Abstract
The role of serum uric acid (SUA) as a prognostic marker for incident heart failure (HF) in hypertensive subjects is uncertain. We have prospectively examined the relationship between SUA and incident HF in 3440 men aged 60–79years separately in those on and not on antihypertensive treatment who were followed up for a mean period of 15years. Men on SUA lowering drugs and those with history of HF or myocardial infarction were excluded. There were 260 incident HF cases. The men were divided into three groups of SUA concentrations/levels (<350, 350–410 and >410μmol/L). Raised SUA was associated with significantly increased risk of HF in men on antihypertensive treatment (N=949) but not in those without (N=2491) (p=0.003 for interaction). In men on antihypertensive treatment those with hyperuricemia (>410μmol/L) had the most adverse biological risk profile for HF including the highest rates of atrial fibrillation and renal dysfunction and the highest mean level of BMI, c-reactive protein and cardiac function (cardiac troponin T). Treated hypertensive men with SUA levels>410μmol/L showed an increase in risk of HF of more than twofold compared to those on treatment with levels <350μmol/L even after adjustment for lifestyle characteristics and biological risk factors [adjusted hazard ratio 2.26 (1.23,4.15)]. SUA improved prediction of HF beyond routine conventional risk factors (p=0.02 for improvement in c-statistics). SUA as a marker of increased xanthine oxidase activity may be a useful prognostic marker for HF risk in older men on antihypertensive treatment.
Highlights
Serum uric acid (SUA) is the end product of purine metabolism in humans; hyperuricaemia is commonly found in patients with heart failure (HF) and hypertension [1,2]
Receiveroperating characteristic (ROC) curves and areas under the curve (AUC) (c-statistics) were used to assess the ability of SUA to predict HF in men on antihypertensive treatment and who had no history of HF or myocardial infarction (MI) beyond a score which included conventional routine risk factors as well as how SUA predicted beyond the Health ABC HF score
No association was seen between SUA and HF in those not on treatment and a test for interaction confirmed a significant difference in the relation between SUA and incident HF in those on and not on antihypertensive treatment (p = 0.02)
Summary
Serum uric acid (SUA) is the end product of purine metabolism in humans; hyperuricaemia is commonly found in patients with heart failure (HF) and hypertension [1,2]. The association of SUA and coronary heart disease has long been recognised [1] and has sparked enormous debate about the role of SUA as a risk factor for CHD and the treatment of hyperuricemia especially in hypertensive patients [1,3,4,5]. In more recent years several studies and meta-analysis have reported raised SUA to be associated with increased risk of incident HF in population studies [6,7,8,9,10]. Whether this association is causal is still a matter of debate.
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