AbstractBackgroundFebuxostat is a selective xanthine oxidase inhibitor that reportedly exhibits antioxidant properties. We previously performed a multicentre, randomized controlled (PRIZE) study for vascular evaluation under uric acid (UA) control by febuxostat to investigate the progression of carotid lesions in asymptomatic hyperuricemic patients with carotid atherosclerosis for 2 years.HypothesisThe current subanalysis of the PRIZE study aimed to assess the effect of febuxostat on the level of malondialdehyde‐modified low‐density lipoprotein (MDA‐LDL), an oxidative stress marker.MethodsWe recruited 383 patients (febuxostat group,n= 200; control group,n= 183) from the PRIZE trial for whom MDA‐LDL measurements were available. The UA, MDA‐LDL, low‐density lipoprotein cholesterol (LDL‐C) levels, and MDA‐LDL/LDL‐C ratio were identified, represented as the estimated difference from baseline to 24 months. We also evaluated the relationship between febuxostat dose (10, ≤20 to <40, and ≤40 to ≤60 mg) and changes in the MDA‐LDL level, LDL‐C level, or MDA‐LDL/LDL‐C ratios.ResultsThe estimated change in MDA‐LDL/LDL‐C ratio from baseline to 24 months was significantly lower in the febuxostat group than in the control group (p= .025), whereas the estimated changes in MDA‐LDL (p= .235) and LDL‐C (p= .323) levels did not differ between the two groups. No significant correlation existed between the febuxostat doses and the estimated change in the MDA‐LDL level (p= .626), LDL‐C level (p= .896), or MDA‐LDL/LDL‐C ratio (p= .747).ConclusionsOur findings may indicate a possibility that febuxostat can lower the MDA‐LDL/LDL‐C ratio, a potential marker of atherosclerosis and oxidative stress, in asymptomatic hyperuricemic patients with carotid atherosclerosis. Further studies are required to validate our findings and elucidate the clinical antioxidant effect of febuxostat.