The serum urate-lowering impact of weight loss among men with a high cardiovascular risk profile: the Multiple Risk Factor Intervention Trial.
OBJECTIVE
To evaluate the person-level impact of weight loss on serum urate levels among men with a high cardiovascular risk profile.


METHODS
We analysed 12,379 men (mean serum urate level=407 μmol/l) from the Multiple Risk Factor Intervention Trial, using data prospectively collected at baseline and annually over a 7-year period (78,881 visits). Our endpoint was normouricaemia, defined by serum urate levels≤360 μmol/l, a widely accepted therapeutic target. Person-level effects were estimated using conditional logistic regression models to adjust for time-varying covariates (age, congestive heart failure, hypertension, diuretic use, renal function, alcohol intake and dietary factors).


RESULTS
There was a graded relation between weight loss and achieving normouricaemia (P-value for trend<0.001). Compared with no weight change (-0.9 to 0.9 kg), the multivariate odds ratios of achieving normouricaemia for a weight loss of 1-4.9, 5-9.9 and ≥10 kg were 1.43 (95% CI: 1.33, 1.54), 2.17 (1.95, 2.40) and 3.90 (3.31, 4.61), respectively. The corresponding serum urate level changes were -7, -19 and -37 μmol/l (-0.12, -0.31 and -0.62 mg/dl). Similar levels of associations persisted among subgroups stratified by demographics, presence of gout, hypertension, diuretic use, renal insufficiency, alcohol intake, trial group assignment and adiposity categories (all P-values for trend<0.001).


CONCLUSIONS
Weight reduction could help achieve a widely accepted therapeutic urate target level (≤360 μmol/l) among men with a high cardiovascular risk profile. Although the urate-lowering effect appeared weaker than that of urate-lowering drugs, other associated health benefits would make weight reduction important, particularly in this population.
Zhu
Yanyan
Y
Section of Rheumatology and the Clinical Epidemiology Unit, Department of Medicine, Boston University School of Medicine, 650 Albany Street Suite 200, Boston, MA 02118, USA.
Zhang
Yuqing
Y
Choi
Hyon K
HK
D001835:Body Weight; D002318:Cardiovascular Diseases / Q000209:etiology / Q000517:prevention & control*; D015331:Cohort Studies; D005500:Follow-Up Studies; D006073:Gout / Q000150:complications*; D006801:Humans; D006973:Hypertension / Q000150:complications*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D012307:Risk Factors; D014527:Uric Acid / Q000097:blood* / Q000378:metabolism; D015431:Weight Loss / Q000502:physiology*
D014527:Uric Acid
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