Abstract
IntroductionSerum uric acid (SUA) has been depicted as a contributory causal factor in metabolic syndrome (MS), which in turn, portends unfavourable prognosis.AimWe assessed the prognostic role of SUA in patients with and without MS.MethodsWe used data from the multicentre Uric Acid Right for Heart Health study and considered cardiovascular mortality (CVM) as death due to fatal myocardial infarction, stroke, sudden cardiac death, or heart failure.ResultsA total of 9589 subjects (median age 58.5 years, 45% males) were included in the analysis, and 5100 (53%) patients had a final diagnosis of MS. After a median follow-up of 142 months, we observed 558 events. Using a previously validated cardiovascular SUA cut-off to predict CVM (> 5.1 mg/dL in women and 5.6 mg/dL in men), elevated SUA levels were significantly associated to a worse outcome in patients with and without MS (all p < 0.0001) and provided a significant net reclassification improvement of 7.1% over the diagnosis of MS for CVM (p = 0.004). Cox regression analyses identified an independent association between SUA and CVM (Hazard Ratio: 1.79 [95% CI, 1.15–2.79]; p < 0.0001) after the adjustment for MS, its single components and renal function. Three specific combinations of the MS components were associated with higher CVM when increasing SUA levels were reported, and systemic hypertension was the only individual component ever-present (all p < 0.0001).ConclusionIncreasing SUA levels are associated with a higher CVM risk irrespective of the presence of MS: a cardiovascular SUA threshold may improve risk stratification.Graphic abstract
Highlights
Serum uric acid (SUA) has been depicted as a contributory causal factor in metabolic syndrome (MS), which in turn, portends unfavourable prognosis
Several epidemiologic studies have reported a relation between serum uric acid (SUA) and Cardiovascular disease (CVD) [6,7,8,9], as recognised by the latest European guidelines that recommend SUA evaluation in the stratification of the future cardiovascular risk of patients with arterial hypertension [3]
We considered cardiovascular mortality (CVM) at the end of the follow-up based on the following events: fatal events due to acute myocardial infarction, heart failure (HF) or stroke and sudden cardiac death
Summary
Serum uric acid (SUA) has been depicted as a contributory causal factor in metabolic syndrome (MS), which in turn, portends unfavourable prognosis. Several epidemiologic studies have reported a relation between serum uric acid (SUA) and CVD [6,7,8,9], as recognised by the latest European guidelines that recommend SUA evaluation in the stratification of the future cardiovascular risk of patients with arterial hypertension [3]. The Working Group on SUA and cardiovascular risk of the Italian Society of Hypertension has designed the URRAH project (Uric Acid Right for Heart Health) to study the relationship between SUA and CVD [10]. Using this extensive, prognostic registry, we investigated the role of SUA levels in improving further risk stratification of patients with MS
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