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High heart rate amplifies the risk of cardiovascular mortality associated with elevated uric acid

Paolo Palatini1, Gianfranco Parati2, Agostino Virdis3

  • 1Department of Medicine, Studium Patavinum, University of Padova, Via S. Fris 121, 31029 Vittorio Veneto, Italy.

European Journal of Preventive Cardiology
|February 14, 2021
PubMed

Insights

Elevated uric acid (UA) increases cardiovascular mortality risk, but this risk is significantly lower in individuals with lower resting heart rates (HR). Heart rate modulates the impact of UA on cardiovascular health.

Area of Science:

  • Cardiovascular Medicine
  • Metabolic Health
  • Epidemiology

Background:

  • The association between uric acid (UA) and cardiovascular disease (CVD) is complex and potentially influenced by other physiological factors.
  • Resting heart rate (HR) is a known cardiovascular risk factor, but its role in modulating the UA-CVD relationship is not well understood.

Purpose of the Study:

  • To investigate whether resting heart rate (HR) influences the association between elevated uric acid (UA) and cardiovascular mortality (CVM).
  • To determine if HR acts as a modulator for UA's risk in predicting CVM.

Main Methods:

  • Utilized data from 19,128 participants in the Uric acid Right for heArt Health (URRAH) study.
  • Employed multivariable Cox regression analyses with a median follow-up of 11.2 years to assess predictors of CVM.
  • Analyzed UA and HR as both continuous and categorical variables, and stratified analyses by HR levels.

Main Results:

  • Both UA and HR were independent predictors of CVM, improving risk discrimination and reclassification.
  • High UA (≥5.5 mg/dL) posed a significantly lower CVM risk in individuals with HR below the median (1.38) compared to those with HR at or above the median (2.09).
  • Risk associated with hyperuricemia was substantially higher in participants with higher HR tertiles (≥76 bpm) versus lower tertiles (<66 bpm).

Conclusions:

  • The impact of uric acid on cardiovascular mortality is modulated by resting heart rate.
  • Findings support the hypothesis that sympathetic nervous system activation, potentially reflected by higher HR, facilitates UA's role as a cardiovascular risk factor.
Abstract

Keywords:
CardiovascularHeart rateLongitudinal studyMortalitySympathetic activityUric acid

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