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Published on: January 28, 2020
Serum uric acid independently predicts mortality in patients with significant, angiographically defined coronary
Troy E Madsen1, Joseph B Muhlestein, John F Carlquist
1Ohio State University Medical Center, Columbus, OH 43210, USA. troymadsen3@yahoo.com
Insights
Elevated serum uric acid (SUA) predicts mortality in coronary artery disease (CAD) patients. This risk is independent of traditional factors, especially in those not using diuretics.
Area of Science:
- Cardiology
- Clinical Biochemistry
Background:
- Serum uric acid (SUA) is an emerging risk factor for coronary artery disease (CAD).
- The prognostic value of SUA in patients with established CAD requires further investigation.
Purpose of the Study:
- To prospectively assess the predictive value of serum uric acid (SUA) levels for mortality in patients with angiographically diagnosed CAD.
Main Methods:
- 1,595 patients with significant CAD (stenosis ≥70%) underwent SUA level measurement.
- Patients were followed for mortality over a mean period of 2.6 years.
- Multivariable Cox regression analysis was used to control for 20 covariables.
Main Results:
- Serum uric acid (SUA) levels independently predicted all-cause mortality in patients with significant CAD.
- Higher SUA levels (fifth quintile) were associated with a 1.9-fold increased mortality risk (univariate analysis).
- In multivariable analysis, SUA remained an independent predictor of mortality (HR 1.5, p=0.04), particularly in non-diuretic users.
Conclusions:
- Serum uric acid (SUA) is an independent predictor of mortality in patients with significant CAD.
- Elevated SUA may represent a significant secondary risk factor for cardiovascular events in this population.
Background:
Uric acid is a nontraditional risk factor implicated in the development of coronary artery disease (CAD). This study prospectively evaluated the predictive value of serum uric acid (SUA) levels for mortality after angiographic diagnosis of CAD.
Methods:
Blood samples were collected from 1,595 consecutive, consenting patients with significant, angiographically defined CAD (stenosis 70%). Baseline and procedural variables were recorded and levels of SUA were measured. Patients were followed to death or to the time of contact (mean 2.6 years, range 1.8-5.0 years).
Results:
Patients averaged 65 +/- 11 years of age, 78% were male and 170 subjects died during the follow-up period. In univariate analysis of prospectively defined quintiles, SUA predicted all-cause mortality (fifth quintile vs. first four quintiles: hazard ratio 1.9, p < 0.001). In multivariable Cox regression controlling for 20 covariables, independent predictive value for mortality was retained by SUA (hazard ratio 1.5, confidence interval 1.02-2.1, p = 0.04). In subgroup analysis based on diuretic use status, SUA independently predicted mortality among patients not using diuretics, while SUA was not a significant predictor of mortality among those who used diuretics.
Conclusions:
In patients with significant, angiographically defined CAD, SUA predicted mortality independent of traditional risk factors. This suggests that elevated SUA may be a risk factor for mortality in patients with significant cardiovascular disease and may be a stronger secondary than primary risk factor in CAD.
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