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Published on: February 22, 2020
Urate predicts subsequent cardiac death in stroke survivors
K Y K Wong1, R S MacWalter, H W Fraser
1The Cardiovascular Research Group, Department of Clinical Pharmacology & Therapeutics, University of Dundee Medical School, Dundee, UK.
Insights
High serum urate levels predict cardiac death in stroke survivors, independent of traditional risk factors. Elevated urate may help identify patients at higher risk for fatal cardiac events post-stroke.
Area of Science:
- Cardiology
- Neurology
- Metabolic Medicine
Background:
- Stroke survivors face increased risk of cardiac death.
- Conventional risk factors do not fully explain post-stroke cardiac mortality.
- The role of serum urate in predicting cardiac events after stroke requires further investigation.
Purpose of the Study:
- To determine if serum urate predicts cardiac death in stroke survivors.
- To assess urate's predictive value independent of atherosclerosis risk factors, creatinine, and diuretic use.
Main Methods:
- Serum urate concentration was measured in 354 unselected stroke survivors.
- Patients were followed for a median of 2.8 years, with cardiac death as the primary endpoint.
- Statistical analysis adjusted for conventional risk factors, renal function, and diuretic use.
Main Results:
- Elevated serum urate was associated with a threefold increased relative risk of cardiac death.
- In non-diuretic users, raised urate showed a 12-fold increased relative risk of cardiac death.
- Specific urate concentrations demonstrated high sensitivity and specificity for predicting 5-year cardiac death post-stroke.
Conclusions:
- Elevated serum urate concentration can stratify risk for future cardiac death after stroke.
- This predictive value holds true even for stroke survivors not using diuretic therapy.
- Serum urate may serve as a valuable biomarker for cardiac risk assessment in post-stroke patients.
Aims:
To test the hypothesis that urate predicts cardiac death after stroke independent of conventional risk factors of atherosclerosis, creatinine and diuretic use.
Methods And Results:
Serum urate concentration was measured in an unselected cohort of 354 stroke survivors who were followed-up for a median of 2.8 years. Cardiac death was the primary end-point. Urate was associated with a statistically significant threefold increase in relative risk of cardiac death even after adjustment for other conventional risk factors. In the subgroup of patients who were not on diuretics, raised urate was associated with a 12-fold significant increase in relative risk of cardiac death after adjusting for renal function and other conventional risk factors. A urate concentration of greater than 0.31 mmol. l(-1) was 78% sensitive at predicting cardiac death within 5 years after stroke, but was only 54% specific. If urate exceeded 0.38 mmol. l(-1), specificity of predicting cardiac death within 5 years after stroke was 88%.
Conclusions:
Elevated serum urate concentration may be used to stratify risk of future cardiac death after stroke. This appeared to be true even in stroke survivors who were not on diuretic therapy.
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