Effects of allopurinol and febuxostat on cardiovascular mortality in elderly heart failure patients

  • Arrigo Francesco Giuseppe CiceroEmail author
  • Eugenio Roberto Cosentino
  • Masanari Kuwabara
  • Daniela Degli Esposti
  • Claudio Borghi


Hyperuricemia is an emerging risk factor for the development of heart failure (HF) and is associated with a worsen prognosis of the disease. The effect of urate lowering drugs (ULT) and, in particular, the xanthine oxidase inhibitor in patients with HF is controversial. The aim of the study is to compare the effects of treatment with two different xanthine oxidase inhibitors (allopurinol or febuxostat) on cardiovascular mortality in elderly patients with chronic HF in a setting of clinical practice. In this observational trial, 255 elderly patients affected by chronic HF and treated with ULT on top of optimal medical treatment for HF. The sample included only outpatients with mild-to-moderate HF mainly secondary to chronic arterial hypertension or coronary artery disease and not previously hospitalized for HF. Patient treated with febuxostat (N. 120) and allopurinol (N. 135) were balanced for most of the baseline variables. In particular age, NYHA class distribution, drug treatment and renal function were comparable at the baseline and during the observation in both groups (p > 0.05). After a mean follow-up period of 5.1 years, the cumulative cardiovascular survival was 0.96 (95% CI 0.93–0.99) in febuxostat-treated patients and 0.89 (95% CI 0.84–0.93) in those treated with allopurinol. The between group difference, adjusted for the main confounding risk factors, was statistically significant (p = 0.04). Our study results suggest that possibility that febuxostat, a selective XO inhibitor, may favorably affect cardiovascular mortality in comparison with allopurinol in elderly patients with mild-to-moderate HF. This preliminary observation deserves further evaluation in the next future.


Allopurinol Febuxostat Heart failure Hyperuricemia Mortality 



This research was funded by institutional funding of the University of Bologna.

Compliance with ethical standards

Conflict of interest

Prof. Claudio Borghi is scientific consultant for Menarini International, no one of the other authors have direct nor indirect conflict of interest in the publication of this paper.

Statements of human and animal rights

The study was carried out in the setting of current clinical practice and has been carried out in agreement with the Declaration of Helsinki.

Informed consent

The study was approved by the local ethical board and each subject signed an informed consent.


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Copyright information

© Società Italiana di Medicina Interna (SIMI) 2019

Authors and Affiliations

  1. 1.Internal Medicine UnitS. Orsola-Malpighi University HospitalBolognaItaly
  2. 2.Cardiology DepartmentToranomon HospitalTokyoJapan

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