Uric acid levels and cardiovascular (CV) risk

• elevated serum uric acid levels are associated with gouty arthritis
  • also elevated uric acid levels have been reported to increase the risk of cardiovascular disease (CVD)
• elevated serum uric acid levels were shown to increase the risk of CVD in prospective cohort studies concerning high-risk groups such as patients with gout, hypertension, stroke, congestive heart failure (CHF) , and/or diabetes
• the First National Health and Nutrition Examination Survey (NHANES-I) found an independent relationship between elevated serum uric acid levels and CVD-related mortality that demonstrated a higher relative risk (RR) in women than in men (RR 1.30 versus 1.17) (1)
  
  
• a prospective cohort study of 41,879 men and 48,514 women ages 35 years was conducted using data from the MJ Health Screening Centers in Taiwan (2)
  • mortality from all causes, total cardiovascular disease (CVD), ischemic stroke, congestive heart failure, hypertensive disease, and coronary heart disease were compared according to increasing serum uric acid levels
    • a total of 1,151 (21.2%) events of 5,427 total deaths were ascribed to CVD (mean followup 8.2 years). Hazard ratios (HRs) for hyperuricemia (serum uric acid level >7 mg/dl (>420 µmoles/litre) were estimated with Cox regression model after adjusting for age, sex, body mass index, cholesterol, triglycerides, diabetes, hypertension, heavy cigarette smoking, and frequent alcohol consumption
      • in all patients, HRs were 1.16 (P < 0.001) for all-cause mortality, 1.39 (P < 0.001) for total CVD, and 1.35 (P = 0.02) for ischemic stroke
      • in subgroup analysis, the HRs for cardiovascular risk remained significant in patients with hypertension (1.44, P < 0.001) and in patients with diabetes (1.64, P < 0.001)
      • in a low metabolic risk subgroup, the HRs for all-cause mortality and total cardiovascular morbidity were 1.24 (P = 0.02) and 1.48 (P = 0.16), respectively
    • the study authors concluded that hyperuricemia was an independent risk factor of mortality from all causes, total CVD, and ischemic stroke in the Taiwanese general population, in high-risk groups, and potentially in low-risk groups

Reference:

• 1) Freedman DS, Williamson DF, Gunter EW, Byers T. Relation of serum uric acid to mortality and ischemic heart disease: the NHANES I epidemiologic followup study. Am J Epidemiol 1995; 141: 637-44
• 2)Chen JH, Chuang SY, Chen HJ, Yeh WT, Pan WH.Serum uric acid level as an independent risk factor for all-cause, cardiovascular, and ischemic stroke mortality: a Chinese cohort study Arthritis Rheum. 2009 Feb 15;61(2):225-32