Asymptomatic hyperuricemia and coronary artery disease in elderly patients without comorbidities.

Junnan Wu,Guangtao Lei,Yuezhong Tang,Guihua Jian,Xianfeng Wu,Xiao Wang,Huan Cheng,Niansong Wang

doi:10.18632/oncotarget.21079

Abstract

Because many subjects with hyperuricemia have comorbidities, it can be difficult to differentiate the role of hyperuricemia from that of other comorbidities of coronary artery disease (CAD). Subjects aged ≥ 65 years were enrolled in the study and were available at enrollment and at 5-year follow-up. Subjects were excluded if they were overweight or obese, hypertensive, diabetic, hyperlipidemic, had a pre-existing cardiovascular disease, a history of gout or hyperuricemia on medications, or chronic kidney disease as estimated by a glomerular filtration rate (eGFR) < 60 mL/min per 1.73 m2. We used Poisson regression to estimate the hazard ratio (HR) for incident CAD events between hyperuricemic (> 7 mg/dL in men and ≥ 6 mg/dL in women) and normouricemic subjects. A total of 2,142 subjects without comorbidities (mean age of 70.7 ± 5.9 years, 1,194 men) were followed for 57.4 ± 8.9 months. Hyperuricemia was associated with an increased cumulative incidence of incident CAD events (15.0% versus 8.8%, P < 0.001). After adjusting for confounding factors, hyperuricemia independently predicted the risk of incident CAD events (HR=1.71, 95% CI 1.26–2.34). In conclusion, asymptomatic hyperuricemia is a valuable biomarker for predicting the development of incident CAD events.

Highlights

Hyperuricemia is known to be associated with cardiovascular disease (CVD), such as coronary artery disease (CAD), stroke and hypertension [1], but the role of serum uric acid (SUA) as an independent risk factor for CVD remains unclear
Of the 8,113 subjects, we excluded 5,971 subjects with comorbidities at baseline: 1,743 with hypertension, 761 with pre-existing CVD, 1,460 with diabetes mellitus (DM), 835 with chronic kidney disease (CKD), 2,920 with hyperlipidemia, 1,622 who were overweight/obese and 361 subjects with hyperuricemia or gout who were on medication (Figure 1)
Our primary finding was that asymptomatic hyperuricemic subjects without comorbidities had a significant increased (1.82-fold) risk for developing incident CAD events

Summary

Introduction

Hyperuricemia is known to be associated with cardiovascular disease (CVD), such as coronary artery disease (CAD), stroke and hypertension [1], but the role of serum uric acid (SUA) as an independent risk factor for CVD remains unclear. Experimental studies have suggested that SUA may have an independent modulatory or causal role in these conditions [9,10,11]. Consistent with these findings, an elevated SUA has been consistently found to predict the development of CAD [1]. The limitations associated with multivariable analysis as a means for determining causation are well known [8, 13, 14]

Methods

Results

Conclusion