH (M.E.D.); University of Vermont, Burlington (M.M.L.); Washington University, St. Louis, MO (D.L.M.); Hennepin County Medical Center, Minneapolis, MN (S.R.G.); Morehouse School of Medicine, Atlanta, GA (E.O.O.); Christiana Care Health System, Newark, DE (M.T.S.); University of Pennsylvania, Philadelphia (K.B.M., T.P.C.); Tufts Medical Center, Boston, MA (M.A.K.); Massachusetts General Hospital, Boston (M.J.S.); and National Heart, Lung, and Blood Institute, Bethesda, MD (M.R.S.)
| | - Adrian F Hernandez
- From Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.M.G.); Duke University Medical Center, Durham, NC (K.J.A., G.M.F., C.M.O., S.E.M., K.L.L., A.F.H.); Mayo Clinic, Rochester, MN (M.M.R.); Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX (A.D.); Ottawa Heart Institute, Ontario, Canada (H.H.); Emory University, Atlanta, GA (J.B.); Cleveland Clinic, OH (W.H.W.T.); MetroHealth Campus of Case Western Reserve University, Cleveland, OH (M.E.D.); University of Vermont, Burlington (M.M.L.); Washington University, St. Louis, MO (D.L.M.); Hennepin County Medical Center, Minneapolis, MN (S.R.G.); Morehouse School of Medicine, Atlanta, GA (E.O.O.); Christiana Care Health System, Newark, DE (M.T.S.); University of Pennsylvania, Philadelphia (K.B.M., T.P.C.); Tufts Medical Center, Boston, MA (M.A.K.); Massachusetts General Hospital, Boston (M.J.S.); and National Heart, Lung, and Blood Institute, Bethesda, MD (M.R.S.)
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Meng H, Liu G, Zhai J, Zhen Y, Zhao Q, Zheng M, Ma G, Wang L, Tian L, Ji L, Duan L, Li L, Liu K, Liu C. Prednisone in Uric Acid Lowering in Symptomatic Heart Failure Patients with Hyperuricemia — The PUSH-PATH3 Study. J Rheumatol 2015; 42:866-9. [DOI: 10.3899/jrheum.141037] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2015] [Indexed: 01/18/2023]
Abstract
Objective.To determine the safety and efficacy of prednisone in patients with symptomatic heart failure (HF) and hyperuricemia.Methods.Prednisone therapy was administered for a short time to 191 symptomatic HF patients with hyperuricemia (serum uric acid > 7 mg/dl).Results.Prednisone significantly reduced serum uric acid by 2.99 mg/dl (p < 0.01) and serum creatinine by 0.17 mg/dl (p < 0.01). These favorable effects were associated with a remarkable increase in urine output, improvement in renal function, and improvement in clinical status.Conclusion.Prednisone can be used safely in symptomatic HF patients with hyperuricemia.
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Relation of serum uric acid levels and outcomes among patients hospitalized for worsening heart failure with reduced ejection fraction (from the efficacy of vasopressin antagonism in heart failure outcome study with tolvaptan trial). Am J Cardiol 2014; 114:1713-21. [PMID: 25312638 DOI: 10.1016/j.amjcard.2014.09.008] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 09/02/2014] [Accepted: 09/02/2014] [Indexed: 12/22/2022]
Abstract
We investigated the clinical profiles associated with serum uric acid (sUA) levels in a large cohort of patients hospitalized for worsening chronic heart failure with ejection fraction (EF) ≤40%, with specific focus on gender, race, and renal function based interactions. In 3,955 of 4,133 patients (96%) with baseline sUA data, clinical characteristics and outcomes were compared across sUA quartiles. The primary end points were all-cause mortality and a composite of cardiovascular mortality or heart failure hospitalization. Interaction analyses were performed for gender, race, and baseline renal function. Median follow-up was 9.9 months. Mean sUA was 9.1 ± 2.8 mg/dl and was higher in men than in women (9.3 ± 2.7 vs 8.7 ± 3.0 mg/dl, p <0.001) and in blacks than in whites (10.0 ± 2.7 vs 9.0 ± 2.8 mg/dl, p <0.001). Higher sUA was associated with lower systolic blood pressure and EF, higher natriuretic peptides, and more impaired renal function. After accounting for 24 baseline covariates, in patients with enrollment estimated glomerular filtration rate ≥30 ml/min/1.73 m(2), sUA was strongly associated with increased all-cause mortality (hazard ratio 1.44, 95% confidence interval 1.22 to 1.69, p <0.001) and the composite end point (hazard ratio 1.44, 95% confidence interval 1.26 to 1.64, p <0.001). However, in patients with estimated glomerular filtration rate <30 ml/min/1.73 m(2), sUA was not related with either end point (both p >0.4). Adjusted interaction analyses for gender, race, and admission allopurinol use were not significant. In conclusion, sUA is commonly elevated in patients hospitalized for worsening chronic heart failure and reduced EF, especially in men and blacks. The prognostic use of sUA differs by baseline renal function, suggesting different biologic and pathophysiologic significance of sUA among those with and without significant renal dysfunction.
