Hyperuricemia Is Associated With Higher Mortality in Non-diabetic Heart Failure Patients.

INTRODUCTION

Hyperuricemia (HU) is associated with an increased risk of incident heart failure (HF) and adverse HF outcomes. Patients with diabetes mellitus (DM) have a greater prevalence of HU.

AIMS

We evaluated the prognostic impact of HU in patients with HF according to the coexistence of DM.

METHODS

A retrospective cohort study of ambulatory patients with HF with left ventricular systolic dysfunction (LVSD) was conducted from January 2012 to May 2018. The end point was all-cause mortality; follow-up was until January 2021. A Cox regression analysis was used to assess the prognostic impact of elevated uric acid (UA) levels. The cut-off for HU was 8.2 mg/dL. A multivariate model was built accounting for confounders. The analysis was stratified according to DM, and interaction between DM and UA levels was tested.

RESULTS

We studied 538 patients, of whom 66% were males. Of the patients, 45% had ischemic HF, 41% had DM, and 11% were receiving urate-lowering therapies. The median (interquartile range (IQR)) admission UA was 5.5 (5.8-9.2) mg/dL, and 40% had UA > 8.2 mg/dL. During a median 46-month follow-up, 48.5% of patients died. Patients with UA > 8.2 mg/dL had a multivariate-adjusted hazard ratio (HR) (95% confidence interval (CI)) of all-cause mortality of 1.75 (1.20-2.55; p=0.003). The interaction between DM and UA levels was significant (p=0.04). The independent association of hyperuricemia with mortality persisted only in non-DM patients (HR: 1.70, 95% CI: 1.16-2.51; p=0.007). In those with DM, hyperuricemia portended no survival disadvantage.

CONCLUSION

DM appears to influence the prognostic impact of HU in chronic HF. The risk of all-cause mortality in hyperuricemic HF patients without DM increases by 70% when compared with those with normal UA levels.