J Cardiol 2006 May; 47（5）: 219 – 228

Hyperuricemia Associated With
High Cardiac Event Rates in the
Elderly With Chronic Heart Failure
Takeshi

NIIZEKI, MD

Yasuchika

TAKEISHI, MD, FJCC

Takanori

ARIMOTO, MD

Hidenobu

OKUYAMA, MD

Naoki NOZAKI, MD
Osamu

HIRONO, MD

YuichiTSUNODA, MD

Tetsu

WATANABE, MD

Joji NITOBE, MD
Takehiko

MIYASHITA, MD

Hiroki

TAKAHASHI, MD

Yo KOYAMA, MD
Isao

KUBOTA, MD, FJCC

Abstract ─────────────────────────────────────────────────────────────────────────────────────────────────────────────────────────────────────────────────────────────────────
Objectives. Congestive heart failure（CHF）is the major cause of death and hospitalization in the elderly
population. Simple markers that can be measured anywhere at low cost are necessary to identify patients athigh risk. Recent studies have reported that hyperuricemia is a prognostic marker for CHF. However, it is
not yet known whether serum levels of uric acid may provide prognostic information in the elderly population. Therefore, this study tried to identify the clinical characteristics of elderly CHF patients（＞− 70 years）
in our institution and to evaluate whether uric acid levels can effectively estimate the prognosis for elderly
CHF patients.
Methods and Results. Uric acid levels were analyzed in 247 CHF patients, and patients were followed（123 patients）had higher rate
up for 451 ± 235 days
（mean ± SD）. Elderly CHF patients aged ＞− 70 yearsof hypertension, lower current smoking rate and higher uric acid levels than those aged ＜ 70 years（124
patients）. There were 72 cardiac events including cardiac deaths and readmissions for worsening CHF.
Multivariate analysis with the Cox proportional hazard model showed that uric acid was the only independent predictor of cardiac events（hazard ratio 1.544, 95% confidence interval 1.215−2.582, p ＜ 0.0001）in
the elderly with CHF. The highest quartile of uric acid level was associated with the highest risk of cardiac
events（a 4.45-fold compared to the lowest quartile）. Kaplan-Meier analysis revealed that uric acid levels
effectively risk stratified elderly CHF patients for cardiac events.
Conclusions. These findings suggest that measurement of uric acid levels in elderly CHF patients may
add valuable prognostic information to predict cardiac events.
────────────────────────────────────────────────────────────────────────────────────────────────────────────────────J Cardiol 2006 May ; 47
（5）
: 219−228

Key Words
Heart failure uric acid

Prognosis

Elderly──────────────────────────────────────────────
山形大学医学部器官病態統御学講座 循環・呼吸・腎臓内科学分野 : 〒 990−9585 山形県山形市飯田西 2−2−2
Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata
Address for correspondence : TAKEISHI Y, MD, FJCC, Department of Cardiology, Pulmonology, and Nephrology, Yamagata
University School of Medicine, Iida-Nishi 2−2−2, Yamagata, Yamagata 990−9585 ; E-mail : takeishi@med.id.yamagata-u.ac.jp
Manuscript received January 6, 2006 ; revised January 26, 2006 ; accepted February 7, 2006

