Effect of urate-lowering therapy on all-cause and CVD-specific mortality in gout and hyperuricemia: a meta-analysis

초록

Objective: The aim of this study was to assess the relationships between urate-lowering therapy (ULT) and both all-cause and cardiovascular disease (CVD)-specific mortality in patients diagnosed with gout or hyperuricemia. Methods: The PubMed, Embase, and Cochrane databases were thoroughly searched to gather literature on overall and/or CVD-specific hazard ratios (HRs) of patients with gout or hyperuricemia. A meta-analysis was conducted to evaluate the mortality risks of UTL users in gout or hyperuricemia populations. Results: This meta-analysis included 11 comparative studies encompassing 38,396 ULT users and 47,530 controls for evaluating all-cause mortality in gout or hyperuricemia. ULT treatment in patients with gout or hyperuricemia led to a significantly lower risk of all-cause mortality compared to patients not receiving ULT (HR = 0.783, 95% confidence interval [CI] = 0.702-0.874; p < 0.001). Both ULT and allopurinol were associated with decreased all-cause mortality rates (ULT HR = 0.651, 95% CI = 0.520-0.816; p < 0.001; allopurinol HR = 0.836, 95% CI = 0.731-0.957; p = 0.009). ULT initiation significantly reduced CVD-specific mortality in hyperuricemia patients, although the same was not observed in gout patients (HR for hyperuricemia = 0.872, 95% CI = 0.796-0.955; p = 0.003; HR for gout = 0.676, 95% CI = 0.296-1.544; p = 0.353). Conclusion: This meta-analysis indicates that ULT substantially reduces all-cause mortality in patients with gout or hyperuricemia, although allopurinol does not significantly affect CVD-specific mortality. These results underscore the potential of ULT for enhancing survival rates in special patient populations.

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