ALLOPURINOL AND FEBUXOSTAT EFFECT ON TOTAL MORTALITY IN HYPERURICEMIC PATIENTS AFFECTED BY MILD-TO-MODERATE HEART FAILURE

Objective: Hyperuricemia is an emerging risk factor for heart failure (HF) development and negative prognosis. Some data suggest that reducing serum uric acid by inhibiting xanthine oxidase (XO) could reverse the negative impact of uric acid on HF patient prognosis. Our aim is to evaluate if treatment with different XO inhibitors could have a different impact on the HF prognosis in a setting of clinical care. Design and method: We prospectively considered a cohort of 255 outpatients affected by chronic HF and pharmacologically treated with SUA lowering drugs, currently attending the HF clinic of the Internal Medicine Dept. at the S. Orsola-Malpighi University Hospital (Bologna, Italy). The sample included only non-previously hospitalized outpatients with mild-to-moderate HF secondary to chronic arterial hypertension or coronary artery disease, after exclusion of patients with HF related to congenital heart diseases, valvulopathies, or cardiomyopathies. We also excluded those patients with a diagnosis of gout, with severe kidney disease or malignancy in order to exclude SUA outliers. Subjects were treated with allopurinol or, if intolerant to allopurinol, with febuxostat. Results: Febuxostat (N. 120) and allopurinol (N. 135) patient groups were balanced for a large number of categorical and continuous variables. No statistically significant difference has been observed as it regards the distribution of CVD risk factors, echocardiographic parameters and cardiopreventive drug used. As it regards NYHA class, at the beginning of the observation febuxostat treated patients were respectively 19.2%, 46.7% and 34.2% in class I, II and III, while allopurinol treated patients 13.3%, 54.8% and 31.9% in class I, II and III, without significant difference between groups. This distribution did not significantly change over the observation period. After a mean follow-up period of 6.2 years, the cumulative survival of febuxostat treated patients was 0.96 (95%CI 0.93 to 0.99), while the one of allopurinol treated patients was 0.89 (95%CI 0.84 to 0.93). The between group difference was statistically significant (p = 0.04). Conclusions: In conclusion, from our data it appears that the use of febuxostat, a more selective XO inhibitor than allopurinol, is associated to a reduced risk of all cause death in HF patients.