Serum Uric Acid and Risk of Chronic Heart Failure: A Systematic Review and Meta-Analysis

Abstract

Objectives: A systematic review and meta-analysis was performed to evaluate the potential prognostic role of serum uric acid (SUA) in patients with chronic heart failure (CHF).Methods: The Embase, PubMed, Web of Science and Cochrane Library databases were searched up to 5 April 2021 for relevant publications. Random effects model was used to pool data. STATA15.0 software was used to perform meta-analysis. Heterogeneity was assessed using the Cochran Q statistic (significance level of P < 0.10) and I2 statistics (significance level of 50%).Results: Ultimately, 18 publications reporting adverse events in CHF patients were included. The results indicate reveal associations between a high level of SUA and the risk of all-cause mortality (HR 2.24, 95% CI 1.49–3.37), cardiovascular mortality (HR 1.14, 95% CI 1.06–1.23), and the composite of death or cardiac events (HR 1.26, 95% CI 1.01–1.56) in CHF patients. A 1 mg/dL increase in serum uric acid led to 4% (HR 1.04, 95% CI 1.02–1.05) and 9% (HR 1.09, 95% CI 1.03–1.17) increases in the risk of all-cause mortality and the composite endpoint of death or cardiac events in CHF patients, respectively.Conclusion: Serum uric acid is positively associated with the risk of adverse events in CHF patients. This study protocol has been registered at PROSPERO as CRD42021247084 (https://www.crd.york.ac.uk/PROSPERO).Systematic Review Registration:https://www.crd.york.ac.uk/PROSPERO.

Uric acid in advanced heart failure: relation to central haemodynamics and outcome

“…Hyperuricaemia is commonly observed in HF and has been established as an independent predictor of increased risk of HF hospitalisations and death by several studies. [5][6][7] Not only is hyperuricaemia a predictor of poor prognosis in HF populations, studies have showed that UA predicts incident HF with both preserved 12 and reduced ejection fraction. [13][14][15][16] There also seems to be a concentration-effect relationship between UA levels and risk of incident HF, and Huang et al showed in a metaanalysis, that for every 1 mg/dL increase in UA, the odds of developing HF increase by 19%.…”

“…Hyperuricaemia is commonly observed in HF and has been established as an independent predictor of increased risk of HF hospitalisations and death by several studies 5–7. Not only is hyperuricaemia a predictor of poor prognosis in HF populations, studies have showed that UA predicts incident HF with both preserved12 and reduced ejection fraction 13–16.…”

“…3 In HF, UA is predictive of symptom burden according to New York Heart Association (NYHA) class 4 and has been recognised as a strong independent predictor of morbidity and mortality in HF. [5][6][7] The exact pathophysiological link between hyperuricaemia and HF has yet to be established and it is unclear if hyperuricaemia plays a causative role in disease progression or is merely a marker associated with a poorer prognosis.…”

“…UA is the end-product of the metabolic breakdown of purines catalysed by the enzyme xanthine oxidase (XO) known to generate free oxygen radicals, and UA may be viewed as a marker of oxidative stress 3. In HF, UA is predictive of symptom burden according to New York Heart Association (NYHA) class4 and has been recognised as a strong independent predictor of morbidity and mortality in HF 5–7. The exact pathophysiological link between hyperuricaemia and HF has yet to be established and it is unclear if hyperuricaemia plays a causative role in disease progression or is merely a marker associated with a poorer prognosis.…”

Increased circulating uric acid aggravates heart failure via impaired fatty acid metabolism

“…Through post-hoc analysis of the GISSI-HF trial, the 3rd serum uric acid tertile (> 7.2 mg/dl) had a nearly 1.8-fold increased risk of both allcause death and cardiovascular death in chronic HF patients 9 . A meta-analysis of 18 studies with over 33,000 sample sizes suggest SUA is positively associated with the risk of all-cause mortality, cardiovascular death and combined death or cardiac events in CHF patients 10 . Arslan and teams found UA combined with NT-proBNP seemed to be a stronger predictor for all-cause mortality and HF hospitalization 11 .…”