Association between Serum Uric Acid and Mortality among Chinese Patients with Coronary Artery Disease

Abstract

Objectives: Several studies have investigated the association between serum uric acid (SUA) and the risks of coronary artery disease (CAD) but have yielded inconsistent results. The aim of this study was to assess whether there is an independent association of SUA with all-cause and cardiovascular disease (CVD) mortality in Chinese patients with CAD. Methods: A prospective cohort study of 1,799 patients was conducted. Cox regression models were used to estimate the association of SUA with the risk of death. Results: During a median follow-up of 3.9 years, 177 deaths were recorded and 126 of these were due to CVD. Patients in the highest SUA quartile had a 2.43-fold risk of all-cause mortality and a 2.44-fold risk of CVD mortality compared with those in the lowest quartile. In the subpopulation analysis, the association between SUA and mortality remained similar when participants were stratified by age, gender, body mass index and type of CAD. In contrast, we found a significant interaction with estimated glomerular filtration rate (eGFR). There was a stronger association between SUA and the risk of all-cause and CVD mortality among patients with an eGFR ≥60 ml/min/1.73 m², but no significant association was found in the population with an eGFR <60 ml/min/1.73 m². Conclusions: Elevated SUA levels were positively associated with an increased risk of all-cause and CVD mortality among CAD patients.

Serum uric acid and cardiovascular mortality in chronic kidney disease: a meta-analysis

“…After the first selection procedure, we evaluated 44 full-text articles further. Finally, 11 articles representing 27,081 study participants fulfilled all eligibility criteria [8–10, 16–20, 30–32]. A detailed description of our study selection is presented in Fig.…”

“…Gender-adjusted only SUA as continuous variable. Glycated hemoglobin-adjusted on in DM.8Li, 2016 [32]PCSChina, CKD 3–5421NANANANAMedian 3.9 yearsNATertile 4 vs. tertile 17.29–18.88 mg/dl vs ≤ 5.08 mg/dl0.72 (0.28,1.81)Age, gender, leisure-time physical activity, smoking, alcohol drinking, occupation, BMI, SBP, DBP, LDL-C, duration of CAD, type of CAD, history of diabetes, history of heart failure, coronary artery stenosis degree on coronary angiography, use of antidiabetic, cholesterol-lowering or antiplatelet drugs, use of diuretics, β-blockers and antihypertensive drugs6Conversion factors for units: serum uric acid in mg/dl to umol/l, ×59.48Abbreviations: AMI acute myocardial infarction, BMI body mass index, CAD coronary artery disease, CV cardiovascular, CVD cardiovascular disease, CHD coronary heart disease, CKD chronic kidney disease, DBP diastolic blood pressure, DM diabetes mellitus, DOPPS The Dialysis Outcome and Practice Patterns Study, DES drug-eluting stent, eGFR estimated glomerular filtration rate, ESRD end-stage renal disease, FMD flow-mediated dilatation, HD hemodialysis, HDL-C high density lipoprotein cholesterol, HOMA-IR homeostasis model assessment-insulin resistance, hsCRP high sensitivity C reactive protein, LDL-C low density lipoprotein cholesterol, MHD maintenance hemodialysis, MDRD Modification of Diet In Renal Disease, NDM nondiabetes, NMD nitroglycerine-mediated dilatation, NA not available, PD peritoneal dialysis, SBP systolic blood pressure, SSOP Socioeconomic Status on the Outcome of Peritoneal Dialysis, SUA serum uric acid, RCT randomized controlled trial, PCS prospective cohort study, RCS retrospective cohort study…”

The Prognostic Role of Serum Uric Acid (SUA) in Coronary Artery Disease: PerSUAsive Data Plea for a Large Morbidity-Mortality Trial

“…In this issue of Cardiology , Li et al [8 ]present data on a well-characterized Chinese cohort with CAD. Their prospective study categorized 1,799 subjects admitted with either established or newly diagnosed CAD into quartiles of SUA measured at index admission.…”

“…While some data suggest differences in demographics between these two types of CAD, no information was available regarding troponin or other markers of myocardial injury. The novelty and major conclusion from the work by Li et al [8] is that SUA is a prognosticator in CAD subjects of Chinese descent. …”

“…Consequently, we strongly advocate for an adequately powered morbidity-mortality trial to prospectively evaluate xanthine oxidase inhibitors - an inexpensive and safe drug class - in patients with CAD and elevated SUA. The findings by Li et al in this issue of Cardiology [8] suggest that such a trial should also enroll Chinese patients as these are at similar risk.…”