Gout Associated With Worse Heart Failure Outcomes

ORLANDO — Gout boosted the risk of death or hospitalization for heart failure in an observational, case-control study of more than 150,000 patients with heart failure.

Patients with heart failure and gout who were on long-term allopurinol treatment had a significantly reduced risk for death or heart failure hospitalization, Dr. George Thanassoulis said at the annual scientific sessions of the American Heart Association.

Allopurinol exerts its benefit for heart failure outcomes not by lowering blood levels of uric acid, but by inhibiting oxidative stress and the endothelial dysfunction that oxidative stress produces, said Dr. Thanassoulis, a cardiologist at Boston University and the Framingham (Mass.) Heart Study. He suggested that allopurinol inhibits xanthine oxidase, the same action that also blunts uric acid production.

The study used administrative health record data from Quebec residents aged older than 65 years. Cases were 14,327 people hospitalized for heart failure but without another heart failure hospitalization during the 3 years before the index episode, a restriction that helped ensure a uniform level of heart failure severity among the patients. Controls were 143,255 people in the Quebec database matched to the cases by follow-up duration and by calendar year.

The average age was 79 years among the cases and 77 years among the controls. Cases and controls were evenly split among men and women. Identification of gout relied on hospitalization, a physician visit, or a diagnostic code in the medical record.

During an average follow-up of 2 years, the rate of death or new heart failure hospitalization was 63% higher in the patients with gout than in those without gout, a statistically significant difference in an analysis that controlled for several demographic and clinical variables including age, gender, comorbidities, and medications.

The risk for death or heart failure hospitalization was even higher in patients who had acute gout, with a twofold higher risk in the adjusted analysis. The researchers defined acute gout as hospitalization or a physician visit for gout within 60 days of the index heart failure event.

Another pair of analyses looked at the impact of allopurinol treatment. Among patients with an index heart failure event who also had gout treatment with allopurinol, there was a significant 31% reduction in the subsequent rate of death or heart failure hospitalization in the adjusted analysis. This benefit was limited to the patients on chronic allopurinol treatment for more than 30 days. Patients on allopurinol for 30 days or less showed no significant reduction in mortality or new heart failure hospitalizations.

The allopurinol analysis also showed no link between the drug and outcomes for the entire heart failure population studied, suggesting that benefit from allopurinol is not general for all heart failure patients, only those with gout.

Dr. Thanassoulis and his associates had no conflicts of interest to disclose.

ORLANDO — Gout boosted the risk of death or hospitalization for heart failure in an observational, case-control study of more than 150,000 patients with heart failure.

Patients with heart failure and gout who were on long-term allopurinol treatment had a significantly reduced risk for death or heart failure hospitalization, Dr. George Thanassoulis said at the annual scientific sessions of the American Heart Association.

Allopurinol exerts its benefit for heart failure outcomes not by lowering blood levels of uric acid, but by inhibiting oxidative stress and the endothelial dysfunction that oxidative stress produces, said Dr. Thanassoulis, a cardiologist at Boston University and the Framingham (Mass.) Heart Study. He suggested that allopurinol inhibits xanthine oxidase, the same action that also blunts uric acid production.

The study used administrative health record data from Quebec residents aged older than 65 years. Cases were 14,327 people hospitalized for heart failure but without another heart failure hospitalization during the 3 years before the index episode, a restriction that helped ensure a uniform level of heart failure severity among the patients. Controls were 143,255 people in the Quebec database matched to the cases by follow-up duration and by calendar year.

The average age was 79 years among the cases and 77 years among the controls. Cases and controls were evenly split among men and women. Identification of gout relied on hospitalization, a physician visit, or a diagnostic code in the medical record.

During an average follow-up of 2 years, the rate of death or new heart failure hospitalization was 63% higher in the patients with gout than in those without gout, a statistically significant difference in an analysis that controlled for several demographic and clinical variables including age, gender, comorbidities, and medications.

The risk for death or heart failure hospitalization was even higher in patients who had acute gout, with a twofold higher risk in the adjusted analysis. The researchers defined acute gout as hospitalization or a physician visit for gout within 60 days of the index heart failure event.

Another pair of analyses looked at the impact of allopurinol treatment. Among patients with an index heart failure event who also had gout treatment with allopurinol, there was a significant 31% reduction in the subsequent rate of death or heart failure hospitalization in the adjusted analysis. This benefit was limited to the patients on chronic allopurinol treatment for more than 30 days. Patients on allopurinol for 30 days or less showed no significant reduction in mortality or new heart failure hospitalizations.

The allopurinol analysis also showed no link between the drug and outcomes for the entire heart failure population studied, suggesting that benefit from allopurinol is not general for all heart failure patients, only those with gout.

Dr. Thanassoulis and his associates had no conflicts of interest to disclose.

ORLANDO — Gout boosted the risk of death or hospitalization for heart failure in an observational, case-control study of more than 150,000 patients with heart failure.

Patients with heart failure and gout who were on long-term allopurinol treatment had a significantly reduced risk for death or heart failure hospitalization, Dr. George Thanassoulis said at the annual scientific sessions of the American Heart Association.

Allopurinol exerts its benefit for heart failure outcomes not by lowering blood levels of uric acid, but by inhibiting oxidative stress and the endothelial dysfunction that oxidative stress produces, said Dr. Thanassoulis, a cardiologist at Boston University and the Framingham (Mass.) Heart Study. He suggested that allopurinol inhibits xanthine oxidase, the same action that also blunts uric acid production.

The study used administrative health record data from Quebec residents aged older than 65 years. Cases were 14,327 people hospitalized for heart failure but without another heart failure hospitalization during the 3 years before the index episode, a restriction that helped ensure a uniform level of heart failure severity among the patients. Controls were 143,255 people in the Quebec database matched to the cases by follow-up duration and by calendar year.

The average age was 79 years among the cases and 77 years among the controls. Cases and controls were evenly split among men and women. Identification of gout relied on hospitalization, a physician visit, or a diagnostic code in the medical record.

During an average follow-up of 2 years, the rate of death or new heart failure hospitalization was 63% higher in the patients with gout than in those without gout, a statistically significant difference in an analysis that controlled for several demographic and clinical variables including age, gender, comorbidities, and medications.

The risk for death or heart failure hospitalization was even higher in patients who had acute gout, with a twofold higher risk in the adjusted analysis. The researchers defined acute gout as hospitalization or a physician visit for gout within 60 days of the index heart failure event.

Another pair of analyses looked at the impact of allopurinol treatment. Among patients with an index heart failure event who also had gout treatment with allopurinol, there was a significant 31% reduction in the subsequent rate of death or heart failure hospitalization in the adjusted analysis. This benefit was limited to the patients on chronic allopurinol treatment for more than 30 days. Patients on allopurinol for 30 days or less showed no significant reduction in mortality or new heart failure hospitalizations.

The allopurinol analysis also showed no link between the drug and outcomes for the entire heart failure population studied, suggesting that benefit from allopurinol is not general for all heart failure patients, only those with gout.

Dr. Thanassoulis and his associates had no conflicts of interest to disclose.