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Risk reclassification ability of uric acid for cardiovascular outcomes in essential hypertension

Maria Perticone1, Giovanni Tripepi2, Raffaele Maio3

  • 1Department of Experimental and Clinical Medicine, University Magna Græcia of Catanzaro, Italy.

International Journal of Cardiology
|May 23, 2017
PubMed

Insights

High uric acid (UA) levels independently predict cardiovascular events in hypertensive patients with normal kidney function. Including UA in risk models significantly improves cardiovascular risk stratification, aiding in better patient management.

Area of Science:

  • Cardiology
  • Nephrology
  • Clinical Risk Stratification

Background:

  • Hyperuricemia is a known risk factor for cardiovascular events across diverse patient populations.
  • This study investigated the prognostic value of uric acid (UA) in stratifying cardiovascular risk among hypertensive individuals with normal renal function.

Purpose of the Study:

  • To determine if incorporating uric acid (UA) into Cox regression models enhances cardiovascular risk stratification in patients with hypertension and preserved renal function.
  • To assess the independent predictive value of UA for cardiovascular and coronary outcomes.

Main Methods:

  • Utilized multiple Cox regression models to analyze the association between UA and cardiovascular outcomes in 1522 hypertensive patients.
  • Employed Harrell's C-index, Net Reclassification Index (NRI), and Integrated Discrimination Improvement (IDI) to evaluate the incremental prognostic value of UA.
  • Outcomes included fatal/nonfatal cardiovascular events and coronary outcomes/death from other cardiovascular causes.

Main Results:

  • Uric acid (UA) showed a strong association with cardiovascular outcomes in unadjusted analyses (P<0.001).
  • Inclusion of UA in Cox models with standard risk factors and e-GFR did not alter its independent predictive power (HR=1.44-1.48, P<0.001).
  • UA significantly improved prognostic accuracy, increasing Harrell's C-index (+5%), NRI (+24.9%), and IDI (+7.6%) for cardiovascular events (P<0.001).

Conclusions:

  • Uric acid (UA) is an independent predictor of cardiovascular outcomes in hypertensive patients with normal renal function.
  • Adding UA to risk models, including Framingham risk factors and e-GFR, significantly enhances prognostic accuracy and enables risk reclassification.
  • These findings support the utility of UA measurement for improved cardiovascular risk assessment in this patient group.
Abstract

Keywords:
Cardiovascular riskEssential hypertensionUric acid

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