Possible burden of hyperuricaemia on mortality in a community-based population: a large-scale cohort study

Yoichiro Otaki,Koichi Asahi,Kazuhiko Tsuruya,Kunitoshi Iseki,Masato Kasahara,Tsuneo Konta,Masahide Kondo,Kunihiro Yamagata,Toshiki Moriyama,Yugo Shibagaki,Shouichi Fujimoto,Kazunobu Ichikawa,Tsuyoshi Watanabe,Ichiei Narita

doi:10.1038/s41598-021-88631-8

Yoichiro Otaki, Koichi Asahi + Show 12 more

Open Access

https://doi.org/10.1038/s41598-021-88631-8

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Abstract

Hyperuricaemia is a risk for premature death. This study evaluated the burden of hyperuricaemia (serum urate > 7 mg/dL) for all-cause and cardiovascular mortality in 515,979 health checkup participants using an index of population attributable fraction (PAF). Prevalence of hyperuricaemia at baseline was 10.8% in total subjects (21.8% for men and 2.5% for women). During 9-year follow-up, 5952 deaths were noted, including 1164 cardiovascular deaths. In the Cox proportional hazard analysis adjusted for confounding factors, hyperuricaemia was independently associated with all-cause and cardiovascular mortality (adjusted hazard ratios [95% confidence interval]; 1.36 [1.25–1.49] and 1.69 [1.41–2.01], respectively). Adjusted PAFs of hyperuricaemia for all-cause and cardiovascular deaths were 2.9% and 4.4% (approximately 1 in 34 all-cause deaths and 1 in 23 cardiovascular deaths), respectively. In the subgroup analysis, the association between hyperuricaemia and death was stronger in men, smokers, and subjects with renal insufficiency. Adjusted PAFs for all-cause and cardiovascular deaths were 5.3% and 8.1% in men; 5.8% and 7.5% in smokers; and 5.5% and 7.3% in subjects with renal insufficiency. These results disclosed that a substantial number of all-cause and cardiovascular deaths were statistically relevant to hyperuricaemia in the community-based population, especially men, smokers, and subjects with renal insufficiency.

Highlights

Hyperuricaemia is a risk for premature death
In the multivariate model adjusted for possible confounders, a significant increase in the hazard ratio (HR) of hyperuricaemia for all-cause and cardiovascular mortality was observed compared with no hyperuricaemia (HR, 1.36 [95% confidence interval {CI} 1.25–1.49] for all-cause mortality and HR, 1.69 [95% CI 1.41–2.01] for cardiovascular mortality)
The HRs for all-cause and cardiovascular mortality owing to dyslipidaemia and alcohol consumption were not increased; the population attributable fraction (PAF) of these factors were not calculated

Summary

Introduction

This study evaluated the burden of hyperuricaemia (serum urate > 7 mg/dL) for all-cause and cardiovascular mortality in 515,979 health checkup participants using an index of population attributable fraction (PAF). Adjusted PAFs for all-cause and cardiovascular deaths were 5.3% and 8.1% in men; 5.8% and 7.5% in smokers; and 5.5% and 7.3% in subjects with renal insufficiency. Similar association was observed in the Japanese general p opulation[11,12,13] These observations suggest the significance of hyperuricaemia on life expectancy, independent of other risk factors. To assess the strength of association between exposure to a specific risk factor and the occurrence of a particular event, a measure of relative risk is often used This measure does not consider the prevalence of risk factors; it is not appropriate to use relative risk to evaluate disease burden. Hyperuricaemia Smoking Diabetes Hypertension Dyslipidaemia Alcohol consumption Men (vs. Women) Age (per 1-year increase) BMI (per 1 kg/m2 increase) eGFR (per 1 mL/min/1.73m2 increase)

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