Alessandro Mantovani1, Giovanni Targher1, Pier Luigi Temporelli2, Donata Lucci3, Lucio Gonzini3, Gian Luigi Nicolosi4, Roberto Marchioli5, Gianni Tognoni6, Roberto Latini6, Franco Cosmi7, Luigi Tavazzi8, Aldo Pietro Maggioni9. 1. Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy. 2. Division of Cardiology, Istituti Clinici Scientifici Maugeri, IRCCS, Veruno, Italy. 3. ANMCO Research Center, Florence, Italy. 4. Department of Cardiology, Santa Maria degli Angeli Hospital, Pordenone, Italy. 5. Therapeutic Science and Strategy Unit (TSSU), IQVIA, Milan, Italy. 6. Department of Cardiovascular Research, IRCCS-Istituto di Ricerche Famacologiche Mario Negri, Milan, Italy. 7. Division of Cardiology, Ospedale Valdichiana Santa Margherita, Cortona, Italy. 8. Maria Cecilia Hospital, GVM Care & Research, Ettore Sansavini Health Science Foundation, Cotignola, Italy. 9. ANMCO Research Center, Florence, Italy. Electronic address: maggioni@anmco.it.
Abstract
BACKGROUND: The prognostic impact of hyperuricemia on long-term clinical outcomes in patients with chronic heart failure (HF) has been investigated in observational registries and clinical trials, but the results have been often inconclusive. We examined the prognostic impact of elevated serum uric acid levels on long-term clinical outcomes in the GISSI-HF (Gruppo Italiano per lo Studio della Sopravvivenza nella Insufficienza Cardiaca-Heart Failure) trial. CLINICAL TRIAL REGISTRATION: CLINICALTRIALS. GOV IDENTIFIER: NCT00336336. METHODS: We assessed the rates of all-cause death, cardiovascular death, cardiovascular hospitalization and the composite of all-cause death or cardiovascular hospitalization over a median follow-up of 3.9 years among 6683 ambulatory patients with chronic HF. RESULTS: Patients in the 3rd serum uric acid tertile (>7.2 mg/dl) had a nearly 1.8-fold increased risk of both all-cause death and cardiovascular death, and a nearly 1.5-fold increased risk of cardiovascular hospitalization and of the composite endpoint compared to those in the 1st uric acid tertile (<5.7 mg/dl). Beyond serum uric acid ≥ 7 mg/dl the risk of outcomes increased sharply and linearly. The significant association between elevated serum uric acid levels and adverse outcomes persisted after adjustment for multiple established cardiovascular risk factors, HF etiology, left ventricular ejection fraction, medication use and other potential confounders, with an adjusted hazard ratio of 1.37 (95% CI 1.22-1.55) for all-cause death, 1.48 (1.29-1.69) for cardiovascular death, 1.19 (1.09-1.30) for cardiovascular hospitalization and 1.21 (1.11-1.31) for the composite endpoint, respectively. CONCLUSIONS:Elevated serum uric acid levels are independently associated with poor long-term survival and increased risk of cardiovascular hospitalization in patients with chronic HF.
RCT Entities:
BACKGROUND: The prognostic impact of hyperuricemia on long-term clinical outcomes in patients with chronic heart failure (HF) has been investigated in observational registries and clinical trials, but the results have been often inconclusive. We examined the prognostic impact of elevated serum uric acid levels on long-term clinical outcomes in the GISSI-HF (Gruppo Italiano per lo Studio della Sopravvivenza nella Insufficienza Cardiaca-Heart Failure) trial. CLINICAL TRIAL REGISTRATION: CLINICALTRIALS. GOV IDENTIFIER: NCT00336336. METHODS: We assessed the rates of all-cause death, cardiovascular death, cardiovascular hospitalization and the composite of all-cause death or cardiovascular hospitalization over a median follow-up of 3.9 years among 6683 ambulatory patients with chronic HF. RESULTS:Patients in the 3rd serum uric acid tertile (>7.2 mg/dl) had a nearly 1.8-fold increased risk of both all-cause death and cardiovascular death, and a nearly 1.5-fold increased risk of cardiovascular hospitalization and of the composite endpoint compared to those in the 1st uric acid tertile (<5.7 mg/dl). Beyond serum uric acid ≥ 7 mg/dl the risk of outcomes increased sharply and linearly. The significant association between elevated serum uric acid levels and adverse outcomes persisted after adjustment for multiple established cardiovascular risk factors, HF etiology, left ventricular ejection fraction, medication use and other potential confounders, with an adjusted hazard ratio of 1.37 (95% CI 1.22-1.55) for all-cause death, 1.48 (1.29-1.69) for cardiovascular death, 1.19 (1.09-1.30) for cardiovascular hospitalization and 1.21 (1.11-1.31) for the composite endpoint, respectively. CONCLUSIONS: Elevated serum uric acid levels are independently associated with poor long-term survival and increased risk of cardiovascular hospitalization in patients with chronic HF.
Authors: Meaghan Lunney; Marinella Ruospo; Patrizia Natale; Robert R Quinn; Paul E Ronksley; Ioannis Konstantinidis; Suetonia C Palmer; Marcello Tonelli; Giovanni Fm Strippoli; Pietro Ravani Journal: Cochrane Database Syst Rev Date: 2020-02-27
Authors: Marie Pavlusova; Jiri Jarkovsky; Klara Benesova; Jiri Vitovec; Ales Linhart; Petr Widimsky; Lenka Spinarova; Kamil Zeman; Jan Belohlavek; Filip Malek; Marian Felsoci; Jiri Kettner; Petr Ostadal; Cestmir Cihalik; Jiri Spac; Hikmet Al-Hiti; Marian Fedorco; Richard Fojt; Andreas Kruger; Josef Malek; Tereza Mikusova; Zdenek Monhart; Stanislava Bohacova; Lidka Pohludkova; Filip Rohac; Jan Vaclavik; Dagmar Vondrakova; Klaudia Vyskocilova; Miroslav Bambuch; Gabriela Dostalova; Stepan Havranek; Ivana Svobodová; Ladislav Dusek; Jindrich Spinar; Roman Miklik; Jiri Parenica Journal: Clin Cardiol Date: 2019-05-29 Impact factor: 2.882
Authors: Ewa Romuk; Celina Wojciechowska; Wojciech Jacheć; Aleksandra Zemła-Woszek; Alina Momot; Marta Buczkowska; Piotr Rozentryt Journal: Oxid Med Cell Longev Date: 2019-10-09 Impact factor: 6.543