Abstract：
OBJECTIVE: To assess the relationships between urate-lowering therapy (ULT) initiation with all-cause mortality in patients with asymptomatic hyperuricemia and Type 2 Diabetes (T2D).
METHODS: This nationwide retrospective cohort study involved patients with T2D and asymptomatic hyperuricemia from 19 academic hospitals across China between 2000 and 2021. The primary exposure was ULT initiation, including allopurinol, febuxostat, or benzbromarone. The primary outcome was all-cause mortality. The secondary outcomes were cardiovascular (CV) and non-CV mortality. Propensity score matching was employed to create a 1:2 matched cohort with balanced likelihood of ULT initiation. Associations between ULT initiation with all-cause and CV mortality were assessed in the matched cohort.
RESULTS: Among 42 507 patients, 5028 initiated ULT and 37 479 did not. In the matched cohort, comprising 4871 ULT initiators and 9047 noninitiators, ULT initiation was significantly associated with reduced risk of all-cause mortality (hazard ratio [HR] 0.77; 95% confidence interval [CI], 0.71-0.84), CV mortality (HR 0.86; 95% CI, 0.76-0.97), and non-CV mortality (HR 0.72; 95% CI, 0.64-0.80) over an average 3.0 years of follow-up. Among the ULT initiators, post-treatment SUA levels of 360-420 μmol/L was related to a significantly lower risk for all-cause mortality compared to levels >420 μmol/L (HR 0.74; 95% CI, 0.59-0.94) while levels ≤360 μmol/L did not (HR, 0.96; 95% CI, 0.81-1.14), suggesting a U-shaped relationship.
CONCLUSIONS: Initiating ULT was associated with a significant reduction in all-cause mortality in patients with T2D and asymptomatic hyperuricemia. Notably, maintaining post-treatment SUA concentrations within 360-420 μmol/L could potentially enhance this reduced mortality.
METHODS: This nationwide retrospective cohort study involved patients with T2D and asymptomatic hyperuricemia from 19 academic hospitals across China between 2000 and 2021. The primary exposure was ULT initiation, including allopurinol, febuxostat, or benzbromarone. The primary outcome was all-cause mortality. The secondary outcomes were cardiovascular (CV) and non-CV mortality. Propensity score matching was employed to create a 1:2 matched cohort with balanced likelihood of ULT initiation. Associations between ULT initiation with all-cause and CV mortality were assessed in the matched cohort.
RESULTS: Among 42 507 patients, 5028 initiated ULT and 37 479 did not. In the matched cohort, comprising 4871 ULT initiators and 9047 noninitiators, ULT initiation was significantly associated with reduced risk of all-cause mortality (hazard ratio [HR] 0.77; 95% confidence interval [CI], 0.71-0.84), CV mortality (HR 0.86; 95% CI, 0.76-0.97), and non-CV mortality (HR 0.72; 95% CI, 0.64-0.80) over an average 3.0 years of follow-up. Among the ULT initiators, post-treatment SUA levels of 360-420 μmol/L was related to a significantly lower risk for all-cause mortality compared to levels >420 μmol/L (HR 0.74; 95% CI, 0.59-0.94) while levels ≤360 μmol/L did not (HR, 0.96; 95% CI, 0.81-1.14), suggesting a U-shaped relationship.
CONCLUSIONS: Initiating ULT was associated with a significant reduction in all-cause mortality in patients with T2D and asymptomatic hyperuricemia. Notably, maintaining post-treatment SUA concentrations within 360-420 μmol/L could potentially enhance this reduced mortality.
摘要：
目的：评估无症状高尿酸血症和2型糖尿病（T2D）患者开始降尿酸治疗（ULT）与全因死亡率之间的关系。
方法：这项全国性的回顾性队列研究涉及2000年至2021年间来自中国19家学术医院的T2D和无症状性高尿酸血症患者。主要暴露是ULT开始，包括别嘌醇,非布索坦,或者苯溴马隆.主要结果是全因死亡率。次要结局是心血管（CV）和非CV死亡率。采用倾向评分匹配来创建具有平衡的ULT启动可能性的1:2匹配队列。在匹配的队列中评估了ULT开始与全因死亡率和CV死亡率之间的关联。
结果：在42.507名患者中，5028启动了ULT，37.479没有启动。在匹配的队列中，包括4871个ULT引发剂和9047个非引发剂，ULT开始与全因死亡率风险降低显著相关(风险比[HR]0.77;95%置信区间[CI],0.71-0.84），CV死亡率（HR0.86；95%CI，0.76-0.97），和非CV死亡率（HR0.72;95％CI，0.64-0.80）在平均3.0年的随访。在ULT发起者中，治疗后SUA水平为360-420μmol/L，与>420μmol/L的水平（HR0.74;95％CI，0.59-0.94）相比，全因死亡率的风险显着降低，而水平≤360μmol/L则没有（HR，0.96；95%CI，0.81-1.14），暗示了一种U型关系。
结论：启动ULT与T2D和无症状高尿酸血症患者全因死亡率的显著降低相关。值得注意的是,将治疗后的SUA浓度维持在360-420μmol/L内可能会增强这种降低的死亡率。
方法：这项全国性的回顾性队列研究涉及2000年至2021年间来自中国19家学术医院的T2D和无症状性高尿酸血症患者。主要暴露是ULT开始，包括别嘌醇,非布索坦,或者苯溴马隆.主要结果是全因死亡率。次要结局是心血管（CV）和非CV死亡率。采用倾向评分匹配来创建具有平衡的ULT启动可能性的1:2匹配队列。在匹配的队列中评估了ULT开始与全因死亡率和CV死亡率之间的关联。
结果：在42.507名患者中，5028启动了ULT，37.479没有启动。在匹配的队列中，包括4871个ULT引发剂和9047个非引发剂，ULT开始与全因死亡率风险降低显著相关(风险比[HR]0.77;95%置信区间[CI],0.71-0.84），CV死亡率（HR0.86；95%CI，0.76-0.97），和非CV死亡率（HR0.72;95％CI，0.64-0.80）在平均3.0年的随访。在ULT发起者中，治疗后SUA水平为360-420μmol/L，与>420μmol/L的水平（HR0.74;95％CI，0.59-0.94）相比，全因死亡率的风险显着降低，而水平≤360μmol/L则没有（HR，0.96；95%CI，0.81-1.14），暗示了一种U型关系。
结论：启动ULT与T2D和无症状高尿酸血症患者全因死亡率的显著降低相关。值得注意的是,将治疗后的SUA浓度维持在360-420μmol/L内可能会增强这种降低的死亡率。
