Serum urate and the risk of major coronary heart disease events.
OBJECTIVE
To examine the relation between serum urate and the risk of major coronary heart disease events.


METHODS
A prospective study of a male cohort.


METHODS
One general practice in each of 24 British towns.


METHODS
7688 men aged 40-59 years at screening.


METHODS
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.
Wannamethee
S G
SG
Department of Primary Care and Population Sciences, Royal Free Hospital School of Medicine, London, UK.
Shaper
A G
AG
Whincup
P H
PH
D000328:Adult; D015415:Biomarkers / Q000097:blood; D002784:Cholesterol / Q000097:blood; D003324:Coronary Artery Disease / Q000097:blood / Q000401:mortality; D003327:Coronary Disease / Q000097:blood* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000401:mortality; D011446:Prospective Studies; D012307:Risk Factors; D014527:Uric Acid / Q000097:blood*
D015415:Biomarkers; D014527:Uric Acid; D002784:Cholesterol