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Comparative Study
. 2015 Dec 18;10(12):e0145193.
doi: 10.1371/journal.pone.0145193. eCollection 2015.

Effect of Urate-Lowering Therapy on All-Cause and Cardiovascular Mortality in Hyperuricemic Patients without Gout: A Case-Matched Cohort Study

Jiunn-Horng Chen  1   2 , Joung-Liang Lan  1   2 , Chi-Fung Cheng  3   4 , Wen-Miin Liang  3   4 , Hsiao-Yi Lin  5   6 , Gregory J Tsay  1   2 , Wen-Ting Yeh  7 , Wen-Harn Pan  7   8
Affiliations
Comparative Study

Effect of Urate-Lowering Therapy on All-Cause and Cardiovascular Mortality in Hyperuricemic Patients without Gout: A Case-Matched Cohort Study

Jiunn-Horng Chen et al. PLoS One. .

Abstract

Objectives: An increased risk of mortality in patients with hyperuricemia has been reported. We examined (1) the risk of all-cause and cardiovascular disease (CVD) mortality in untreated hyperuricemic patients who did not receive urate-lowering therapy (ULT), and (2) the impact of ULT on mortality risk in patients with hyperuricemia.

Methods: In this retrospective case-matched cohort study during a mean follow-up of 6.4 years, 40,118 Taiwanese individuals aged ≥17 years who had never used ULT and who had never had gout were examined. The mortality rate was compared between 3,088 hyperuricemic patients who did not receive ULT and reference subjects (no hyperuricemia, no gout, no ULT) matched for age and sex (1:3 hyperuricemic patients/reference subjects), and between 1,024 hyperuricemic patients who received ULT and 1,024 hyperuricemic patients who did not receive ULT (matched 1:1 based on their propensity score and the index date of ULT prescription). Cox proportional hazard modeling was used to estimate the respective risk of all-cause and CVD (ICD-9 code 390-459) mortality.

Results: After adjustment, hyperuricemic patients who did not receive ULT had increased risks of all-cause (hazard ratio, 1.24; 95% confidence interval, 0.97-1.59) and CVD (2.13; 1.34-3.39) mortality relative to the matched reference subjects. Hyperuricemic patients treated with ULT had a lower risk of all-cause death (0.60; 0.41-0.88) relative to hyperuricemic patients who did not receive ULT.

Conclusion: Under-treatment of hyperuricemia has serious negative consequences. Hyperuricemic patients who received ULT had potentially better survival than patients who did not.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Survival curves comparing the 3,088 untreated hyperuricemic patients (HUA /No Gout /No ULT) and 9,264 matched reference individuals (No HUA /No Gout /No ULT) (Figs 1A and 1B), and comparing the 1,024 matched pairs of hyperuricemic patients who did and did not receive ULT (Figs 1C and 1D).
Fig 2
Fig 2. Mortality risk (HR [95% CI]) of hyperuricemia patients according to the use of ULT in subgroups stratified by the presence or absence of concomitant medications including anti-hypertensive, anti-diabetic, and lipid-lowering drugs.
Fig 3
Fig 3. Mortality risk stratified according to the duration of ULT use.
See this image and copyright information in PMC

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