Uric Acid-Lowering Therapy with Febuxostat in Patients with Chronic Heart Failure and Hyperuricemia: A Prospective and Observational Cohort Study.

IF 3.8 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Balkan Medical Journal Pub Date : 2025-09-22 DOI:10.4274/balkanmedj.galenos.2025.2025-6-168

Jiahan Ke, Xiaohan Qiu, Min Wang, Huasu Zeng, Changqian Wang, Junfeng Zhang, Huafang Zhu, Jun Gu

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引用次数: 0

Abstract

Background: Hyperuricemia is associated with poor clinical outcomes in several cardiovascular diseases, including heart failure (HF). However, whether lowering serum uric acid (SUA) levels improves the prognosis of HF remains insufficiently studied.

Aims: To evaluate whether urate-lowering therapy (ULT) with febuxostat confers clinical benefits in patients with HF and concomitant hyperuricemia.

Study design: Prospective, observational cohort study.

Methods: Patients with chronic HF and hyperuricemia were enrolled and assigned either to a febuxostat group or to a non-ULT group and were followed prospectively for 5 years. The primary endpoint was all-cause mortality or rehospitalization for HF.

Results: Among 2005 patients, those with higher SUA levels experienced more endpoint events. After propensity score matching, we found that febuxostat therapy significantly reduced the incidence of primary endpoints in patients with HFwith preserved ejection fraction (HFpEF) [p = 0.012; hazard ratios (HR), 0.744; 95% confidence intervals (CI), 0.589-0.939], but not in those with HF with reduced ejection fraction (HFrEF) or mildly reduced ejection fraction (HFmrEF) (p = 0.234; HR, 0.894; 95% CI, 0.742-1.077). The benefits of febuxostat in HFpEF were most evident in patients within the highest tertiles of B-type natriuretic peptide (BNP) (p = 0.021; HR, 0.647; 95% CI, 0.436-0.960) and SUA (p = 0.025; HR, 0.651; 95% CI, 0.441-0.963).

Conclusion: High SUA levels are associated with increased all-cause mortality and rehospitalization for HF. Febuxostat-mediated SUA reduction significantly improved clinical outcomes in patients with HFpEF, particularly those with elevated SUA and BNP levels.

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非布司他降尿酸治疗慢性心力衰竭和高尿酸血症患者：一项前瞻性和观察性队列研究。

背景：高尿酸血症与包括心力衰竭（HF）在内的几种心血管疾病的不良临床结果相关。然而，降低血清尿酸（SUA）水平是否能改善心衰的预后仍未得到充分研究。目的：评价非布司他降尿酸治疗（ULT）是否对HF合并高尿酸血症患者有临床益处。研究设计：前瞻性、观察性队列研究。方法：纳入慢性心衰和高尿酸血症患者，并将其分配到非布司他组或非ult组，前瞻性随访5年。主要终点是HF的全因死亡率或再住院。结果：在2005例患者中，SUA水平较高的患者发生了更多的终点事件。倾向评分匹配后，我们发现非布司他治疗显著降低了保留射血分数（HFpEF）的hff患者主要终点的发生率[p = 0.012；风险比（HR）， 0.744；95%可信区间（CI）， 0.589-0.939]，但在心力衰竭伴射血分数降低（HFrEF）或轻度射血分数降低（HFmrEF）的患者中无统计学意义（p = 0.234； HR, 0.894; 95% CI, 0.742-1.077）。非布司他对HFpEF的益处在b型利钠肽（BNP）最高三分位数的患者中最为明显（p = 0.021； HR, 0.647; 95% CI, 0.436-0.960）和SUA （p = 0.025； HR, 0.651; 95% CI, 0.441-0.963）。结论：高SUA水平与HF的全因死亡率和再住院率增加有关。非布司他介导的SUA减少显著改善了HFpEF患者的临床结果，特别是那些SUA和BNP水平升高的患者。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Balkan Medical Journal MEDICINE, GENERAL & INTERNAL-

CiteScore

4.10

自引率

6.70%

发文量

审稿时长

6-12 weeks

期刊介绍： The Balkan Medical Journal (Balkan Med J) is a peer-reviewed open-access international journal that publishes interesting clinical and experimental research conducted in all fields of medicine, interesting case reports and clinical images, invited reviews, editorials, letters, comments and letters to the Editor including reports on publication and research ethics. The journal is the official scientific publication of the Trakya University Faculty of Medicine, Edirne, Turkey and is printed six times a year, in January, March, May, July, September and November. The language of the journal is English. The journal is based on independent and unbiased double-blinded peer-reviewed principles. Only unpublished papers that are not under review for publication elsewhere can be submitted. Balkan Medical Journal does not accept multiple submission and duplicate submission even though the previous one was published in a different language. The authors are responsible for the scientific content of the material to be published. The Balkan Medical Journal reserves the right to request any research materials on which the paper is based. The Balkan Medical Journal encourages and enables academicians, researchers, specialists and primary care physicians of Balkan countries to publish their valuable research in all branches of medicine. The primary aim of the journal is to publish original articles with high scientific and ethical quality and serve as a good example of medical publications in the Balkans as well as in the World.