219

220

Niizeki, Takeishi, Arimoto et al

INTRODUCTION
Chronic heart failure（CHF）is the leading causeof death and hospitalization among elderly patients,
and the incidence of CHF increases with advancing
age1−5）. CHF is accompanied by various pathophysiological changes which trigger disease progression, and deterioration of ventricular function isstill common in elderly patients with CHF 6,7）.
Although the current therapy for CHF such as
angiotensin-converting enzyme inhibitors and βblockers can relieve symptoms and prolong life, theincidence, readmission rate and mortality are still
increasing beacause of the aging of the population8−12）. The frequent coexistence of co-morbid illness and psychosocial issues in older patients often
makes diagnosis and management difficult, andprognostic parameters of elderly patients with CHF
have not been definitely identified. Therefore,
objective parameters are needed to diagnose andassess the severity of CHF in elderly patients.
A number of parameters are useful to predict
prognosis of patients with CHF 13−17）. However,many modern markers are used only for research
purposes and are not widely available in routine
clinical practice. Several studies have recently
shown that serum level of uric acid is a promisingmarker for prognosis in CHF patients18,19）. In addition, hyperuricemia is related to impaired oxidative
metabolism and vascular dysfunction in CHF20, 21）.
The present study tried to clarify the clinicalcharacteristics and prognosis of elderly CHF
patients in our institution, and to assess whether
uric acid levels can effectively estimate prognosis＞ 70 years）
CHF patients. Serum uricin elderly（−acid levels were measured at admission and theassociation with subsequent cardiac events wasassessed in 247 consecutive patients hospitalized
for chronic heart failure.
SUBJECTS AND METHODS
Study design
We prospectively studied 247 consecutive
patients who had been admitted for the treatment ofworsening chronic heart failure, or for diagnosis
and pathophysiological investigations, or therapeutic evaluations of heart failure from April 1996 to
February 2005. Informed consent was obtained
from all patients before participation in this study,
and the protocol was approved by the Human
Investigations Committee of our institution.

The diagnosis of heart failure was based on a history of dyspnea and symptomatic exercise intolerance with signs of pulmonary congestion or peripheral edema, or documentation of left ventricularenlargement or dysfunction by chest radiography,
echocardiography, or radionuclide ventriculography. Baseline characteristics of the patients are presented in Table 1. Definite hypertension was
defined as self-reported hypertension and systolicblood pressure ＞ 140 mmHg or diastolic bloodpressure ＞ 90 mmHg, or patients received antihypertensive treatment. A diagnosis of diabetes andhyperlipidemia were obtained from medical records
or patient history.
Venous blood samples were obtained at admission, and two-dimensional echocardiography was
performed by experts unaware of patient characteristics within 1 week after admission. Attending
physicians were kept unaware of the results of thebiochemical markers, and optimal medical therapy
was performed independently based on measurements such as improvement in symptoms, physicalexamination findings, and pulmonary congestion onchest radiography22,23）.
End-points and follow-up
No patients were lost to follow-up（mean followup 451 ± 235 days, range 5 to 1,080 days）after
admission to Yamagata University Hospital. Eventswere adjudicated using medical records, electrocardiograms, chest radiographs, autopsy reports, deathcertificates, and witness statements24,25）. The endpoints, which were judged independently byresearchers, were cardiac death, defined as deathfrom worsening heart failure or sudden cardiac
death, and worsening heart failure requiring readmission. Sudden cardiac death was defined as death
without definite premonitory symptoms or signs
and was established by the attending physician.
Statistical analysis
Results are presented as the mean ± SD value
for continuous variables and as the percentage of
total patients for categorical variables. The independent samples t-test and chi-square test or linear
regression analysis were used for comparison ofcontinuous and categorical variables, respectively.
p values ＜ 0.05 were considered statistically significant. Cox proportional hazard analyses were performed to determine the independent predictor of
cardiac events for the entire population.
J Cardiol 2006 May; 47（5）: 219 – 228

Hyperuricemia in Elderly Heart Failure

Table 1

221

Clinical characteristics of 247 patients with chronic heart failure＞70 years old−（n＝123）＜70 years old（n＝124）Age（yr）

