Heart failure & cardiomyopathiesSecondary analysis
Uric Acid and SGLT2 Inhibition With Empagliflozin in Heart Failure With Preserved Ejection Fraction
- Post hoc analysis of the EMPEROR-Preserved randomised trial
Authors' conclusion
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.
Study context
- Population
- Patients with heart failure with preserved ejection fraction (HFpEF)
- Comparison
- Empagliflozin vs placebo; Serum uric acid (SUA) levels in relation to outcomes
- Primary endpoint
- Effect of empagliflozin on SUA in relation to therapeutic efficacy (trial primary outcome: CV mortality or HF hospitalization)
Primary result
As reported in the abstract
SUA change with empagliflozin and treatment benefit by baseline SUA
Difference
−0.99 mg/dL
P < 0.0001
- Treatment benefit on primary endpoint not influenced by baseline SUA
- HR: 0.79 [95% CI: 0.69-0.90]; P = 0.0004
- Change in SUA an independent correlate of treatment benefit on primary endpoint
- P = 0.07
Further findings
| Outcome | HR (95% CI) | P value | |
|---|---|---|---|
| Elevated SUA (highest tertile, 8.8 ± 1.4 g/dL) and outcomes — Highest SUA tertile vs Placebo · primary endpoint | 1.23 (0.98–1.53) | P = 0.07 | |
| Elevated SUA (highest tertile, 8.8 ± 1.4 g/dL) and outcomes — Highest SUA tertile vs Placebo · HF hospitalization | 1.42 (1.08–1.86) | P = 0.01 | |
| 0.512Hazard ratio (log scale) |
Hyperuricemia prevalence (SUA >5.7 mg/dL women, >7.0 mg/dL men)
- Prevalence of hyperuricemia
- 49%
Elevated SUA (highest tertile, 8.8 ± 1.4 g/dL) and outcomes
- Elevated SUA associated with advanced heart failure (HF) severity
Original publication
Uric Acid and SGLT2 Inhibition With Empagliflozin in Heart Failure With Preserved Ejection Fraction. JACC Heart Fail. Published 23 October 2024. doi:10.1016/j.jchf.2024.08.020
Summarised from the published abstract; every number is checked against it