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Association between urate-lowering therapy and cardiovascular events in patients with asymptomatic hyperuricemia

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A Correction to this article was published on 26 January 2024

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Abstract

Introduction/objectives

To investigate the role of urate-lowering therapy (ULT) in the prevention of cardiovascular disease (CVD) in patients with asymptomatic hyperuricemia using the Japanese healthcare record database.

Methods

This retrospective cohort study used data from the JMDC Claims Database, which includes records of medical check-ups and Japanese health insurance claims. Subjects aged at least 18 years with a serum uric acid (sUA) level ≥ 7.0 mg/dL and at least one medical check-up from January 2007 to August 2021 were included in this study. The exposure was any ULT prescription, and the primary outcome included composite CVD outcomes, including coronary artery disease, stroke, and atrial fibrillation. Analysis was performed with a new-user design and overlap weighting to balance the baseline characteristics of the subjects. Cox proportional hazards models were used to investigate the association between ULT and the development of CVD.

Results

In total, 152,166 patients were included in the main analysis before overlap weighting in this retrospective cohort study. The number of subjects in the ULT group was 5,270, and there were 146,896 subjects in the control group. Composite CVD outcomes were observed in a total of 7,703 patients. The risk of developing composite CVD outcomes was not different between the ULT group and the control group (HR: 1.01, 95% CI: 0.89 to 1.13).

Conclusions

ULT for patients with asymptomatic hyperuricemia did not prevent the development of CVD based on the Japanese claims database.

Key points

• Among subjects with asymptomatic hyperuricemia, ULT was not associated with a lower risk of CVD

• There was no appropriate cutoff for initiating ULT in patients with asymptomatic hyperuricemia

• There was no appropriate cutoff as the therapeutic goal of ULT in patients with asymptomatic hyperuricemia

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Data availability

Data sharing is not permitted under the JMDC policy. If readers are interested in our dataset, please contact JMDC for data availability (https://www.jmdc.co.jp).

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Acknowledgements

We thank the editing service “American Journal Experts” for proofreading our manuscript.

Funding

This work was supported by a Grant-in-Aid for Scientific Research from the Japan Society for the Promotion of Science (grant number: 20H03941). The funder and the data provider had no role in the present study, including collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

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Authors and Affiliations

  1. Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshida-Konoe-Cho, Sakyo-Ku, Kyoto, 606-8501, Japan

    Hiroyuki Hashimoto, Masato Takeuchi & Koji Kawakami

Authors
  1. Hiroyuki Hashimoto
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  2. Masato Takeuchi
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Contributions

All authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship of this article. They also reviewed the manuscript critically for important intellectual content and have given their approval for the final version to be published.

H.H. contributed to the conception and design of the work; the acquisition, analysis, and interpretation of data; and the drafting of the manuscript. M.T. contributed to the analysis and interpretation of the work. K.K. contributed to the conception of the work and the acquisition of data for the work. All authors agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Koji Kawakami.

Ethics declarations

Ethics approval

This study was approved by the Institutional Review Board at Kyoto University. We performed this study in accordance with the ethical standards laid out in the 1964 Declaration of Helsinki and its later amendments. The data were obtained by contract from JMDC Inc. and permission was obtained to use them in the study and to publish the results in a scientific paper. Individual consent was not needed because the data were anonymized.

Competing interests

Koji Kawakami has received research funds from Eisai Co., Ltd., Kyowa Kirin Co., Ltd., Sumitomo Pharma Co., Ltd., Mitsubishi Corporation, and Real World Data Co. Ltd.; consulting fees from LEBER Inc., JMDC Inc., Shin Nippon Biomedical Laboratories Ltd., and Advanced Medical Care Inc.; executive compensation from Cancer Intelligence Care Systems, Inc.; and honoraria from Mitsubishi Corporation, Pharma Business Academy, and Toppan Inc. Other authors have no conflicts of interest to declare.

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Hashimoto, H., Takeuchi, M. & Kawakami, K. Association between urate-lowering therapy and cardiovascular events in patients with asymptomatic hyperuricemia. Clin Rheumatol 42, 3075–3082 (2023). https://doi.org/10.1007/s10067-023-06710-9

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