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Serum urate and the risk of major coronary heart disease events
S G Wannamethee1, A G Shaper, P H Whincup
1Department of Primary Care and Population Sciences, Royal Free Hospital School of Medicine, London, UK.
Insights
Serum urate is associated with coronary heart disease risk, particularly in men with prior myocardial infarction. However, it is not an independent risk factor, being linked to other metabolic factors.
Area of Science:
- Cardiovascular Medicine
- Metabolic Syndrome Research
- Epidemiology
Background:
- Elevated serum urate levels are common and associated with various health conditions.
- Understanding the independent role of serum urate in cardiovascular disease (CVD) risk is crucial for clinical practice.
Purpose of the Study:
- To investigate the relationship between serum urate and the risk of major coronary heart disease (CHD) events.
- To determine if serum urate is an independent risk factor for CHD.
Main Methods:
- Prospective study of 7688 men aged 40-59.
- Follow-up for major fatal and non-fatal CHD events over an average of 16.8 years.
- Statistical analysis adjusted for multiple cardiovascular risk factors.
Main Results:
- Serum urate showed a positive association with CHD risk, influenced by factors like body mass index and blood pressure.
- This association was attenuated by diastolic blood pressure and total cholesterol, with cholesterol being a critical factor.
- A significant positive association was observed only in men with previous myocardial infarction.
Conclusions:
- Serum urate is not an independent risk factor for CHD.
- The association is dependent on pre-existing conditions like myocardial infarction and atherosclerosis.
- Raised serum urate is part of a cluster of risk factors associated with insulin resistance syndrome.
Objective:
To examine the relation between serum urate and the risk of major coronary heart disease events.
Design:
A prospective study of a male cohort.
Setting:
One general practice in each of 24 British towns.
Subjects:
7688 men aged 40-59 years at screening.
Main Outcome Measures:
Fatal and non-fatal coronary heart disease events.
Results:
There were 1085 major coronary heart disease events during the average follow up period of 16.8 years. Serum urate was significantly associated with a wide range of cardiovascular risk factors including body mass index, alcohol intake, antihypertensive treatment, pre-existing coronary heart disease, serum triglycerides, cholesterol, and diastolic blood pressure. There was a significant positive association between serum urate and risk of coronary heart disease after adjustment for lifestyle factors and disease indicators. This relation was attenuated to non-significance upon additional adjustment for diastolic blood pressure and serum total cholesterol: cholesterol appeared to be the critical factor in attenuating this relation. When the association between serum urate and risk of coronary heart disease was examined by presence and grade of pre-existing coronary heart disease, a positive association was seen only in men with previous definite myocardial infarction, even after full adjustment (P = 0.07).
Conclusions:
The relation between serum urate and the risk of coronary heart disease depends heavily upon the presence of pre-existing myocardial infarction and widespread underlying atherosclerosis as well as the clustering of risk factors. Thus serum urate is not a truly independent risk factor for coronary heart disease. Raised serum urate appears to be an integral part of the cluster of risk factors associated with the insulin resistance syndrome that include obesity, raised serum triglycerides, and serum cholesterol.