Abstract
Limited data suggests possible gender-specific association between serum uric acid (SUA) and cardiovascular disease (CVD) incidence. The aim of the present analysis was to evaluate the association between SUA levels and 10-year CVD incidence (2002-2012) in the ATTICA study participants. Overall, 1687 apparently healthy volunteers, with SUA measurements, residing in the greater metropolitan Athens area (Greece), were included. Multivariable Cox-regression models were used to estimate the hazard ratios for SUA in relation to 10-year CVD incidence. Receiver operating curve analysis was conducted to detect optimal SUA cut-off values. Participants in the 2nd and 3rd SUA tertile had 29 and 73% higher 10-year CVD incidence compared with those in the 1st tertile (p < 0.001). In gender-specific analysis, only in women SUA was independently associated with CVD incidence; women in the 3rd SUA tertile had 79% greater 10-year CVD event risk compared to their 1st tertile counterparts. Obese in the 3rd SUA tertile had 2-times higher CVD incidence compared to those in the 1st tertile. Similar findings were observed in metabolically healthy (vs. unhealthy) and metabolically healthy obese. SUA thresholds best predicting 10-year CVD incidence was 5.05 and 4.15 mg/dL (0.30 and 0.25 mmol/L) in men and women, respectively. In conclusion, increased SUA levels were independently related to 10-year CVD event rate in women, obese and metabolically healthy individuals. SUA could predict 10-year CVD incidence even at low levels. Further studies are warranted to identify SUA cut-off values that may improve the detection of individuals at higher CVD risk in clinical practice.
Highlights
Serum uric acid (SUA), the final oxidation product of purine metabolism, has been traditionally associated with gout arthritis/arthropathy and nephrolithiasis [1]
Participants in the 2nd and 3rd SUA tertile had about 29% (HR 1.29, 95% confidence intervals (CI): 1.19–1.40) and 73% (HR 1.73, 95% CI: 1.23–2.42) higher risk to develop cardiovascular disease (CVD) within the decade compared with their 1st tertile counterparts, respectively
After adjusting for anthropometric, lifestyle, biochemical and clinical factors, 1 mg/dL (0.06 mmol/L) rise in SUA levels resulted in about 10% higher 10year CVD risk
Summary
Serum uric acid (SUA), the final oxidation product of purine metabolism, has been traditionally associated with gout arthritis/arthropathy and nephrolithiasis [1]. Hyperuricemia has been related to increased total and CVD mortality [19,20,21,22]. Apart from these diseases, SUA levels are influenced by gender [23], age [24] and drug therapy (e.g., antihypertensive, antidiabetic and hypolipidemic) [25,26,27,28,29,30]. There has been some discussion regarding the possible effect of gender on the association between SUA and CVD risk, the latter being stronger in women [33,34,35,36].
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