77±5＊

57±11

Sex（male/female）

59/64

84/40

17/50/41/15＊

43/49/29/3

Hypertension＊
67（54）

53（43）

Diabetes mellitus

24（20）

33（27）

Hyperlipidemia

20（16）

29（23）

Current smoking＊
17（14）

39（31）

Dilated cardiomyopathy

44（36）

46（37）

Ischemic heart disease29（24）

33（27）

Valvular heart disease26（21）

22（18）

Hypertensive heart disease18（14）

10（8）Tachycardia-induced cardiomyopathy

6（5）13（10）

Uric acid（mg/dl）

6.35±2.26＊

5.89±1.87

Creatinine（mg/dl）

0.91±0.31

0.88±0.30

Hemoglobin（g/dl）

12.6±1.98

13.7±2.12

Na（mEq/l）

140±3.5141±2.7

LVEDD
（mm）

52±9.854±9.8

LVEF
（%）

49±19

47±19

＊
18（15）

6（5）NYHA functional class（Ⅰ/Ⅱ/Ⅲ/Ⅳ）

Etiology of chronic heart failure

Blood examination at admission

Echocardiography at admission

Cardiac events
Cardiac deaths
Re-hospitalizations＊

29（24）

19（15）

Total events＊
47（38）

25（20）

ACE inhibitors and/or ARBs＊
88（72）

73（59）

Beta-blockers

38（31）

36（29）Ca channel blockers

31（25）

30（24）

Spironolactone

31（25）

26（21）

Loop diuretics＊
79（64）

54（44）

Digoxin＊46（37）

27（22）

Statins

15（12）

18（15）

Allopurinol

17（14）

15（12）

Medical treatment＊（ ）: %. p＜0.05 vs ＜70 years old group.
NYHA＝New York Heart Association ; LVEDD＝left ventricular dimension at enddiastole ; LVEF＝left
ventricular ejection fraction ; ACE＝angiotensin-converting enzyme ; ARB＝angiotensinⅡreceptor blocker.

Independent predictors selected by univariate
analysis were entered into multivariate analysis. We
determined the multivariate-adjusted risk for quartiles 2 through 4 compared with quartile 1. Cardiac
event-free curve was computed according to the
Kaplan-Meier method and analyzed by a log-rank
test. All analyses were performed using a standard
statistical program package（StatView, version 5.0,
SAS Institute Inc）.
J Cardiol 2006 May; 47（5）: 219 – 228

RESULTSClinical characteristics of elderly CHF patients
Comparison of the clinical characteristics
between CHF patients aged ＞− 70 and ＜ 70 years ispresented in Table 1. Elderly CHF patients ＞− 70
years had higher rate of hypertension, lower current
smoking rate and higher uric acid levels than those
aged ＜ 70 years. There were no differences in dia-

222

Niizeki, Takeishi, Arimoto et al

Table 2 Comparisons of clinical characteristics of 123 elderly patients with chronic heart failure
between event-free and cardiac event groups
Event-free（n＝76）

Cardiac event（n＝47）

p value

Age（yr）

78±5

77±5

0.5273Sex（male/female）

32/44

27/20

0.298814/36/21/5

3/14/20/10

0.0039Hypertension

47（62）

20（43）

0.0369Diabetes mellitus

15（20）

9（19）0.9363Hyperlipidemia

10（13）

10（21）

0.2358Current smoking

8（11）

9（19）

0.1782Ischemic heart disease19（25）

10（21）

Non-ischemic heart disease57（75）

37（79）

0.1492

NYHA functional class（Ⅰ/Ⅱ/Ⅲ/Ⅳ）

Etiology of chronic heart failure

Blood examination at admission
Uric acid（mg/dl）

5.9±2.0

6.8±2.6

0.0082Creatinine（mg/dl）

0.84±0.24

0.97±0.37

0.0063

Hemoglobin（g/dl）

12.7±1.96

12.8±2.05

0.6322Na（mEq/l）

141±2.5140±4.5

0.2980

LVEDD
（mm）

51±9

53±11

0.3261

LVEF
（%）

51±18

46±21

0.1913

Echocardiography at admission

（ ）
: %.
Abbreviations as in Table 1.

ing a mean follow-up period of 451 ± 235 days,
and 47 of these 72 events（65%）occurred in those70
years.
Ratesofcardiac death（15% vsaged ＞−
5%）, re-hospitalization（23% vs 15%）, and total
cardiac events（ 38% vs 20%）were significantly
higher in patients aged ＞− 70 years（ Table 1）.
Kaplan-Meier analysis also showed that elderly
CHF patients aged ＞− 70 years had significantly
lower cardiac event-free rates（p ＝ 0.0017 ; Fig. 1）.

