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Added predictive value of high uric acid for cardiovascular events in the Ambulatory Blood Pressure International
Gianpaolo Reboldi1, Paolo Verdecchia2, Francesca Saladini3
1University of Perugia, Perugia, Italy.
Insights
High uric acid (UA) levels are a significant predictor of cardiovascular events (CVE). This study identified sex-specific cut-points, revealing that elevated UA independently increases CVE risk, particularly in men.
Area of Science:
- Cardiovascular Medicine
- Metabolic Health
- Epidemiology
Background:
- The prognostic significance of uric acid (UA) for cardiovascular events (CVE) remains a subject of ongoing research and debate.
- Understanding the relationship between UA and CVE is crucial for refining cardiovascular risk assessment.
Purpose of the Study:
- To investigate the association between uric acid levels and cardiovascular events in a large cohort.
- To identify optimal sex-specific cut-points for uric acid to predict cardiovascular risk.
Main Methods:
- Utilized multivariable Cox regression and survival models with UA as both a continuous and categorical variable.
- Analyzed data from 5243 participants in the ABP-International study with a median follow-up of 5.9 years.
- Employed an outcome-oriented approach to determine optimal sex-specific UA cut-points.
Main Results:
- Uric acid was a significant predictor of CVE in all participants, men, and women, with a linear relationship observed.
- For every 1 mg/dL increase in UA, the relative hazard for CVE increased by 16% in men and 19% in women.
- Optimal cut-points were identified as 6.3 mg/dL for men and 4.4 mg/dL for women; high UA was associated with a 38% greater CVE risk, significant primarily in men.
Conclusions:
- Elevated uric acid is an independent predictor of subsequent cardiovascular events.
- Sex-specific uric acid cut-points improve cardiovascular risk discrimination and reclassification beyond traditional models.
- The findings underscore the importance of considering uric acid levels in cardiovascular risk assessment, particularly in men.
Abstract:
The prognostic value of uric acid (UA) for cardiovascular events (CVE) is still debated. Our purpose was to investigate the association between UA and CVE in 5243 participants of the ABP-International study with the main aim of identifying optimal sex-specific cut-points. In multivariable Cox analyses, the relationship between CVE and UA as a continuous variable was modeled by including both linear and nonlinear terms. Survival models were also estimated with UA as a categorical variable. Optimal UA cut-points were determined using an outcome-oriented approach. During a median follow-up of 5.9 years, there were 423 CVE (93 fatal). In age- and sex-adjusted Cox models, UA as a continuous variable was a significant predictor of CVE in all individuals and in men and women considered separately. The relationship between UA and CVE was linear (P-value for nonlinearity 0.54 and 0.80 for men and women, respectively). For each 1 mg/dL increase in UA, the relative hazard increase was 16% in men and 19% in women. In fully adjusted models, UA remained a significant predictor of CVE in the whole study cohort. The optimal cut-point best separating patients at low and high risk of CVE was 6.3 mg/dL for men and 4.4 mg/dL for women. Subjects with high UA had a 38% greater risk of CVE. In a sex-specific analysis, the association remained significant only in men (hazard ratio, 1.47; P < 0.01). In conclusion, high UA is an independent predictor for subsequent CVE and significantly improves risk discrimination and reclassification over the baseline multivariable model.
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