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Hyperuricemia in US Population with Heart Failure: Causal or Incidental Bystander?

Increased level of uric acid (UA) has been associated with a higher prevalence of cardiovascular diseases (CVD), and European Society of Cardiology (ESC) guidelines highlight UA measurement as an additional marker to stratify cardiovascular risk [1]. Increased UA levels have been observed in 5–20% of the general population, and this rate increases up to 25% in hospitalized patients. In patients affected by heart failure (HF), both in acute and chronic settings, the prevalence of hyperuricaemia ranges from 30 to 60% [2, 3]. This analysis of the National Health and Nutrition Examination Survey (NHANES) confirmed that the prevalence of hyperuricaemia (defined as UA levels > 7.0 mg/dL for men and > 5.7 mg/dL for women) is around 50% in HF patients [4]. Although current findings confirm previous analyses, further elements should be taken into account/further observations should be made. Firstly, HF diagnosis was not performed by physicians but only through patient interviews. This did not permit to distinguish HF aetiology (such as coronary artery disease, valvular heart diseases, idiopathic cardiomyopathy, etc.) and HF subtype (HF with reduced [HFrEF] or preserved [HFpEF] ejection fraction) which usually reflects different pathogenesis and cardiovascular risk burden. Indeed, a high prevalence of increased UA levels has been found in both HFrEF and HFpEF, although prognostic power has been found only in HFpEF patients [5]. Secondly, the current study did not evaluate the potential role of UA in HF development and progression. Hyperuricaemia and HF are strictly related, but whether it is the cause or the effect of metabolism alteration or increased systemic endothelial dysfunction and increased vascular stress is far from being established. Current and other studies demonstrated that almost 50% of HF patients experienced increased UA serum levels; this association is due to both oxidant stress and pro-inflammatory overdrive in HF, which could worsen clinical status symptoms by Received: August 29, 2019 Accepted: August 31, 2019 Published online: October 23, 2019