Fig. 1 Kaplan-Meier analysis of cardiac event-freerates in patients with chronic heart failure

betes mellitus, hyperlipidemia, etiologies of heart
failure, serum creatinine levels, Na levels, hemoglobin levels, or echocardiographic findings.
Elderly CHF patients aged ＞− 70 years were given
angiotensin-converting enzyme inhibitors/angiotensin Ⅱ receptor blockers, loop diuretics anddigoxin more frequently than those aged ＜ 70years.
The 247 CHF patients had 72 cardiac events dur-

Clinical outcomes in elderly CHF patients
In 123 elderly patients with CHF, there were 12
non-cardiac deaths（3 cerebral hemorrhage, 3 coloncancer, 2 ileus, 2 pneumonia, and 2 suicides）
and 47
cardiac events（38%）, including 18 cardiac deaths（3 in-hospital deaths）and 29 readmissions forworsening heart failure. Thirty of the 47 cardiac
events（ 64%）occurred within 12 months after
admission（3 in-hospital cardiac deaths, 11 cardiac
deaths, and 16 readmissions for worsening heart
failure）. The cause of cardiac death was worsening
chronic heart failure in 11 patients, fatal acute
myocardial infarction in 3 patients and sudden
death in 4 patients. The 3 in-hospital cardiac deaths
J Cardiol 2006 May; 47（5）: 219 – 228

Hyperuricemia in Elderly Heart Failure

223

Table 3 Univariate and multivariate analyses of predictors of cardiac events in elderly chronic
heart failure patients
Variable

Hazard ratio

95% confidence interval

p value

Univariate analysis
Uric acid

1.803

1.199−2.337＜0.0001

Creatinine

2.431

1.833−6.743

0.0107

NYHA functional class

1.935

1.227−2.587

0.0332Uric acid

1.544

1.215−2.582＜0.0001

Creatinine

1.846

0.952−4.434

0.1110

NYHA functional class

1.250

0.873−3.772

0.3502Multivariate analysis

Abbreviation as in Table 1.

Fig. 2 Kaplan-Meier analysis of cardiac event-freerates in elderly patients with chronic heart failure
UA ＝ uric acid.

were caused by worsening chronic heart failure.
Clinical characteristics in the 123 elderly patientswith CHF were compared between patients withand without cardiac events（Table 2）. Patients withcardiac events had more severe New York Heart
Association（NYHA）functional class（p ＝ 0.0039）,
higher levels of uric acid（p ＝ 0.0082）, higher levels of creatinine（p ＝ 0.0063）, and lower rate of
hypertension（p ＝ 0.0369）compared to those without cardiac events. Other parameters including age,sex, numbers of patients with ischemic heart disease, levels of hemoglobin and Na, and echocardiographic data were not significantly different.
Medical treatments such as digitalis, angiotensinconverting enzyme inhibitors, angiotensin Ⅱ receptor blockers, statins, Ca channel blockers,β-blockers, and allopurinol at discharge were also similarin the two groups.
J Cardiol 2006 May; 47（5）: 219 – 228

