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.
Division of Epidemiology and Preventive Medicine, Sackler Medical Faculty, Tel-Aviv, Israel. gerber.yariv@mayo.edu
Yariv
Y
Gerber
David
D
Tanne
Jack H
JH
Medalie
Uri
U
Goldbourt
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