Serum uric acid for risk stratification of patients with coronary artery disease.
OBJECTIVE
In patients with coronary artery disease (CAD), elevated serum uric acid (SUA) levels may predict worse cardiovascular outcomes. It is known that SUA levels are influenced by renal function. We aimed to assess the predictive value of SUA while taking into account patients' renal function.


METHODS
The primary end point (PEP) risk, including fatal or nonfatal myocardial infarction (MI) or sudden death, was assessed by SUA quintiles before and after adjustment for the estimated glomerular filtration rate (eGFR) in 2,796 nondiabetic CAD patients enrolled in the Bezafibrate Infarction Prevention study.


RESULTS
The PEP risk increased from the lowest (11.8%) to highest SUA quintile (18.0%), p < 0.005, respectively. After adjustment for age, sex, smoking, prior MI, metabolic syndrome variables, NYHA classes II-IV, heart rate and treatment with bezafibrate, diuretics, angiotensin-converting enzyme inhibitors, beta-blockers, calcium channel blockers and antiplatelets, the highest SUA quintile exhibited the highest PEP risk [hazard ratio (HR): 1.47 (95% CI: 1.06-2.04)]. Patients in the highest - compared with those in the lowest - quintiles continued to demonstrate an increased PEP risk [HR: 1.46 (95% CI: 1.04-2.06)], even after additional adjustment for the eGFR.


CONCLUSIONS
In nondiabetic patients with CAD, elevated SUA levels are associated with an increased risk of cardiac events, independent of renal function.
Heart Institute, Sheba Medical Center, Tel Hashomer, Israel. brodov_y@bezeqint.net
Yafim
Y
Brodov
Pierre
P
Chouraqui
Ilan
I
Goldenberg
Valentina
V
Boyko
Lori
L
Mandelzweig
Shlomo
S
Behar
D000368:Aged; D015415:Biomarkers / Q000097:blood; D003324:Coronary Artery Disease / Q000097:blood* / Q000150:complications; D016757:Death, Sudden, Cardiac; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000150:complications; D011237:Predictive Value of Tests; D051437:Renal Insufficiency / Q000097:blood* / Q000150:complications; D012189:Retrospective Studies; D018570:Risk Assessment; D014527:Uric Acid / Q000097:blood*
D015415:Biomarkers; D014527:Uric Acid