High uric acid levels（＞− 7.0 mg/dl）were observed in 2 of 17 patients（11.8%）with NYHA functional class Ⅰ, in 19 of 50 patients（38.0%）with
class Ⅱ, in 20 of 41 patients（48.8%）with class Ⅲ,
and in 9 of 15 patients（60.0%）with class Ⅳ（p ＝0.0236）. Uric acid levels were not different
between patients with ischemic and non-ischemic
etilogies（ 5.9 ± 2.5 vs 6.4 ± 2.3 mg/dl, p ＝0.2662）. In patients with NYHA functional class
Ⅲ/Ⅳ, use of loop diuretics was more frequentcompared to patients with NYHA class Ⅰ/Ⅱ［44/56（78.6%）vs 35/67（52.2%）, p ＝ 0.0097］.
Comparison of uric acid levels and cardiac event
rates between patients with preserved left ventricular systolic function（ ＞− 50%）and those with
reduced left ventricular systolic function（＜ 50%）
showed no significant difference.
Independent predictors of cardiac events inelderly CHF patients
Prognostic variables to predict cardiac events inelderly CHF patients were examined by univariate
and multivariate Cox proportional hazard analyses（Table 3）. Univariate analysis related uric acid,creatinine, and NYHA functional class to subsequent cardiac events. Thus, these three parameters
were entered into multivariate analysis.
Multivariate analysis showed uric acid was the only
independent predictor of cardiac events in elderly
patients with CHF［hazard ratio 1.544, 95% confidence interval（CI）1.215−2.582, p ＜ 0.0001］.
Kaplan-Meier curves were constructed forpatients with normal and high levels of uric acid
（Fig. 2）. Patients with high uric acid levels（＞−
7.0 mg/dl）had significantly lower cardiac event-224

Niizeki, Takeishi, Arimoto et al

Fig. 4 Kaplan-Meier analysis of elderly patients withchronic heart failure
Patients divided into four groups as in Fig. 3.
Fig. 3 Association between concentrations of serum
uric acid and cardiac events in 123 elderly
patients with chronic heart failure
Patients were divided into four groups based on the,uric acid levels:1st quartile（＜− 5.0 mg/dl, n ＝ 30）
2nd quartile（5.1−6.4 mg/dl, n ＝ 30）, 3rd quartile（ 6.5− 8.6 mg/dl, n ＝ 31）, and 4th quartile. Hazard ratios relative to 1st（8.7 mg/dl ＜−, n ＝ 32）
quartile are shown.
＊p ＜ 0.05 vs 1st quartile patients.

free rates than those with normal uric acid levels（＜ 7.0 mg/dl）. Serum uric acid levels could reliably risk stratify elderly patients with CHF for
future cardiac events.
Graded relationships between uric acid levels
and cardiac events
Patients were divided into four groups based on
the uric acid levels : 1st quartile（＜− 5.0 mg/dl, n ＝30）, 2nd quartile（ 5.1−6.4 mg/dl, n ＝ 30）, 3rd
quartile（6.5−8.6 mg/dl, n ＝ 31）, and 4th quartile（8.7 mg/dl ＜− , n ＝ 32）. In the highest quartile,
NYHA functional class was more severe, creatininelevel was higher, and left ventricular ejection fraction was lower than in the lower three quartiles（Table 4）. The highest quartile of uric acid was
associated with the highest risk of cardiac events（4.45-fold compared to the lowest quartile）asshown in Fig. 3. Hazard ratios were 1.000, 1.424（95% CI 0.479−2.254）, 3.118（CI 1.011−6.181）,
for quartiles 1 throughand 4.453（CI 1.201−8.889）
4. Cumulative event-free curves were constructedby the Kaplan-Meier method（Fig. 4）. Patients in
the highest quartile had a significantly lower cardiac event-free rate than the other three quartiles（p ＜ 0.001）.

DISCUSSION
Our results demonstrated that serum uric acidlevel was associated with a high risk of cardiac
events in elderly patients with CHF. Uric acid level
could potentially improve the risk stratification ofelderly with CHF.
It is important to accurately define prognostic
factors in patients with heart failure to identify
high-risk individuals who require closer follow-up
and more intensive intervention. A number of parameters can predict the prognosis of patients with
CHF 13−17）. Brain natriuretic peptide is released
from the ventricles as ventricular function deteriorates, and is a well-established prognostic indicatorin CHF patients14,26）. However, many modern parameters are used only for research purposes and are
not widely available. Therefore, simple markers
that can be measured anywhere at low cost are necessary. High serum uric acid levels are a strong,
independent marker of impaired prognosis inpatients with moderate and severe heart failure18,19）.
Hyperuricemia is a marker of impaired oxidative
metabolism, hyperinsulinemia, inflammatory
cytokine activation, and vascular dysfunction20,21）.
In the present study, we examined the potential
prognostic value of uric aid in elderly persons with
CHF. Univariate and multivariate Cox proportional
hazard analyses demonstrated that uric acid level
was an independent predictor of future cardiac
events（Table 3）. We also showed that the risk ofcardiac events increased with increasing uric acidlevel. The highest quartile of uric acid level was
associated with a 4.45-fold event risk
（Fig. 3）.
In the present study, elderly CHF patients
J Cardiol 2006 May; 47（5）: 219 – 228

