Hyperuricemia, Gout Linked to Increased Mortality Risk in Heart Failure

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New research leveraging data from the National Health and Nutrition Examination Survey (NHANES) is shedding further light on the increased risk of mortality associated with hyperuricemia and gout in patients with heart failure.

Results of the study, which included weighted samples of more than 200 million ambulatory patients, suggests, when compared to counterparts without hyperuricemia or gout, those with gout had a 37% increase in likelihood of mortality while those with hyperuricemia had a 45% increase in likelihood of mortality during the follow-up period.¹

“In the present study, we used a large-scale representative cohort of NHANES and found that patients with [heart failure] complicated with [hyperuricemia] or gout had a high risk of all-cause mortality after long-term follow-up,” wrote investigators.¹

The intersection of gout and heart failure represents one of many urgent unmet needs in modern medicine. With the prevalence of gout increasing in many parts of the world juxtaposed with the mortality risk associated with heart failure, the need to address this issue becomes clear.² According to the American Heart Association’s most recent report on heart disease and stroke statistics, heart failure was responsible for approximately 85,000 deaths in the US during 2020, which was 9.2% of all deaths attributable to cardiovascular disease.³

The current study was launched by a team of investigators from the Peking Union Medical College Hospital in China with the intent of developing a more thorough understanding of the relationship between hyperuricemia, gout, heart failure, and all-cause mortality. With this in mind, investigators designed their study as an analysis of data from adult participants with or without hyperuricemia, gout, and HF from NHANES survey cycles occurring in 2001-2018 and 2007-2018.¹

Of note, data recorded in survey cycles from 2001-2018 were used to assess associations between hyperuricemia and heart failure and, due to apparent limitations in data, only data recorded in cycles from 2007-2018 were used to assess associations between gout and heart failure. For inclusion in the study, patients were required to have data related to uric acid levels, gout, and heart failure, be at least 20 years of age, and could not be pregnant.¹

Overall, investigators identified unweighted populations of 50,201 adults from the 2001-2018 survey cycles and 34,770 adults from the 2007-2018 survey cycles. Patients were excluded from analyses if they were missing data on uric acid, gout, or heart failure status. In total, 43,555 and 34,268 eligible participants patients were identified for inclusion in the hyperuricemia and heart failure and gout and heart failure analyses, respectively. The weighted equivalents were 204,179,060 and 223,702,171 in the hyperuricemia and heart failure and the gout and heart failure analyses, respectively.¹

Results of the investigators’ analysis indicated patients with heart failure and hyperuricemia had a median survival time of 7.00 years and a 5-year survival rate of 59.9%. Those with heart failure and gout had a median survival time of 6.25 years and a 5-year survival rate of 55.9%.¹

Further analysis suggested those with heart failure and hyperuricemia had an increased risk of all-cause mortality relative to those with heart failure but without hyperuricemia (Odds Ratio [OR], 1.37; 95% Confidence Interval [CI], 1.18-1.60) during a median follow-up of 9.67 (5.42–13.92) years. Similarly, those with heart failure and gout had an increased risk of all-cause mortality relative to those with heart failure but without gout (OR, 1.45; 95% CI, 1.15-1.82) during a median follow-up of 7.17 (4.08–10.08) years.¹

Investigators noted multiple limitations within their study to consider before overinterpretation of results. These included only having a single measurement of uric acid per patient, diagnosis of heart failure based on a questionnaire, and potential for confiding due to limited availability.¹

References:

1. Han Y, Cao Y, Han X, et al. Hyperuricemia and gout increased the risk of long-term mortality in patients with heart failure: insights from the National Health and Nutrition Examination Survey. J Transl Med. 2023;21(1):463. Published 2023 Jul 12. doi:10.1186/s12967-023-04307-z
2. Zhang J, Jin C, Ma B, et al. Global, regional and national burdens of gout in the young population from 1990 to 2019: a population-based study. RMD Open. 2023;9(2):e003025. doi:10.1136/rmdopen-2023-003025
3. Tsao CW, Aday AW, Almarzooq ZI, et al. Heart Disease and Stroke Statistics-2023 Update: A Report From the American Heart Association [published correction appears in Circulation. 2023 Feb 21;147(8):e622]. Circulation. 2023;147(8):e93-e621. doi:10.1161/CIR.0000000000001123