WHAT SERUM URIC ACID LEVELS ARE ASSOCIATED WITH INCREASED CARDIOVASCULAR RISK? THE CZECH POST-MONICA STUDY

Abstract

Objective: To evaluate longitudinal trends and determinants of mean serum uric acid (SUA) levels in two representative Czech population surveys (2006–09 and 2015–18) and to determine the SUA levels associated with increased 10-year risk of cardiovascular (CV) death. Design and method: Two independent cross-sectional surveys of major CV risk factors were performed in the Czech Republic in 2006–09 and 2015–18; 1% percent random samples aged 25–64 years stratified by age and gender were examined. The number of participants was 3612 in 2006–09, and 2621 in 2015–18. Ten-year risk of CV death was categorized using the SCORE algorithm as low (<1%), intermediate (1% to <5%), high (>=5% to 10%), and very high (>=10%). Results: Final analyses included 3542 individuals (48.2% men; mean age 47.1 ± 11.3) in 2006–09, and 2304 individuals (47.4% men; mean age 47.9 ± 10.9) in 2015–18. Over the period of 10 years, there was a highly significant increase in SUA levels (μmol/l) from 344.6 ± 81.1 to 374.4 ± 73.3 in men, and from 250.1 ± 73.8 to 278.9 ± 66.1 in women. Simultaneously, there was a significant increase in waist-to-height ratio (WtHR) from 0.56 ± 0.07 to 0.57 ± 0.07 in men, and from 0.53 ± 0.1 to 0.54 ± 0.1 in women (all P < 0.001). In multivariate linear regression analyses conducted in the 2015–18 survey, SUA levels increased with male gender, use of diuretics, an increase in WtHR, serum triglycerides, aspartate aminotransferase, gamma-glutamyl transferase, and alcohol intake, and a decrease in estimated glomerular filtration rate, and glycated hemoglobin. When analysing pooled data of the two surveys, mean SUA levels increased with each increase in 10-year CV risk category in women (P < 0.001), but not in men (P = 0.21). In receiver operating characteristic (ROC) analysis, the cut-off value of SUA levels discriminating between low/intermediate and high/very high CV risk category in women was 306 μmol/l (sensitivity 53%; specificity 82%; area under the ROC curve 0.713 [95% CI 0.683–0.743]). Conclusions: Over the past decade, increasing visceral obesity has been the main factor contributing to the increase in uricemia in the Czech population. The SUA levels associated with increased 10-year CV death risk are substantially lower in Czech women than the currently used cut-off values for hyperuricemia.