Cardiology Dept, Guglielmo da Saliceto Hospital, AUSL Piacenza and University of Parma, Italy.
Clinical Cardiology and Rehabilitation Unit, Università degli Studi di Milano, Centro Cardiologico Monzino IRCCS, Italy.
Eur J Prev Cardiol. 2020 Dec;27(2_suppl):35-45. doi: 10.1177/2047487320957793.
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.
尽管在社区慢性心力衰竭患者中药物治疗有所改善，但发病率和死亡率仍然很高。心力衰竭患者的医疗复杂性增加可能反映在非心血管合并症的增加，这些合并症在该人群中被认为是独立的预后因素。心力衰竭和慢性肾脏病有许多共同的危险因素，并且常常同时存在。肾衰竭的存在与心力衰竭患者心血管和非心血管死亡率的增加相关。慢性肾脏病也与心力衰竭治疗的证据不足有关，这可能会降低发病率和死亡率。更有针对性的治疗方法对于改善这些疾病患者的预后非常重要。近年来，血清尿酸作为心血管风险的决定因素引起了人们的兴趣。流行病学、实验和临床数据表明，高尿酸血症患者的心脏、肾脏和血管损伤以及心血管事件风险增加。此外，血清尿酸升高预示着急性和慢性心力衰竭的预后更差。虽然研究提出了通过使用尿酸降低剂来预防心力衰竭的可能性，但文献对于降低尿酸是否会带来可衡量的临床益处仍存在争议。现有证据表明，慢性肾脏病和尿酸升高可能会使心力衰竭患者的预后恶化。本综述的目的是分析这些合并症在风险分层中的可能应用，并作为治疗靶点，以改善心力衰竭患者的预后。
