Abstract
Objectives: We investigated the association between serum uric acid (SUA) levels and the risk of the first stroke in Chinese adults with hypertension.Methods: A total of 11, 841 hypertensive patients were selected from the Chinese Hypertension Registry for analysis. The relationship between SUA levels and first stroke was determined using multivariable Cox proportional hazards regression, smoothing curve fitting, and Kaplan–Meier survival curve analysis.Results: During a median follow-up of 614 days, 99 cases of the first stroke were occurred. Cox proportional hazards models indicated that SUA levels were not significantly associated with the first stroke event [adjusted-hazard ratio (HR) per SD increase: 0.98, 95% CI 0.76–1.26, P = 0.889]. In comparison to the group without hyperuricemia (HUA), there were no significantly higher risks of first stroke events (adjusted-HR: 1.22, 95% CI 0.79–1.90, P = 0.373) in the population with HUA. However, in the population less than 60 years old, subjects with HUA had a significantly higher risk of the first stroke than the population without HUA (adjusted-HR: 4.89, 95% CI 1.36–17.63, P = 0.015). In subjects older than 60 years, we did not find a significant relationship between HUA and first stroke (adjusted-HR: 0.97, 95% CI 0.60–1.56, P = 0.886). Survival analysis further confirmed this discrepancy (log-rank P = 0.013 or 0.899 for non-aging or aging group).Conclusion: No significant evidence in the present study indicated that increased SUA levels were associated with the risk of first stroke in the Chinese adults with hypertension. Age played an interactive role in the relationship between HUA and the first stroke event.
Highlights
Serum uric acid (SUA) is a final enzymatic product of purine metabolism, and several gradual changes have led to the higher SUA levels in humans than in other mammals
Compared with patients with SUA concentrations ≤ 325.80 μmol/L, there was a higher proportion of men, overweight, general obesity, central obesity, smoking and drinking habits, coronary heart disease (CHD), diabetes mellitus (DM), dyslipidemia and antihypertensive agent usage, elevated values of diastolic blood pressure (DBP), BMI, WHR, Hcy, total cholesterol (TC), TG, LDL-C, blood urea nitrogen (BUN), serum creatinine, AST, ALT, total and direct bilirubin, and lower values of systolic blood pressure (SBP), high-density lipoprotein cholesterol (HDL-C), and estimated glomerular filtration rate (eGFR) in patients of the third and highest SUA quartiles
Subjects aged less than 60 years had a higher prevalence of overweight and general obesity, central obesity, HUA, DM, and dyslipidemia, a lower prevalence of smoking habits, CHD, antihypertensive and antiplatelet agent usage, and a lower level of eGFR than the aging group
Summary
Serum uric acid (SUA) is a final enzymatic product of purine metabolism, and several gradual changes have led to the higher SUA levels in humans than in other mammals. Most prospective studies have assessed the association of HUA with stroke incidence in the general population (Chien et al, 2005; Bos et al, 2006; Gerber et al, 2006; Hozawa et al, 2006; Tu et al, 2019; Li J. et al, 2020), patients with hypertension (Shi et al, 2017; Zhang et al, 2020), atrial fibrillation (Chao et al, 2014), and non-insulin-dependent diabetes mellitus (DM) (Lehto et al, 1998). Two meta-analytical reviews of prospective observational studies suggest that HUA may modestly increase the risks of both stroke incidence and mortality (Kim et al, 2009; Li et al, 2014)
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