Dapagliflozin reduces the risk of adverse cardiovascular outcomes in patients with heart failure, whether or not they also have gout. The sodium glucose cotransporter 2 inhibitor also reduces the need for uric acid-lowering therapy.
In a post hoc analysis of data from the DAPA-HF and DELIVER trials, 1117 of 11,005 patients with heart failure (10.1%) had a history of gout. Gout was present in 10.3% and 10.1% of patients with a left ventricular ejection fraction up to 40% and more than 40%, respectively. In the group with and without gout, 59.7% and 43.8% also had stage 3 or higher chronic kidney disease. The gout group had more men, higher body mass index, and greater comorbidity burden. The patients with gout also were more commonly treated with loop diuretics.
The primary outcome of worsening heart failure or cardiovascular death occurred at a significantly higher rate among patients with vs without gout: 14.7 vs 10.5 per 100 person-years. The gout group had a significant 15% higher risk of the primary outcome.
Dapagliflozin 10 mg, once daily, reduced the risk of the primary outcome by 16% and 21% among patients with and without gout, respectively, compared with placebo, John J. V. McMurray, MD, of British Heart Foundation Cardiovascular Research Centre, University of Glasgow in the United Kingdom, and colleagues reported in JAMA Cardiology.
Baseline use of uric acid-lowering therapy or colchicine was 63.7% and 7.8%, respectively, among the group with and without gout. Among a subset of patients naïve to these therapies at baseline, dapagliflozin reduced the risk of initiating uric acid-lowering therapy by 50% and 57% and colchicine by 48% and 40% in the group with and without gout, respectively, compared with placebo.
“These data underline the substantial and clinically important benefits of dapagliflozin in [heart failure], irrespective of gout status,” according to Dr McMurray’s team.
“Dapagliflozin reduced the initiation of medications used to reduce urate level or to treat gout flares, representing a meaningful additional clinical benefit of dapagliflozin in patients with [heart failure].”
Disclosure: The DAPA-HF and DELIVER trials were funded by AstraZeneca. Please see the original reference for a full list of disclosures.
This article originally appeared on Renal and Urology News
Butt JH, Docherty KF, Claggett BL, et al. Association of dapagliflozin use with clinical outcomes and the introduction of uric acid-lowering therapy and colchicine in patients with heart failure with and without gout: A patient-level pooled meta-analysis of DAPA-HF and DELIVER. JAMA Cardiol. Published online February 22, 2023. doi:10.1001/jamacardio.2022.5608