Inflammation Mediates the Relationship Between Serum Uric Acid and New-Onset Diabetes Risk in Patients with Coronary...

Serum uric acid (SUA), a key metabolite in purine metabolism, has been linked to various metabolic disturbances. However, its specific role in the development of new-onset diabetes among patients with coronary heart disease (CHD) remains unclear.

This multi-center study included 5141 CHD patients. To assess the relationship between SUA and diabetes, we used Cox regression and generalized additive models, along with gender-stratified threshold analyses to explore the dose-response pattern. Additionally, the incremental predictive value of SUA was evaluated by calculating the integrated discrimination improvement (IDI) and net reclassification improvement (NRI). Lastly, mediation analysis was performed to examine the potential role of inflammatory markers in the observed association.

Elevated SUA levels were significantly associated with an increased risk of diabetes in CHD patients, showing a clear nonlinear relationship. We identified risk thresholds at SUA levels of >345 μmol/L for females and >350.5 μmol/L for males. SUA levels improved diabetes risk prediction, with NRI=0.033 and IDI=0.003. Furthermore, mediation analysis revealed that inflammatory markers partially mediated the association between SUA and diabetes risk, with the highest proportion of mediation reaching 32.27%.

Elevated SUA is an independent risk factor for new-onset diabetes in CHD patients, with gender-specific risk thresholds. This association is partially mediated through inflammation. Monitoring and managing SUA levels may help reduce the risk of diabetes in this high-risk group. Moreover, the mediating role of inflammation provides an important basis for future in-depth mechanistic studies.