Cheng Ching-Lan, Yen Chi-Tai, Su Chien-Chou, Lee Cheng-Han, Huang Chien-Huei, Yang Yea-Huei Kao
School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Department of Pharmacy, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Front Cardiovasc Med. 2022 Aug 11;9:891606. doi: 10.3389/fcvm.2022.891606. eCollection 2022.
Gout or rapid reduction in serum uric acid level may increase the incidence of heart failure (HF). To compare the risk of HF between febuxostat and allopurinol in gout patients with coexisting cardiovascular (CV) diseases, the varying severity would be likely to confound the risk estimation. Gout and HF are both sex-related diseases, and the risk difference from the urate-lowering agents between women and men remains unknown.
To evaluate the HF hospitalisations risk of febuxostat and allopurinol in gout patients in real-world settings.
A population-based cohort enrolled patients with allopurinol or febuxostat initiation from 2011 to 2018. Participants were grouped into, without (low CV risk group) or with (high CV risk group) a history of recent major CV admission. The primary outcome was HF hospitalization. The secondary outcomes were composite CV events, all-cause mortality, and the cause of CV mortality. We used the 'as-treated' analysis and Cox proportional hazards model after propensity score (PS) matching. Patients were further stratified into men and women to evaluate the gender differences.
Febuxostat users had a significantly higher risk of HF hospitalization than allopurinol users in gout patients either with low CV risk [hazard ratio (HR) 1.39; 95% confidence interval (CI) 1.25-1.55] or high CV risk [HR 1.36; 95% CI 1.22-1.52]. Particularly, women with gout had a higher risk of HF hospitalization than men.
The HF hospitalization risk was highest in gout women with high CV risk and febuxostat use. Monitoring of HF is warranted in these patients.
痛风或血清尿酸水平快速降低可能会增加心力衰竭（HF）的发病率。为了比较非布司他与别嘌醇在合并心血管（CV）疾病的痛风患者中发生HF的风险，不同的严重程度可能会混淆风险评估。痛风和HF都是与性别相关的疾病，男女之间降尿酸药物的风险差异尚不清楚。
评估非布司他和别嘌醇在真实世界中痛风患者发生HF住院的风险。
一项基于人群的队列研究纳入了2011年至2018年开始使用别嘌醇或非布司他的患者。参与者被分为无近期重大CV住院史（低CV风险组）或有近期重大CV住院史（高CV风险组）。主要结局是HF住院。次要结局是复合CV事件、全因死亡率和CV死亡原因。我们在倾向评分（PS）匹配后使用“实际治疗”分析和Cox比例风险模型。患者进一步分为男性和女性以评估性别差异。
在低CV风险[风险比（HR）1.39；95%置信区间（CI）1.25 - 1.55]或高CV风险[HR 1.36；95% CI 1.22 - 1.52]的痛风患者中，使用非布司他的患者发生HF住院的风险显著高于使用别嘌醇的患者。特别是，痛风女性发生HF住院的风险高于男性。
CV风险高且使用非布司他的痛风女性发生HF住院的风险最高。这些患者有必要监测HF。
