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Serum uric acid variation and the risk of cardiovascular disease: A prospective cohort study
Xue Tian1, Shuohua Chen2, Yijun Zhang1
1Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China.
Insights
Serum uric acid (SUA) variation, not just high levels, increases cardiovascular disease (CVD) risk. Both rising and falling SUA levels elevate CVD risk, primarily driven by inflammation and blood pressure.
Area of Science:
- Cardiology
- Metabolic Health
- Epidemiology
Background:
- The link between serum uric acid (SUA) and cardiovascular disease (CVD) is unclear, often based on single measurements.
- Previous studies lack analysis of SUA level fluctuations over time.
Purpose of the Study:
- To investigate the association between serum uric acid (SUA) variation and cardiovascular disease (CVD) risk.
- To assess how the magnitude and direction of SUA changes impact CVD risk.
Main Methods:
- Analysis of 41,578 participants from the Kailuan study with four biennial SUA measurements (2006-2012).
- Quantification of SUA variation using coefficient of variation, standard deviation, and other metrics.
- Application of Cox regression and Bayesian networks to determine CVD risk and pathways.
Main Results:
- A significant association was found between substantial SUA variation and increased CVD risk (HR 1.24).
- Both increases and decreases in SUA levels were linked to higher CVD risk (HRs 1.24 and 1.19, respectively).
- Older adults showed a greater impact of SUA variation on CVD risk.
Conclusions:
- Elevated serum uric acid (SUA) variation is a significant predictor of cardiovascular disease (CVD) risk.
- The direction of SUA fluctuation (increase or decrease) did not alter the heightened CVD risk.
- Inflammation and elevated blood pressure are key mediators in the SUA variation-CVD pathway.
Background:
The association of serum uric acid (SUA) with cardiovascular disease (CVD) is inconsistent and limited by a single measurement of SUA. This study aimed to investigate the association of SUA variation, considering its magnitude and direction, with the risk of CVD.
Methods:
This study included 41,578 participants with four biennial measurements of SUA during 2006-2012 from the Kailuan study. SUA variation was measured using the coefficient of variation (primary index), standard deviation, average real variability, and variability independent of mean, and the direction of variation was also assessed. Multivariate-adjusted Cox regressions were used to assess the associations, and Bayesian network was utilized to find the most important pathway from SUA variation to CVD.
Results:
During a median follow-up of 6.74 (interquartile range: 6.45-7.03) years, we identified 1,852 (4.45%) cases of incident CVD. A large SUA variation (top vs. bottom tertiles) was associated with a higher risk of CVD (hazard ratio [HR], 1.24; 95% confidence interval [CI], 1.11-1.40), especially in older adults than that in young adults (Pint=0.0137). The higher risk of CVD was observed with both large rises (HR, 1.24; 95% CI, 1.10-1.39) and falls (HR, 1.19; 95% CI, 1.03-1.38) in SUA variation. The hazardous effect of SUA variation on CVD was mainly induced by excessive inflammation and elevated blood pressure. Similar results were observed for CVD subtypes.
Conclusions:
Elevated SUA variation was associated with a higher risk of CVD, irrespective of the direction of SUA variation, and inflammation played an important role in the pathway.
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