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Berezin AE, Kremzer AA, Samura TA, Berezina TA, Martovitskaya YV. Serum uric Acid predicts declining of circulating proangiogenic mononuclear progenitor cells in chronic heart failure patients. J Cardiovasc Thorac Res 2014; 6:153-62. [PMID: 25320662 PMCID: PMC4195965 DOI: 10.15171/jcvtr.2014.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 09/03/2014] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Serum uric acid (SUA) is considered a marker for natural progression of chronic heart failure (CHF) mediated cardiovascular remodelling. CHF associates with declining of circulating mononuclear progenitor cells (MPCs). The objective of this study was to evaluate the interrelationship between SUA concentrations and proangiogenic MPCs in ischemic CHF patients. METHODS The study population was structured retrospectively after determining the coronary artery disease (CAD) by contrast-enhanced spiral computed tomography angiography in 126 subjects with symptomatic ischemic mild-to-severe CHF and 128 CAD subjects without CHF. Baseline biomarkers were measured in all patients. Cox proportional multivariate hazard ratio was calculated for predictors of MPCs declining in both CHF and non-CHF patient population predictors of MPCs declining in CHF subjects were examined in stepwise logistic regression. C-statistics, integrated discrimination indices (IDI) and net-reclassification improvement were utilized for prediction performance analyses. RESULTS Cox proportional adjusted hazard ratio analyses for CD14(+)CD309(+) and CD14(+)CD309(+)Tie2(+) MPCs by SUA has shown that the higher quartiles (Q3 and Q4) of SUA compared to the lower quartiles (Q1 and Q2) are associated with increased risks of depletion of both CD14(+)CD309(+) and CD14(+)CD309(+)Tie2(+) MPCs. The addition of Q4 SUA to the ABC model improved the relative IDI by 13.8% for depletion of CD14(+)CD309(+) MPCs and by 14.5% for depletion of CD14(+)CD309(+)Tie2(+) MPCs. CONCLUSION Circulating levels of proangiogenic MPCs are declined progressively depending on the levels of SUA in the HF subjects with CHF. We suggest that even mild elevations of SUA might be used to predict of relative depletion of proangiogenic MPCs among chronic HF patients.
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Affiliation(s)
| | - Alexander A Kremzer
- State Medical University, Clinical Pharmacology Department, Zaporozhye, Ukraine
| | - Tatyana A Samura
- State Medical University, Clinical Pharmacology Department, Zaporozhye, Ukraine
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Abstract
Acute heart failure (AHF) is characterized by high morbidity and mortality and high costs. Although the treatment of AHF has not changed substantially in recent decades, it is becoming clear that treatment strategies for AHF need to address both the immediate hemodynamic abnormalities giving rise to congestion as well as prevent organ damage that can influence long-term prognosis. Serelaxin, the recombinant form of human relaxin-2, a naturally occurring peptide hormone, has been found to significantly improve symptoms and signs of AHF, prevent in-hospital worsening heart failure, as well as significantly improve 180-day cardiovascular and all-cause mortality after a 48-h infusion commenced within 16 h of presentation (RELAX-AHF study). Available data suggest that the clinical benefits may be attributable to a potential combination of multiple actions of serelaxin, including improving systemic, cardiac, and renal hemodynamics, and protecting cells and organs from damage via anti-inflammatory, anti-cell death, anti-fibrotic, anti-hypertrophic, and pro-angiogenic effects. This manuscript describes the short- and long-term effects of serelaxin in AHF patients, analyzing how these effects can be explained by taking into account the range of hemodynamic and non-hemodynamic actions of serelaxin. In addition, this paper also addresses several aspects related to the role of serelaxin in the therapy of AHF that remain to be clarified and warrant further investigation.
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Abstract
Heart failure is one of the most prevalent cardiovascular diseases in the United States, and is associated with significant morbidity, mortality, and costs. Prompt diagnosis may help decrease mortality, hospital stay, and costs related to treatment. A complete heart failure evaluation comprises a comprehensive history and physical examination, echocardiogram, and diagnostic tools that provide information regarding the etiology of heart failure, related complications, and prognosis in order to prescribe appropriate therapy, monitor response to therapy, and transition expeditiously to advanced therapies when needed. Emerging technologies and biomarkers may provide better risk stratification and more accurate determination of cause and progression.
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Affiliation(s)
- Maria Patarroyo-Aponte
- Division of Cardiovascular Medicine, University of Minnesota Medical Center, Lillehei Heart Institute, University of Minnesota, 420 Delaware Street Southeast, MMC 508, Minneapolis, MN 55455, USA
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Givertz MM, Mann DL, Lee KL, Ibarra JC, Velazquez EJ, Hernandez AF, Mascette AM, Braunwald E. Xanthine oxidase inhibition for hyperuricemic heart failure patients: design and rationale of the EXACT-HF study. Circ Heart Fail 2013; 6:862-8. [PMID: 23861505 DOI: 10.1161/circheartfailure.113.000394] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Michael M Givertz
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
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Tolonen J, Lassus JPE, Siirila-Waris K, Tarvasmäki T, Pulkki K, Sund R, Peuhkurinen K, Nieminen MS, Harjola VP. The role of cardiorenal biomarkers for risk stratification in the early follow-up after hospitalisation for acute heart failure. Biomarkers 2013; 18:525-31. [DOI: 10.3109/1354750x.2013.821522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Pascual-Figal DA, Caballero L, Sanchez-Mas J, Lax A. Prognostic markers for acute heart failure. ACTA ACUST UNITED AC 2013; 7:379-92. [DOI: 10.1517/17530059.2013.814638] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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