Serum uric acid and the risk of mortality during 23 years follow-up in the Scottish Heart Health Extended Cohort Study

Abstract

Background Elevated uric acid is a prevalent condition with controversial health consequences. Observational studies disagree with regard to the relationship of uric acid with mortality, and with factors modifying this relationship. Objective We examined the association of serum uric acid with mortality in 15,083 participants in the Scottish Heart Health Extended Cohort (SHHEC) Study. Methods Serum uric acid measured at study enrollment. Death was ascertained using both the Scottish death register and record linkage. Results During a median follow-up of 23 years, there were 3,980 deaths. In Cox proportional hazards models with sexes combined, those in the highest fifth of uric acid had significantly greater mortality (HR 1.18, 95% CI: 1.06, 1.31) compared with the second fifth, after adjustment for traditional cardiovascular risk factors. This relationship was modified by sex (P-interaction = 0.002) with adjusted HRs of 1.69 (95% CI: 1.40, 2.04) and 0.99 (95% CI: 0.86, 1.14) in women and men, respectively. Compared with the second fifth, the highest fifth of uric acid was most associated with kidney-related death (HR: 2.08, 95% CI: 1.31, 3.32). Conclusion Elevated uric acid is associated with earlier mortality, especially in women. Future studies should evaluate mechanisms for these interactions and explore the strong association with renal-related mortality.

Hyperuricemia and risk of increased arterial stiffness in healthy women based on health screening in Korean population

“…Barbieri et al [22] further showed that higher uric acid levels are significantly associated with higher prevalence of severe coronary artery disease only in women. Their findings are similar to ours, and this sex-linked difference was also found in other larger studies, such as the Chicago Heart Association Detection Project [23], National Health and Nutrition Examination Survey I epidemiologic follow-up study [24], post hoc analysis of the Losartan Intervention For Endpoint reduction in hypertension trials [25], and Scottish Heart Health Extended Cohort study [26]. The Scottish Heart Health Extended Cohort study demonstrated that uric acid level is more strongly associated with mortality in women than in men [26].…”

Serum uric acid as a predictor for cardiovascular and all-cause mortality in women versus men

“…Higher levels of serum uric acid (SUA) are confirmed in men than in women at all ages [1]. Many studies [2][3][4][5] indicated excess mortality in women than men, but others [6,7] did not confirm these findings. Most studies on SUA levels and mortality risk were conducted in a single sex populations [8][9][10][11] or not conducted gender specific analyses [12].…”

“…Overall quality of the included studies was good (range from 6 to 8) based on a 9-star NOS scales. Six studies [2][3][4][5][6][7] reported data on all-cause mortality according to the gender. Compared the highest to lowest SUA category, pooled RR of all-cause mortality was 1.15 (95% CI 0.89-1.49) for women and 1.13 for men (Fig.2).…”

“…Our initial search identified 629 articles, six studies [2][3][4][5][6][7] finally included in this meta-analysis. Characteristics of the individual studies are shown in Table 1.…”

Opposing effects of sodium intake on uric acid and blood pressure and their causal implication

“…Elevated uric acid levels often accompany high blood pressure (1,2) and are associated with cardiovascular disease risk (3–7). Recently, several trials of urate-lowering therapy have shown that short-term reductions in uric acid are associated with a reduction in blood pressure (8–11).…”