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Sacubitril/valsartan reduces serum uric acid concentration, an independent predictor of adverse outcomes in PARADIGM-HF
- Source :
- Mogensen, U M, Køber, L, Jhund, P S, Desai, A S, Senni, M, Kristensen, S L, Dukát, A, Chen, C H, Ramires, F, Lefkowitz, M P, Prescott, M F, Shi, V C, Rouleau, J L, Solomon, S D, Swedberg, K, Packer, M & Mcmurray, J J V 2018, ' Sacubitril/valsartan reduces serum uric acid concentration, an independent predictor of adverse outcomes in PARADIGM-HF ', European Journal of Heart Failure, vol. 20, no. 3, pp. 514-522 . https://doi.org/10.1002/ejhf.1056, European Journal of Heart Failure
- Publication Year :
- 2018
-
Abstract
- Aims Elevated serum uric acid concentration (SUA) has been associated with an increased risk of cardiovascular disease, but this may be due to unmeasured confounders. We examined the association between SUA and outcomes as well as the effect of sacubitril/valsartan on SUA in patients with heart failure with reduced ejection fraction (HFrEF) in PARADIGM-HF. ..................................................................................................................................................................... Methods and results The association between SUA and the primary composite outcome of cardiovascular death or heart failure (HF) hospitalization, its components, and all-cause mortality was examined using Cox regression analyses among 8213 patients using quintiles (Q1–Q5) of SUA adjusted for baseline prognostic variables including estimated glomerular filtration rate (eGFR), diuretic dose, and log N-terminal pro-brain natriuretic peptide. Change in SUA from baseline over 12 months was also evaluated in each treatment group. Patients in Q5 (SUA ≥8.6 mg/dL) compared with Q1 ( < 5.4 mg/dL) were younger (62.8 vs. 64.2 years), more often male (88.7% vs. 63.1%), had lower systolic blood pressure (119 vs. 123 mmHg), lower eGFR (57.4 vs. 76.6 mL/min/1.73 m2), and greater diuretic use. Higher SUA was associated with a higher risk of the primary outcome (adjusted hazard ratios) Q5 vs. Q1=1.28 [95% confidence intervals (1.09–1.50), P =0.003], cardiovascular death [1.44 (1.11–1.77), P =0.001], HF hospitalization [1.37 (1.11–1.70), P =0.004], and all-cause mortality [1.36 (1.13–1.64), P =0.001]. Compared with enalapril, sacubitril/valsartan reduced SUA by 0.24 (0.17–0.32) mg/dL over 12 months (P < 0.0001). Sacubitril/valsartan improved outcomes, irrespective of SUA concentration. ..................................................................................................................................................................... Conclusion Serum uric acid concentration was an independent predictor of worse outcomes after multivariable adjustment in patients with HFrEF. Compared with enalapril, sacubitril/valsartan reduced SUA and improved outcomes irrespective of SUA.
- Subjects :
- Male
Tetrazoles
Heart failure
Angiotensin Receptor Antagonists
Angiotensin
Double-Blind Method
Humans
Mortality
Heart Failure
Aminobutyrates
Biphenyl Compounds
Stroke Volume
Focus on Clinical Trials
Middle Aged
Prognosis
Uric Acid
Drug Combinations
Treatment Outcome
Valsartan
Female
Neprilysin
Co‐morbidities in Clinical Trials
Uric acid
Biomarkers
Follow-Up Studies
Glomerular Filtration Rate
Research Article
Subjects
Details
- Language :
- English
- ISSN :
- 13889842
- Database :
- OpenAIRE
- Journal :
- Mogensen, U M, Køber, L, Jhund, P S, Desai, A S, Senni, M, Kristensen, S L, Dukát, A, Chen, C H, Ramires, F, Lefkowitz, M P, Prescott, M F, Shi, V C, Rouleau, J L, Solomon, S D, Swedberg, K, Packer, M & Mcmurray, J J V 2018, ' Sacubitril/valsartan reduces serum uric acid concentration, an independent predictor of adverse outcomes in PARADIGM-HF ', European Journal of Heart Failure, vol. 20, no. 3, pp. 514-522 . https://doi.org/10.1002/ejhf.1056, European Journal of Heart Failure
- Accession number :
- edsair.pmid.dedup....6f4a2fed6e5e2c9e531abff035d8d7b7