Serum uric acid and long-term mortality from stroke, coronary heart disease and all causes.
BACKGROUND
Increased serum uric acid (SUA) levels are linked to obesity, dyslipidemia, diabetes and hypertension. Whether SUA carries a risk for coronary heart disease (CHD) and stroke remains uncertain.


METHODS
A prospective cohort study.


METHODS
Of an original cohort of middle-aged workers who were examined in 1963 and followed-up for 23 years, 9125 men, free of CHD at entry, are included in this study. Subjects were divided into quintiles according to baseline SUA levels. Hazard ratios (HR) for all-cause, CHD, and stroke mortality were estimated in SUA quintiles, with the third serving as a referent.


RESULTS
During follow-up, 2893 deaths were recorded, including 830 ascribed to CHD and 292 to stroke. The HR for all death [1.22, 95% confidence interval (CI) 1.09-1.37] and CHD (1.29, 95% CI 1.05-1.58) were increased in the upper SUA quintile. Fatal stroke showed a U-shaped relationship as both the upper (HR 1.48, 95% CI 1.02-2.17) and bottom (HR 1.43, 95% CI 0.99-2.08) quintiles were associated with a higher risk. Adjustment for confounders reduced the HR of the upper quintile for all outcomes, but did not attenuate the association of the bottom quintile with stroke (HR 1.52, 95% CI 1.04-2.23). When analysed separately by stroke type, the latter association seemed to be stronger for hemorrhagic (HR 3.27, 95% CI 1.14-9.33) than for ischemic stroke (HR 1.34, 95% CI 0.87-2.05).


CONCLUSIONS
In addition to findings supporting increased mortality among hyperuricemic subjects, we identified an association between low SUA levels and fatal stroke, which deserves further investigation.
Gerber
Yariv
Y
Division of Epidemiology and Preventive Medicine, Sackler Medical Faculty, Tel-Aviv, Israel. gerber.yariv@mayo.edu
Tanne
David
D
Medalie
Jack H
JH
Goldbourt
Uri
U
D015415:Biomarkers / Q000097:blood*; D015331:Cohort Studies; D003327:Coronary Disease / Q000097:blood / Q000401:mortality*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012044:Regression Analysis; D020521:Stroke / Q000097:blood / Q000401:mortality*; D016019:Survival Analysis; D013997:Time Factors; D014527:Uric Acid / Q000097:blood*
D015415:Biomarkers; D014527:Uric Acid