Internal Medicine Unit, S. Orsola-Malpighi University Hospital, Building 2 -IV Floor - Via Albertoni 15, 40138, Bologna, Italy.
Cardiology Department, Toranomon Hospital, Tokyo, Japan.
Intern Emerg Med. 2019 Sep;14(6):949-956. doi: 10.1007/s11739-019-02070-y. Epub 2019 Mar 12.
Hyperuricemia is an emerging risk factor for the development of heart failure (HF) and is associated with a worsen prognosis of the disease. The effect of urate lowering drugs (ULT) and, in particular, the xanthine oxidase inhibitor in patients with HF is controversial. The aim of the study is to compare the effects of treatment with two different xanthine oxidase inhibitors (allopurinol or febuxostat) on cardiovascular mortality in elderly patients with chronic HF in a setting of clinical practice. In this observational trial, 255 elderly patients affected by chronic HF and treated with ULT on top of optimal medical treatment for HF. The sample included only outpatients with mild-to-moderate HF mainly secondary to chronic arterial hypertension or coronary artery disease and not previously hospitalized for HF. Patient treated with febuxostat (N. 120) and allopurinol (N. 135) were balanced for most of the baseline variables. In particular age, NYHA class distribution, drug treatment and renal function were comparable at the baseline and during the observation in both groups (p > 0.05). After a mean follow-up period of 5.1 years, the cumulative cardiovascular survival was 0.96 (95% CI 0.93-0.99) in febuxostat-treated patients and 0.89 (95% CI 0.84-0.93) in those treated with allopurinol. The between group difference, adjusted for the main confounding risk factors, was statistically significant (p = 0.04). Our study results suggest that possibility that febuxostat, a selective XO inhibitor, may favorably affect cardiovascular mortality in comparison with allopurinol in elderly patients with mild-to-moderate HF. This preliminary observation deserves further evaluation in the next future.
高尿酸血症是心力衰竭（HF）发展的一个新的危险因素，与疾病预后恶化相关。尿酸降低药物（ULT）的作用，特别是黄嘌呤氧化酶抑制剂在 HF 患者中的作用存在争议。本研究的目的是比较两种不同的黄嘌呤氧化酶抑制剂（别嘌醇或非布司他）在临床实践中治疗老年慢性 HF 患者对心血管死亡率的影响。在这项观察性试验中，255 名患有慢性 HF 的老年患者在 HF 的最佳药物治疗基础上加用 ULT。该样本仅包括因慢性动脉高血压或冠状动脉疾病导致的轻中度 HF 的门诊患者，且之前未因 HF 住院。接受非布司他（N. 120）和别嘌醇（N. 135）治疗的患者在大多数基线变量上是平衡的。特别是年龄、NYHA 分级分布、药物治疗和肾功能在两组的基线和观察期间均具有可比性（p > 0.05）。在平均 5.1 年的随访后，接受非布司他治疗的患者心血管累积生存率为 0.96（95%CI 0.93-0.99），而接受别嘌醇治疗的患者为 0.89（95%CI 0.84-0.93）。在调整主要混杂风险因素后，两组间差异具有统计学意义（p = 0.04）。我们的研究结果表明，选择性 XO 抑制剂非布司他可能比别嘌醇更有利于降低老年轻中度 HF 患者的心血管死亡率。这一初步观察结果值得在未来进一步评估。
