Abstract
Background To evaluate the effect of a 1 mg/dl reduction in uric acid (UA) on cardiovascular events and mortality in patients treated with sodium‐glucose cotransporter 2 (SGLT2) inhibitors. Research Design and Methods We performed a systematic review of the MEDLINE and EMBASE databases searched up to 30 June 2023 (PROSPERO, CRD42022355479) to identify large‐scale SGLT2 inhibitor trials. Random‐effects meta‐analyses were used to pool the estimates. Results In total, five SGLT2 inhibitor trials (31 535 patients, 54% with heart failure) were analysed. Over a median follow‐up of 2.2 years, the mean reduction in UA was −0.79 mg/dl (95% confidence interval (CI), −1.03 to −0.54). Every 1 mg/dl reduction in UA was associated with a significantly lower risk of a composite of cardiovascular death and hospitalization for heart failure [hazard ratio, 0.64 (95% CI, 0.46–0.88)] and hospitalization for heart failure (0.68; 95% CI, 0.62–0.74), with a similar risk of mortality. Conclusions SGLT2 inhibitors reduced UA levels and cardiovascular events independently of heart failure status.