Elevated Serum Uric Acid May Be Associated With Greater Number of Comorbidities in HFpEF

The prevalence of elevated baseline serum uric acid levels was found to be high in patients with heart failure with preserved ejection fraction.

The prevalence of elevated baseline serum uric acid (sUA) levels was found to be high in patients with heart failure with preserved ejection fraction (HFpEF), and to be associated with a greater number of comorbidities and reduced function, according to a study published in the American Journal of Medicine.

A total of 212 outpatients with HFpEF with normal or elevated (>6 mg/dL) baseline sUA levels (n=66 and n=146, respectively) were enrolled. The participants’ clinical characteristics and quality of life were assessed, and echocardiography, cardiopulmonary exercise (CPX) testing, 6-minute walk testing (6MWT), and serum biomarker testing were conducted.

Patients with elevated vs normal sUA levels at baseline had a higher body mass index (33.3 vs 31.3, respectively; P =.022), higher prevalence of diabetes (48.6% vs 28.8%, respectively; P =.007), higher blood urea nitrogen (25.1 vs 19.2 mg/dl, respectively; P =.001), higher N-terminal-pro hormone BNP (783 vs 480 pg/ml, respectively; P =.020), higher high-sensitivity troponin levels (10.1 vs 7.2 pg/mL, respectively; P =.024), lower glomerular filtration rates (52.6 vs 66.4 mL/min/1.73 m2, respectively; P <.001), and were more likely to have been hospitalized for heart failure in the previous year (42.5% vs 21.2%, respectively; P =.003).

Higher baseline levels of sUA were associated with worsening of peak VO2 (-0.38 mL/min/kg; 95% CI, -0.55 to -0.21; P <.01), 6MWT distance (-7.2 meters; 95% CI, -14.1 to -0.3; P =.04), and left ventricular mass (7.7 grams; 95% CI, 2.9-12.5; P <.01). A reduction in cystatin C was associated with a decrease in the sUA from baseline to 24 weeks (adjusted beta coefficient, -0.05 mg/L; 95% CI, -0.08 to -0.03; P <.01). This reduction was not associated with any significant changes in high-sensitivity troponin I, high-sensitivity C-reactive protein, or N-terminal-pro hormone BNP.

Although there were fewer deaths or cardiovascular/renal hospitalization events over the 24-week follow-up period in the normal baseline sUA group (n=7; Kaplan-Meier [KM] estimate, 11.0; 95% CI, 5.4-21.7) compared with the elevated baseline sUA group (n=22; KM estimate, 14.2; 95% CI, 9.4-21.2), no association between baseline sUA and the composite of death or cardiovascular/renal hospitalization was detected at the 24-week follow-up (adjusted hazard ratio, 0.94; 95% CI, 0.8-1.11; P =.47).

Limitations of this study include its exploratory nature, small sample size, and the lack of assessment of differences in diuretic regimens between groups.

“sUA is an important marker of comorbidities, functional status, and clinical prognosis in patients with HFpEF,” concluded the study authors. “Future clinical trials of sUA lowering therapies in patients with HFpEF are promising.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Carnicelli A, Sun JL, Alhanti B, et al. Elevated uric acid prevalence and clinical outcomes in patients with heart failure with preserved ejection fraction: Insights from RELAX [published online May 13, 2020]. Am J Med. doi:10.1016/j.amjmed.2020.03.054