Joint Association of Hyperuricemia and Vitamin D Deficiency with Cardiovascular Disease Risk and All-Cause Mortality

The aim of this study was to investigate the independent and joint associations of serum uric acid (SUA) and 25-hydroxyvitamin D with the risk and all-cause mortality of cardiovascular disease (CVD).The data of participants aged ≥ 20 years, with or without CVD, from National Health and Nutrition Examination Survey (NHANES) 2007-2018 were included. Multivariable logistic regression, Kaplan-Meier curve, Cox proportional-hazards model, and restricted cubic spline analysis were employed to evaluate the associations between hyperuricemia (HUA) and vitamin D deficiency (VDD) with the risk and all-cause mortality of CVD. Sensitivity analysis and propensity score matching were performed to test the stability of findings.A total of 30,337 (Weighted n = 208,828,585) participants were involved in this study, including 3360 CVD patients (Weighted n = 18,316,965). The participant group with both HUA and VDD exhibited the highest risk of CVD (OR 1.50 (1.17-1.83), P for trend < 0.01). Kaplan-Meier curves demonstrated a statistically significant difference in survival probability over different categories in mortality outcomes. Patients with both HUA and VDD exhibited the highest risk of all-cause mortality (HR 1.96 (1.47-2.62), P for trend < 0.01). An estimated 35%~38% of the increased all-cause mortality was attributable to the comorbidity of HUA and VDD in CVD patients.Combined HUA and VDD were significantly associated with increased risk of CVD and elevated the risk of all-cause mortality in CVD patients. These findings indicate that concurrent management of HUA and VDD may reduce the burden of CVD and improve prognosis in CVD patients.