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Rapid reduction in uric acid by a urate-lowering agent is associated with recurrent cardiovascular events.

Abstract：

OBJECTIVES:Results from a recent study showed that the risk of cardiovascular and all-cause mortality was higher in patients who received febuxostat, a potent urate-lowering agent, than that in patients who received allopurinol. Therefore, we hypothesized that an abrupt change in serum urate levels caused by urate-lowering agents would influence the risk of cardiovascular events. METHODS:We included patients with a history of cardiovascular disease (CVD) who received allopurinol or febuxostat. Cardiovascular events were defined as follows: nonfatal myocardial infarction, nonfatal stroke, unstable angina, heart failure, and cardiovascular death. The change in serum urate levels was determined by the difference or reduction rate in urate within 6 months after exposure to allopurinol or febuxostat. The factors associated with cardiovascular events were evaluated by Cox regression analysis. RESULTS:In total, 207 patients with CVD who were exposed to allopurinol or febuxostat were included. Cardiovascular events occurred in 38 patients (18.4%). In univariate analysis, age, diabetes mellitus, baseline urate levels, difference in mean urate levels between baseline and post-exposure (Δuratemean), and reduction rate in urate to the lowest post-exposure levels (Δuratelowest/day) were associated with cardiovascular events. Further, results from the multivariate analysis revealed that age [hazard ratio (HR) 1.036, 95% confidence interval (CI), 1.001-1.072, p = 0.042], Δuratemean (HR 1.188, CI, 1.033-1.366, p = 0.015), and Δuratelowest/day (HR 6.963, CI, 2.215-21.886, p = 0.001) were associated with cardiovascular events. CONCLUSION:Rapid reduction in serum urate levels was associated with a higher risk of cardiovascular events. Thus, careful attention should be paid to abruptly changing serum urate levels after treating urate-lowering agent in high-risk CVD patients.

journal_name

Med Hypotheses

journal_title

Medical hypotheses

authors

Lee JS,Oh JS,Kim YG,Lee CK,Yoo B,Hong S

doi

10.1016/j.mehy.2020.109740

subject

Has Abstract

pub_date

2020-08-01 00:00:00

pages

109740

eissn

0306-9877

issn

1532-2777

pii

S0306-9877(20)30176-6

journal_volume

141

pub_type

杂志文章

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