Document Detail


Uric acid level and allopurinol use as risk markers of mortality and morbidity in systolic heart failure.
MedLine Citation:
PMID:  21095282     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Previous studies have not extensively examined the association of hyperuricemia and adverse outcomes in systolic heart failure (HF) in relation to xanthine oxidase inhibitor therapy.
METHODS: The Prospective Randomized Amlodipine Survival Evaluation study included New York Heart Association class IIIB or IV patients with left ventricular ejection fraction <30%. For analysis, the population was divided into uric acid quartiles among nonallopurinol users (2.2-7.1, >7.1-8.6, >8.6-10.4, >10.4 mg/dL) and those using allopurinol. Multivariate Cox regression modeling was performed to identify predictors of mortality. Uric acid quartile and allopurinol groups were referenced to the lowest uric acid quartile.
RESULTS: A total of 1,152 patients were included. In general, patients in the allopurinol group and in the highest uric acid quartile had indicators of more severe HF, including worse renal function and greater proportion of New York Heart Association class IV patients, and greater diuretic use. The allopurinol group and highest uric acid quartile had the highest total mortality (41.7 and 42.4 per 100 person-years, respectively) and combined morbidity/mortality (45.6 and 51.0 per 100 person-years, respectively). Allopurinol use and highest uric acid quartile were independently associated with mortality (hazard ratio [HR] 1.65, 95% CI 1.22-2.23, P = .001 and HR 1.35, 95% CI 1.07-1.72, P = .01, respectively) and combined morbidity/mortality (uric acid quartile 4 vs 1: HR 1.32, 95% CI 1.06-1.66, P = .02; allopurinol use: HR 1.48, 95% CI 1.11-1.99, P = .008).
CONCLUSION: Elevated uric acid level was independently associated with mortality in patients with severe systolic HF, even when accounting for allopurinol use.
Authors:
Audrey H Wu; Jalal K Ghali; Gerald W Neuberg; Christopher M O'Connor; Peter E Carson; Wayne C Levy
Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  American heart journal     Volume:  160     ISSN:  1097-6744     ISO Abbreviation:  Am. Heart J.     Publication Date:  2010 Nov 
Date Detail:
Created Date:  2010-11-24     Completed Date:  2011-01-18     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  928-33     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2010 Mosby, Inc. All rights reserved.
Affiliation:
University of Michigan Health System, Ann Arbor, MI, USA. ahwu@med.umich.edu
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MeSH Terms
Descriptor/Qualifier:
Aged
Allopurinol / administration & dosage*
Biological Markers / blood
Enzyme Inhibitors / administration & dosage
Female
Follow-Up Studies
Heart Failure, Systolic / blood*,  drug therapy,  epidemiology
Humans
Hyperuricemia / blood,  complications,  drug therapy
Male
Middle Aged
Morbidity / trends
Prognosis
Proportional Hazards Models
Prospective Studies
Risk Assessment
Risk Factors
Severity of Illness Index
Survival Rate / trends
United States / epidemiology
Uric Acid / blood*
Chemical
Reg. No./Substance:
0/Biological Markers; 0/Enzyme Inhibitors; 315-30-0/Allopurinol; 69-93-2/Uric Acid

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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