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Lipids, Lipoproteins, and Cardiovascular Risk Factors |
1 Department of Medical Statistics, Informatics and Health Economics, Innsbruck Medical University, Innsbruck, Austria;
2 Department of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria;
3 Gerontology Research Center, National Institute on Aging, Baltimore, MD, USA;
4 School of Public Health and Population Sciences, University College Dublin, Dublin, Ireland;
5 Department of Epidemiology, University of Ulm, Ulm, Germany;
6 Agency for Preventive and Social Medicine, Bregenz, Austria.
aAddress correspondence to this author at: Department of Medical Statistics, Informatics and Health Economics, Innsbruck Medical University, Schoepfstrasse 41, 6020 Innsbruck, Austria. Fax 43 (512) 9003-73922; e-mail alexander.strasak{at}i-med.ac.at.
Background: The role of serum uric acid (SUA) as an independent risk factor for cardiovascular disease (CVD) remains controversial, and little is known about its prognostic importance for mortality from congestive heart failure (CHF) and stroke. Few large-scale epidemiologic studies with sufficient follow-up have addressed the association of SUA and CVD mortality in apparently healthy men across a wide age range.
Methods: A cohort of 83 683 Austrian men (mean age, 41.6 years) was prospectively followed for a median of 13.6 years. We used Cox proportional hazards models adjusted for established risk factors to evaluate SUA as an independent predictor for CVD mortality.
Results: The highest quintile of SUA concentration (>398.81 µmol/L) was significantly related to mortality from CHF (P = 0.03) and stroke (P <0.0001); adjusted hazard ratios (95% confidence interval) for the highest vs lowest quintiles of SUA were 1.51 (1.03–2.22) and 1.59 (1.23–2.04), respectively. SUA was not associated, however, with mortality from acute, subacute, or chronic forms of coronary heart disease (CHD) after adjustment for potential confounding factors (P = 0.12). Age was a significant effect modifier for the relation of SUA to fatal CHF (P = 0.05), with markedly stronger associations found in younger individuals.
Conclusions: Our study demonstrates for the first time in a large prospective male cohort that SUA is independently related to mortality from CHF and stroke. Although increased SUA is not necessarily a causal risk factor, our results suggest the clinical importance of monitoring and intervention based on the presence of an increased SUA concentration, especially because SUA is routinely measured.
The following articles in journals at HighWire Press have cited this article:
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  L. Pacifico, V. Cantisani, C. Anania, E. Bonaiuto, F. Martino, R. Pascone, and C. Chiesa Serum uric acid and its association with metabolic syndrome and carotid atherosclerosis in obese children Eur. J. Endocrinol., January 1, 2009; 160(1): 45 - 52. [Abstract] [Full Text] [PDF]
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 A. M. Strasak, C. C. Kelleher, J. Klenk, L. J. Brant, E. Ruttmann, K. Rapp, H. Concin, G. Diem, K. P. Pfeiffer, H. Ulmer, et al. Longitudinal Change in Serum Gamma-Glutamyltransferase and Cardiovascular Disease Mortality: A Prospective Population-Based Study in 76 113 Austrian Adults Arterioscler. Thromb. Vasc. Biol., October 1, 2008; 28(10): 1857 - 1865. [Abstract] [Full Text] [PDF]
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 R. Yahyaoui, I. Esteva, J. J. Haro-Mora, M. C. Almaraz, S. Morcillo, G. Rojo-Martinez, J. Martinez, J. M. Gomez-Zumaquero, I. Gonzalez, V. Hernando, et al. Effect of Long-Term Administration of Cross-Sex Hormone Therapy on Serum and Urinary Uric Acid in Transsexual Persons J. Clin. Endocrinol. Metab., June 1, 2008; 93(6): 2230 - 2233. [Abstract] [Full Text] [PDF]
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C. Meisinger, W. Koenig, J. Baumert, and A. Doring Uric Acid Levels Are Associated With All-Cause and Cardiovascular Disease Mortality Independent of Systemic Inflammation in Men From the General Population: The MONICA/KORA Cohort Study Arterioscler. Thromb. Vasc. Biol., June 1, 2008; 28(6): 1186 - 1192. [Abstract] [Full Text] [PDF]
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 W. Koenig and C. Meisinger Uric Acid, Type 2 Diabetes, and Cardiovascular Diseases: Fueling the Common Soil Hypothesis? Clin. Chem., February 1, 2008; 54(2): 231 - 233. [Full Text] [PDF]
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