Lin Meng-Jiao, Zou Shu-Bin, Zhu Bai-Xiang
Three departments of cardiovascular medicine, Harbin 242 Hospital, Harbin 150066, Heilongjiang Province, China.
World J Clin Cases. 2024 Jun 26;12(18):3468-3475. doi: 10.12998/wjcc.v12.i18.3468.
Patients with chronic heart failure (CHF) frequently develop hyperuricemia, an elevated serum uric acid level, associated with adverse outcomes. Dapagliflozin, a sodium-glucose cotransporter-2 inhibitor, demonstrates reduction in cardiovascular mortality and hospitalization in patients with CHF and ejection fraction (HFrEF), irrespective of diabetes. However, dapagliflozin's effect on the uric acid levels in patients with CHF and hyperuricemia remain unclear.
To investigate the effects of dapagliflozin on uric acid levels in CHF patients with hyperuricemia.
We conducted a randomized, double-blind, placebo-controlled trial in 200 patients with CHF and hyperuricemia, with HFrEF and serum uric acid levels ≥ 7 mg/dL (≥ 416 μmol/L). The participants were randomly assigned to receive a daily dose of 10 mg dapagliflozin or placebo for 24 months. The primary endpoint was the change in serum uric acid level from baseline to 24 months. Secondary endpoints included changes in left ventricular ejection fraction (LVEF), N-terminal pro-B-type natriuretic peptide (NT-proBNP), and quality of life (QoL) scores, as well as the incidence of cardiovascular death and hospitalization for heart failure.
At 24 months, dapagliflozin significantly reduced serum uric acid levels by 1.2 mg/dL (71 μmol/L) compared with placebo (95%CI: -1.5 to -0.9; < 0.001). Dapagliflozin also significantly improved LVEF by 3.5% (95%CI: 2.1-4.9; < 0.001), NT-proBNP by 25% (95%CI: 18-32; < 0.001), and QoL scores by 10 points (95%CI: 7-13; < 0.001) and reduced the risk of cardiovascular death and hospitalization for heart failure by 35% (95%CI: 15-50; = 0.002) compared with the placebo. Adverse events were similar between the two groups, except for a higher rate of genital infections in the dapagliflozin group (10% 2%, = 0.01).
Dapagliflozin significantly lowered serum uric acid levels and improved the clinical outcomes in patients with CHF and hyperuricemia. Therefore, dapagliflozin may be a useful therapeutic option for this high-risk population.
慢性心力衰竭（CHF）患者常出现高尿酸血症，即血清尿酸水平升高，这与不良预后相关。达格列净是一种钠-葡萄糖协同转运蛋白2抑制剂，在射血分数降低的心力衰竭（HFrEF）患者中，无论是否患有糖尿病，均可降低心血管死亡率和住院率。然而，达格列净对CHF合并高尿酸血症患者尿酸水平的影响尚不清楚。
探讨达格列净对CHF合并高尿酸血症患者尿酸水平的影响。
我们对200例CHF合并高尿酸血症、HFrEF且血清尿酸水平≥7mg/dL（≥416μmol/L）的患者进行了一项随机、双盲、安慰剂对照试验。参与者被随机分配接受每日10mg达格列净或安慰剂治疗24个月。主要终点是从基线到24个月血清尿酸水平的变化。次要终点包括左心室射血分数（LVEF）、N末端B型利钠肽原（NT-proBNP）和生活质量（QoL）评分的变化，以及心血管死亡和因心力衰竭住院的发生率。
24个月时，与安慰剂相比，达格列净使血清尿酸水平显著降低1.2mg/dL（71μmol/L）（95%CI：-1.5至-0.9；P<0.001）。达格列净还使LVEF显著提高3.5%（95%CI：2.1-4.9；P<0.001），NT-proBNP降低25%（95%CI：18-32；P<0.001），QoL评分提高10分（95%CI：7-13；P<0.001），并使心血管死亡和因心力衰竭住院的风险比安慰剂降低35%（95%CI：15-50；P=0.002）。两组不良事件相似，但达格列净组生殖器感染发生率较高（10%对2%，P=0.01）。
达格列净显著降低了CHF合并高尿酸血症患者的血清尿酸水平，并改善了临床结局。因此，达格列净可能是这一高危人群的一种有效治疗选择。
