The relation of postmenopausal hormone therapy to serum uric acid and the risk of coronary heart disease events: the Heart and Estrogen-Progestin Replacement Study (HERS).
OBJECTIVE
To determine whether baseline serum uric acid (UA) levels and estrogen-progestin (E+P)-associated change in serum UA in postmenopausal women with coronary disease are associated with recurrent coronary heart disease (CHD) events.


METHODS
2763 postmenopausal women enrolled in the Heart and Estrogen-Progestin Replacement Study (HERS) were randomly assigned to take conjugated E+P or placebo in a secondary CHD prevention study. The primary outcome for these analyses was nonfatal myocardial infarction or CHD death during a mean follow up of 4.1 years.


RESULTS
The baseline serum UA for the cohort was 5.4 mg/dl and, compared with placebo, E+P on average lowered serum UA levels slightly (0.2 mg/dl) at one year of follow up (p<0.0001). Baseline serum UA levels were associated in simple proportional hazards models with CHD events; each standard deviation increase (1.3 mg/dl) was associated with a 22% increased risk of primary CHD events (p=.0001). This association, however, was no longer statistically significant after multivariable adjustment (p=0.36). There was no association between on-study change in serum UA level and any CHD outcome.


CONCLUSIONS
Treatment with E+P lowered serum UA levels slightly, but neither baseline UA nor change in UA affected CHD risk.
Simon
Joel A
JA
General Internal Medicine Section, Medical Service, Veterans Affairs Medical Center, and Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco 94121, USA. jasimon@itsa.ucsf.edu
Lin
Feng
F
Vittinghoff
Eric
E
Bittner
Vera
V
D000368:Aged; D015415:Biomarkers; D008076:Cholesterol, HDL / Q000097:blood / Q000187:drug effects; D008078:Cholesterol, LDL / Q000097:blood / Q000187:drug effects; D003327:Coronary Disease / Q000097:blood / Q000453:epidemiology / Q000517:prevention & control*; D003404:Creatinine / Q000097:blood; D015914:Estrogen Replacement Therapy / Q000009:adverse effects / Q000379:methods*; D004966:Estrogens, Conjugated (USP) / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D017258:Medroxyprogesterone Acetate / Q000009:adverse effects / Q000627:therapeutic use*; D017698:Postmenopause / Q000097:blood; D011237:Predictive Value of Tests; D012307:Risk Factors; D014280:Triglycerides / Q000097:blood; D014527:Uric Acid / Q000097:blood*
D015415:Biomarkers; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D004966:Estrogens, Conjugated (USP); D014280:Triglycerides; D014527:Uric Acid; D003404:Creatinine; D017258:Medroxyprogesterone Acetate