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Uric acid within the "normal" range predict 9-year cardiovascular mortality in older individuals. The InCHIANTI study
Gloria Brombo1, Francesco Bonetti1, Stefano Volpato1
1Department of Medical Sciences, Section of Internal and Cardiorespiratory Medicine, University of Ferrara, Italy.
Insights
High uric acid levels increase cardiovascular mortality risk. This study found the lowest mortality in older adults occurred at uric acid levels below 4.3 mg/dl, suggesting current targets may be too high.
Area of Science:
- Gerontology
- Cardiovascular Medicine
- Metabolic Health
Background:
- Elevated uric acid is linked to cardiovascular disease and mortality.
- Identifying a specific uric acid threshold for increased cardiovascular risk is crucial.
Purpose of the Study:
- To determine the uric acid concentration threshold associated with increased cardiovascular mortality in older adults.
- To investigate the relationship between uric acid levels and overall/cardiovascular mortality.
Main Methods:
- Analysis of data from the InCHIANTI study, a 9-year cohort study of 947 Italian adults over 64 years old.
- Participants were free from cardio-cerebrovascular disease at baseline.
- Plasma uric acid levels were analyzed using multivariate Cox proportional hazard models.
Main Results:
- Higher uric acid concentrations correlated with increased cardiovascular mortality.
- The lowest cardiovascular mortality was observed at uric acid levels around 4.1 mg/dl.
- A significant increase in cardiovascular mortality risk was noted for uric acid levels above 4.3 mg/dl.
Conclusions:
- In older adults without prior cardiovascular events, optimal uric acid levels for lowest mortality are below current targets.
- These findings suggest potential benefits of reducing uric acid levels in specific populations.
- Further research is warranted to confirm these observations and explore interventions.
Background And Aims:
Increased uric acid levels correlate with cardiovascular disease and cardiovascular/overall mortality. To identify a uric acid threshold above which cardiovascular mortality rises, we studied the relationship between uric acid concentration and overall/cardiovascular mortality.
Methods And Results:
We analyzed data from the InCHIANTI study, a cohort study of Italian community-dwelling people with 9 years of follow-up. We selected a sample of 947 individuals over 64 years of age, free from cardio-cerebrovascular disease and with available uric acid measurement at baseline. The sample was divided according to plasma uric acid tertiles. The Hazard ratio (HR) for mortality was calculated by multivariate Cox proportional hazard model. Mean age of participants was 75.3 ± 7.3 years; the mean value of uric acid was 5.1 ± 1.4 mg/dl. Over 9-years of follow-up, 342 (36.1%) participants died, 143 deaths (15.1%) were due to cardiovascular disease. Subjects with higher uric acid concentrations presented a higher cardiovascular mortality [II (4.6-5.5 mg/dl) vs I (1.8-4.5 mg/dl) tertile HR: 1.98, 95%C.I. 1.22-3.23; III (≥5.6 mg/dl) vs I tertile HR: 1.87, 95%C.I. 1.13-3.09]. We found a non-linear association between uric acid concentrations and cardiovascular mortality with the lowest mortality for values of about 4.1 mg/dl and a significant risk increment for values above 4.3 mg/dl.
Conclusion:
In community-dwelling older individuals free from cardio-cerebrovascular events, the lowest 9-year cardiovascular mortality was observed for uric acid values far below current target values. If confirmed, these data might represent the background for investigating the efficacy of uric acid levels reduction in similar populations.