Hyperuricemia in Elderly Heart Failure

Table 4225

Comparisons of clinical characteristics in elderly chronic heart failure patients between
quartiles of uric acid levels
1st quartile（n＝30）

2nd quartile（n＝30）

3rd quartile（n＝31）

4th quartile（n＝32）

Uric acid range（mg/dl）＜5.0−

5.1−6.4

6.5−8.6Age（yr）

77±6

77±5

77±6

＜
8.7−
79±5#

Sex（male/female）

16/14

14/16

12/19

17/15

NYHA functional class

2.0±0.7

2.2±0.9

2.4±0.7＊

2.9±0.6＊＊#

Hypertension

22（73）

15（50）

17（55）

13（41）
7（22）Diabetes mellitus

8（27）

4（13）

5（16）

Hyperlipidemia

7（23）

5（17）

5（16）

3（9）

Current smoking

6（20）

3（10）

4（13）

4（13）

7（23）

14（47）

11（35）

12（38）
8（25）Etiology of chronic heart failure
Dilated cardiomyopathy
Ischemic heart disease

8（27）

5（17）

8（26）

Valvular heart disease

5（17）

7（23）

6（19）

8（25）

Hypertensive heart disease

8（27）

1（3）

5（16）

4（13）

2（7）

3（10）

1（3）

0

4.0±0.8

5.7±0.4＊＊

7.6±0.7＊＊##

Tachycardia-induced
Cardiomyopathy
Blood examination
Uric acid（mg/dl）＊

9.4±2.1＊＊##Creatinine（mg/dl）

0.78±0.24

0.88±0.20

0.98±0.29

1.03±0.39＊

Hemoglobin（g/dl）

12.2±2.1

13.1±1.912.6±1.812.3±2.1

Na（mEq/l）

141±4.4

141±2.4

141±3.5140±3.4

LVEDD
（mm）

49±10

53±9

52±10

53±11

LVEF
（%）

60±19

51±14

48±21＊

40±18＊＊#

5（17）

4（13）

3（10）

6（19）
12（38）†

Echocardiography

Cardiac events
Cardiac deaths
Re-hospitalizations

1（3）

6（20）

10（32）

Total events

6（20）

10（33）

13（42）

18（56）†

ACE inhibitors and/or ARBs

22（73）

17（57）

27（87）

22（69）

Beta-blockers

5（17）

9（30）

12（39）

12（38）

12（40）

7（23）

9（29）

3（9）

Spironolactone

5（17）10（33）

7（23）

9（28）

Loop diuretics

13（43）

20（67）

21（68）

25（78）†

Digoxin

6（20）

15（50）

10（32）

15（47）

Statins

4（13）

5（17）

3（10）

3（9）

5（17）

2（6）

7（22）

Treatment before admission

Ca channel blockers

Allopurinol
（
##

3（10）

）
: %.＊p＜0.05 vs 1st quartile, #p＜0.05 vs 2nd quartile, and p＜0.05 vs 3rd quartile.＊＊p＜0.01 vs 1st quartile,p＜0.01 vs 2nd quartile, and p＜0.01 vs 3rd quartile. †p＜0.05 by chi-square test.

