Uric acid is a biomarker for heart failure, but not therapeutic target: result from a comprehensive meta‐analysis

Abstract

Aims

This systematic review and meta‐analysis aimed to investigate the association between serum uric acid (SUA) levels and the incidence rate and prognosis of heart failure (HF), as well as the impact of uric acid‐lowering treatment on HF patients.

Methods and results

PubMed and Embase were searched for original articles reporting on the association between SUA and HF incidence, adverse outcomes, and the effect of uric acid‐lowering treatment in HF patients. Data were pooled using random effects or fixed effects models. Univariable meta‐regression analysis assessed the influence of study characteristics on research outcomes. Statistical analyses were conducted using RevMan software and STATA software version 15.0. Eleven studies on HF incidence and 24 studies on adverse outcomes in HF patients were included. Higher SUA levels were associated with an increased risk of HF (RR: 1.81, 95% CI: 1.53–2.16), all‐cause mortality (RR: 1.44, 95% CI: 1.25–1.66), cardiac death (RR: 1.56, 95% CI: 1.32–1.84), and HF rehospitalization (RR: 2.07, 95% CI: 1.37–3.13) in HF patients. Uric acid‐lowering treatment was found to increase all‐cause mortality in HF patients (RR: 1.15, 95% CI: 1.05–1.25).

Conclusions

Uric acid is an independent predictor of heart failure occurrence and adverse prognosis. Targeting uric acid lowering as a therapeutic intervention does not improve the prognosis of patients with heart failure. It may not be advisable to use traditional urate‐lowering drugs in young patients with heart failure, and elderly patients should exercise caution when using them.