Losartan and dapagliflozin combination therapy in reducing uric acid level compared to monotherapy in patients with heart failure

Abstract

Background: Sodium-Glucose Transport Protein 2 (SGLT2) inhibitors, and Angiotensin II Receptor Antagonists (ARBs) also have the effect of reducing serum uric acid but few studies worldwide assessed. Objective: Evaluate the effectiveness of serum uric acid lowering treatment of SGLT2 inhibitors, and ARB in heart failure (HF) patients. Methods: We conducted a cross-sectional analysis study with 8 weeks of follow-up on 733 heart failure (HF) patients treated at Can Tho Central General Hospital from January 2023 to March 2024. Patients enrolled in the study were examined and received losartan (Group A) or dapagliflozin (Group B) monotherapy or losartan and dapagliflozin combined therapy (Group C). The uric acid concentration group was defined into three subgroups with tertile 1 from smallest to quartile (Q) 1, tertile 2 from Q2 to Q3, and tertile 3 from Q3 to the largest value. Results: After 8 weeks of treatment, the uric acid reduction effect between groups A, B, and C showed that the combination group had the optimal reducing effect compared to losartan and dapagliflozin monotherapy with the mean difference being −229.62 ± 76.65 µmol/L, −217.00 ± 146.17 µmol/L, and −284.43 ± 136.32 µmol/L, respectively. In total, combination therapy showed the best reduction outcome in the population of male, female, patients with type 2 diabetes mellitus (T2DM), and dyslipidemia with the mean difference ranging from −226.21 ± 74.65 µmol/L to −231.85 ± 76.28 µmol/L and −209.62 ± 184.94 µmol/L to −225.75 ± 78.53 µmol/L and −273.02 ± 204.54 µmol/L to −308.93 ± 72.97 µmol/L in group A, B, and C, respectively. Conclusion: The optimal therapy for reducing uric acid levels in HF patients was the combination of losartan and dapagliflozin, and the effectiveness did not change through sex, T2DM, and dyslipidemia patients.