title: Serum uric acid and risk of ischemic stroke: the ARIC Study.
abstract: OBJECTIVE
  Since serum uric acid (UA) is strongly associated with cardiovascular risk factors, it has been debated whether serum UA is a stroke risk factor or whether UA may be simply "marking" subjects with other, causal risk factors. We therefore investigated the relation between UA and ischemic stroke in the Atherosclerosis Risk in Communities (ARIC) Study.
  
  
  RESULTS
  Of 15,792 ARIC participants, 13,413 who were free of recognized stroke or coronary heart disease (CHD) at baseline and had a baseline UA measurement were included in the analysis. We followed the participants for ischemic stroke incidence (N=381) over 12.6 years. Although serum UA was independently and positively related to ischemic stroke incidence when we adjusted for age, sex, race, and education, the positive relation was weakened when additionally adjusted for possible confounding variables. The positive multivariate-adjusted association between serum UA and ischemic stroke was observed among subjects not using diuretics (adjusted relative hazard in the highest quartile versus the lowest: relative hazard (RH)=1.49; 95% confidence interval (CI): 1.00-2.23) (P for trend: 0.02), but not among diuretic users (P for interaction: 0.08).
  
  
  CONCLUSIONS
  Our findings suggest that UA is an independent predictor of ischemic stroke among subjects not using diuretics, but that elevated UA itself may not cause ischemic stroke.
authors.affiliation: Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, 1300 South 2nd Street, Suite 300, Minneapolis, MN 55454-1015, USA.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Hozawa
authors.forename: Aaron R
authors.initials: AR
authors.lastname: Folsom
authors.forename: Hassan
authors.initials: H
authors.lastname: Ibrahim
authors.forename: F Javier
authors.initials: FJ
authors.lastname: Nieto
authors.forename: Wayne D
authors.initials: WD
authors.lastname: Rosamond
authors.forename: Eyal
authors.initials: E
authors.lastname: Shahar
mesh_terms: D015415:Biomarkers; D002545:Brain Ischemia / Q000097:blood* / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D015995:Prevalence; D012307:Risk Factors; D017678:Sex Distribution; D020521:Stroke / Q000097:blood* / Q000453:epidemiology*; D014527:Uric Acid / Q000097:blood*
chemical_list: D015415:Biomarkers; D014527:Uric Acid