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Uric aid and SGLT2 inhibition with empagliflozin in heart failure with preserved ejection fraction: the EMPEROR-preserved trial

Background - Sodium-glucose cotransporter 2 (SGLT2) inhibitors improve outcome in patients with heart failure (HF) and reduce serum uric acid (SUA). The relevance of this metabolic effect in patients with heart failure with preserved ejection fraction (HFpEF) is unclear. - Objectives - The authors i...

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Main Authors: Döhner, Wolfram (Author) , Anker, Stefan D. (Author) , Butler, Javed (Author) , Zannad, Faiez (Author) , Filippatos, Gerasimos (Author) , Coats, Andrew J. S. (Author) , Ferreira, João Pedro (Author) , Henrichmoeller, Ingrid (Author) , Brückmann, Martina (Author) , Schueler, Elke (Author) , Pocock, Stuart J. (Author) , Januzzi, James L. (Author) , Packer, Milton (Author)
Format: Article (Journal)
Language:English
Published: December 2024
In: JACC Heart failure
Year: 2024, Volume: 12, Issue: 12, Pages: 2057-2070
ISSN:2213-1787
DOI:10.1016/j.jchf.2024.08.020
Online Access:Verlag, kostenfrei, Volltext: https://doi.org/10.1016/j.jchf.2024.08.020
Verlag, kostenfrei, Volltext: https://www.sciencedirect.com/science/article/pii/S2213177924006267
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Author Notes:Wolfram Doehner, MD, P HD, Stefan D. Anker, MD, P HD, Javed Butler, MD, MPH, MBA, Faiez Zannad, MD, PH D, Gerasimos Filippatos, MD, Andrew J.S. Coats, DM, João Pedro Ferreira, MD, PHD, Ingrid Henrichmoeller, MD, Martina Brueckmann, MD, Elke Schueler, DIPL MATH, Stuart J. Pocock, PH D, James L. Januzzi, MD, Milton Packer, MD
Description
Summary:Background - Sodium-glucose cotransporter 2 (SGLT2) inhibitors improve outcome in patients with heart failure (HF) and reduce serum uric acid (SUA). The relevance of this metabolic effect in patients with heart failure with preserved ejection fraction (HFpEF) is unclear. - Objectives - The authors investigated the effect of empagliflozin on SUA levels in relation to the therapeutic efficacy in patients with HFpEF. - Methods - This post hoc analysis of the EMPEROR-Preserved (EMPagliflozin outcomE tRial in Patients With chrOnic heaRt Failure With Preserved Ejection Fraction; NCT03057951) trial assessed the clinical effect of SUA reduction in relation to the outcome endpoints of the trial (composite primary outcome of cardiovascular mortality or hospitalization for HF, its individual components, and all-cause mortality in patients with HFpEF). - Results - Hyperuricemia (SUA >5.7 mg/dL for women, >7.0 mg/dL for men) was prevalent in 49% of patients. Elevated SUA (highest tertile SUA 8.8 ± 1.4 g/dL) was associated with advanced HF severity and with higher risk of adverse outcome (primary endpoint HR: 1.23 [95% CI: 0.98-1.53]; P = 0.07; HF hospitalization HR: 1.42 [95% CI: 1.08-1.86]; P = 0.01). SUA was reduced early (after 4 weeks vs placebo −0.99 ± 0.03 mg/dL; P < 0.0001) and throughout follow-up, with reduction in all prespecified subgroups. Empagliflozin reduced clinical events of hyperuricemia (acute gout, gouty arthritis, or initiation of antigout therapy) by 38% (HR: 0.62 [95% CI: 0.51-0.76]; P < 0.0001). The treatment benefit on the primary endpoint was not influenced by baseline SUA (HR: 0.79 [95% CI: 0.69-0.90]; P = 0.0004). The change in SUA was an independent correlate of the treatment benefit on the primary endpoint (P = 0.07). - Conclusions - Hyperuricemia is a common complication in HFpEF and is related to advanced disease severity and adverse outcome. Empagliflozin induced a rapid and sustained reduction of SUA levels and of clinical events related to hyperuricemia.
Item Description:Online verfügbar: 23.Okober 2024, Artikelversion: 2. Dezember 2024
Gesehen am 07.04.2025
Physical Description:Online Resource
ISSN:2213-1787
DOI:10.1016/j.jchf.2024.08.020

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