St Michael's Hospital, Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada.
Xijing Hospital, Fourth Military Medical University, Xi'an, China.
Diabetes Obes Metab. 2020 Jul;22(7):1207-1214. doi: 10.1111/dom.13991. Epub 2020 Mar 28.
In the EMPA-REG OUTCOME trial, we explored the association between pre-randomization uric acid level tertile (<309.30 μmol/L; 309.30 to <387.21 μmol/L; ≥387.21 μmol/L) and cardiovascular (CV) death, hospitalization for heart failure (HHF), HHF or CV death, all-cause mortality, three-point major adverse CV events (MACE), and incident or worsening nephropathy. Patients with type 2 diabetes and CV disease received empagliflozin or placebo. The median baseline plasma uric acid level was 344.98 μmol/L, and patients' baseline characteristics were mainly balanced across tertiles. Baseline uric acid levels were associated with cardio-renal outcomes: in the placebo group, for the highest versus lowest tertile, the multivariable hazard ratios for three-point MACE, HHF or CV death, and incident or worsening nephropathy were 1.22 (95% confidence interval [CI] 0.89-1.67; P = 0.2088), 1.51 (95% CI 1.02-2.23; P = 0.0396) and 1.77 (95% CI 1.33-2.34; P < 0.0001), respectively. When tested as a continuous variable, baseline uric acid was associated with all outcomes in the placebo group. Empagliflozin improved all cardio-renal outcomes across tertiles, with all interaction P values >0.05. Further investigation of these relationships is required.
在 EMPA-REG OUTCOME 试验中，我们探讨了随机分组前尿酸水平三分位（<309.30 μmol/L；309.30 至 <387.21 μmol/L；≥387.21 μmol/L）与心血管（CV）死亡、心力衰竭住院（HHF）、HHF 或 CV 死亡、全因死亡率、三点主要不良 CV 事件（MACE）和新发或恶化肾病之间的关系。患有 2 型糖尿病和 CV 疾病的患者接受恩格列净或安慰剂治疗。中位基线血浆尿酸水平为 344.98 μmol/L，患者的基线特征在三分位组之间基本平衡。基线尿酸水平与心肾结局相关：在安慰剂组中，与最低三分位相比，最高三分位的三点 MACE、HHF 或 CV 死亡和新发或恶化肾病的多变量风险比分别为 1.22（95%置信区间 [CI]0.89-1.67；P=0.2088）、1.51（95%CI1.02-2.23；P=0.0396）和 1.77（95%CI1.33-2.34；P<0.0001）。当作为连续变量检验时，基线尿酸与安慰剂组的所有结局均相关。恩格列净改善了三分位内的所有心肾结局，所有交互 P 值均大于 0.05。需要进一步研究这些关系。
