Uric Acid and Sodium-Glucose Cotransporter-2 Inhibition With Empagliflozin in Heart Failure With Reduced Ejection Fraction: The EMPEROR-Reduced Trial

Eur Heart J 2022; online ahead of print

Hyperuricaemia is a common finding in people with HF, and is related to advanced clinical status, higher natriuretic peptides, lower peak oxygen uptake, higher ventricular filling pressure, and lower cardiac output. Empagliflozin is known to reduce SUA, but the relevance of this in patients with HF was previously unclear. This analysis of patients in the EMPEROR-Reduced study aimed to investigate the effect of empagliflozin on SUA levels and the therapeutic efficacy of empagliflozin in relation to SUA. Overall, empagliflozin reduced events of clinically relevant hyperuricaemia by 32% within 4 weeks of therapy. The magnitude of the SUA lowering effect was consistent across prespecified subgroups. The benefit on the primary outcome was observed independently of SUA.

As a hypothesis-generating finding, an interaction between SUA and treatment effect suggests a benefit of empagliflozin on mortality in patients in elevated SUA.