aged ＞− 70 years had higher uric acid levels thanthose aged ＜ 70 years, suggesting decreases inrenal function with aging. In addition, elderly CHF
patients aged ＞− 70 years were given loop diuretics
more frequently than those aged ＜ 70 years, andthis might affect the higher uric acid levels in the
J Cardiol 2006 May; 47（5）: 219 – 228

elderly.
The incidence and prevalence of CHF increase
dramatically with advancing age1−5）. Increasing age
has been reported to increase the mortality of CHF
patients8−12）. However, prognostic assessment ofelderly patients with CHF is far from clearly estab-226

Niizeki, Takeishi, Arimoto et allished. Epidemiologic data indicate that CHF represents a crucial problem in the elderly population interms of social, economic, and health burden8−12）.
Despite their importance in the worsening of CHF
and prevention of the progression of this syndrome,
the risks of re-hospitalization and the causes ofexacerbation have not been systematically evaluated. In addition, the detailed mechanisms behind theincreased mortality in older CHF patients are still
unclear 6,7）. In the present study, we examined theclinical characteristics and the potential prognostic
value of uric aid in elderly CHF patients aged ＞− 70
years, because the prevalence of CHF increases1）
and these patients have higher rate of readmission
and mortality27,28）. Ageing is associated with important structural and functional changes in the vascular system and the heart, but little is known about
how ageing interacts with the pathophysiology
underlying the process of developing heart failure.
Further research needs to elucidate more effective
要treatment strategies for prevention of CHF and to
decrease the morbidity and mortality of CHF in theelderly.
CONCLUSIONS
These data suggest that high serum uric acidlevel is a reliable marker for prognosis in the elderly patients with chronic heart failure. We suggestthat measurement of uric acid levels should be considered as a routine measurement in the assessmentand follow-up for elderly patients with chronic
heart failure with low cost and wide availability.
Acknowledgments
This study was supported in part by a grant-in-aid for Scientific
Research（No. 17590702）from the Ministry of Education, Science,Sports and Culture, Japan and grants from The Japan Heart
Foundation, The Mochida Memorial Foundation, and Takeda
Science Foundation.

約

高齢者心不全高尿酸血症は心事故率の高さと相関する

目

新関

武史

竹石

恭知

有本

貴範

廣 野

摂

角田

裕一

渡 辺

高 橋

大

小 山

奥山

英伸

野崎

直樹

哲

二藤部丈治

宮下

武彦

容

久保田

功

的 : 心不全は高齢者の死亡と入院の主たる原因の一つである．リスクの高い高齢者心不全例の判別に役立つ指標の確立が求められている．尿酸値が心不全の予後予測に有用であると報告されているが，高齢者においてはまだ十分に検討されていない．本研究では当院の 70 歳以上の高齢者
心不全症例の臨床的特徴を明らかにすること，高齢者心不全症例における尿酸値の予後予測としての有用性を検討することを目的とした．
方

法 : 心不全の診断と治療のために入院した 247 例において，70 歳以上の高齢者（123 例）の臨床像を 70 歳未満の症例（124 例）と比較した．入院時に採血し尿酸値を測定し，心血管事故の発生について平均 451 ± 235 日間の追跡調査を行った．
結果 : 70 歳以上の高齢者では 70 歳未満と比べて高血圧の合併が多く，喫煙率は低く，尿酸値

は高値であった．観察期間中，心血管死と心不全増悪による再入院を含む 72 件の心事故が発生した．心事故群で尿酸値は高値で，Cox 比例ハザード解析では尿酸値は予後を予測する独立した危険因子であった（ハザード比 1.544, 95% 信頼区間 1.215 − 2.582, p ＜ 0.0001）．尿酸値が高いほど相対的リスクは高く，Kaplan-Meier 解析でも尿酸値は高齢者心不全のリスクの判別に有用であることが示された．
結語 : 尿酸値は簡便に低コストで測定でき，高齢者心不全例の予後予測に有用であった．

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J Cardiol 2006 May; 47（5）: 219 – 228

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