Effects of febuxostat and allopurinol on the inflammation and cardiac function in chronic heart failure patients with hyperuricemia

Background An elevated uric acid (UA) level is associated with an increased risk of adverse outcomes in patients with chronic heart failure (CHF). Febuxostat and allopurinol lower the UA levels and attenuate the expression of an inflammatory marker, monocyte chemoattractant protein (MCP)-1. However, a direct comparison of the effects of febuxostat and allopurinol on the inflammation and cardiac function in CHF patients with hyperuricemia has not yet been performed. Methods A total of 61 CHF patients with hyperuricemia who had a mean left ventricular ejection fraction (LVEF) of 37.1±6.7% were randomly assigned to receive febuxostat (n=31) or allopurinol (n=30). Results The MCP-1 levels and LVEF at baseline were comparable between the groups. However, after 12months of treatment, the febuxostat group achieved significantly higher percent decreases in the UA and MCP-1 levels from baseline than those of the allopurinol group (p<0.001). The LVEF in both groups had improved after 12months; however, a greater percent increase in the LVEF from baseline was observed in the febuxostat group than that in the allopurinol group (p<0.001). The percent increase in the LVEF from baseline was found to be significantly associated with the percent decrease in MCP-1 (r=−0.634, p<0.001) in the febuxostat group. Conclusions These data indicate that febuxostat is more effective than allopurinol in reducing the UA level and inflammation and may improve the cardiac function in CHF patients with hyperuricemia due, at least in part, to reductions in inflammation.