Yen Fu-Shun, Hsu Chih-Cheng, Li Hsin-Lun, Wei James Cheng-Chung, Hwu Chii-Min
Dr. Yen's Clinic, Taoyuan City, Taiwan.
Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, Taiwan.
Front Med (Lausanne). 2020 Feb 27;7:63. doi: 10.3389/fmed.2020.00063. eCollection 2020.
Substantial evidence has demonstrated a close relationship between hyperuricemia and cardiovascular (CV) diseases, but few studies have explored the possibility of using urate-lowering therapy (ULT) to attenuate the development of CV diseases. To compare the risks of incident coronary artery disease (CAD), stroke, and heart failure (HF) between ULT users and non-users in patients with gout, we conducted a retrospective cohort study from the population-based National Health Insurance Research Database in Taiwan. In total, 4,072 patients with gout were included between 2000 and 2012. The overall incident rates of CAD, stroke, and HF were compared between 2,036 ULT users and 2,036 matched non-users. The incident rates of incident CAD were 1.3 and 1.7 per 100 person-years for ULT users and non-users. ULT users had a lower adjusted hazard ratio (aHR) for CAD [aHR: 0.7, 95% confidence interval (CI): 0.55-0.89] compared with non-users. ULT users also had a lower aHR for incident stroke (aHR: 0.68, 95% CI: 0.5-0.92) compared with non-users. ULT had a neutral effect on the risk of incident HF (aHR: 0.92, 95% CI: 0.58-1.45). Among the urate-lowering therapy, subgroup analyses indicated that uricosuric agents had a significant effect on the prevention of CAD and stroke development; and the protection against the development of CAD by uricosuric agents appeared to have a dose-response trend. Our study demonstrated that ULT associated with lower risks of incident CAD and stroke. We recommend that patients with gout receive ULT to lower the burden of CV diseases.
大量证据表明高尿酸血症与心血管（CV）疾病之间存在密切关系，但很少有研究探讨使用降尿酸治疗（ULT）来减缓CV疾病发展的可能性。为比较痛风患者中ULT使用者和非使用者发生冠心病（CAD）、中风和心力衰竭（HF）的风险，我们基于台湾地区国民健康保险研究数据库进行了一项回顾性队列研究。2000年至2012年期间共纳入4072例痛风患者。比较了2036例ULT使用者和2036例匹配的非使用者中CAD、中风和HF的总体发病率。ULT使用者和非使用者的CAD发病率分别为每100人年1.3例和1.7例。与非使用者相比，ULT使用者发生CAD的调整后风险比（aHR）较低[aHR：0.7，95%置信区间（CI）：0.55 - 0.89]。与非使用者相比，ULT使用者发生中风的aHR也较低（aHR：0.68，95%CI：0.5 - 0.92）。ULT对HF发病风险具有中性作用（aHR：0.92，95%CI：0.58 - 1.45）。在降尿酸治疗中，亚组分析表明促尿酸排泄剂对预防CAD和中风的发生有显著作用；促尿酸排泄剂对CAD发生的保护作用似乎呈剂量反应趋势。我们的研究表明ULT与较低的CAD和中风发病风险相关。我们建议痛风患者接受ULT以减轻CV疾病负担。
