title: Uric acid and cardiovascular disease risk reclassification: findings from NHANES III.
abstract: BACKGROUND
  The studied associations between serum uric acid (sUA) and cardiovascular disease (CVD) events have been controversial. We sought to evaluate the association between sUA and CVD mortality, including its ability to reclassify risk in a multiethnic nationally representative population free of clinical CVD and diabetes at baseline.
  
  
  METHODS
  The study cohort included 11,009 adults enrolled as a part of the National Health and Nutrition Examination Survey (NHANES) III. Multivariate Cox proportional hazard analysis was performed to evaluate sUA as a predictor of CVD and coronary heart disease (CHD) mortality. Discriminative and recalibrative properties of sUA for CHD deaths were also assessed over traditional CVD risk factors. Net reclassification index (NRI) was calculated by comparing regression models incorporating traditional CVD risk factors with and without sUA.
  
  
  RESULTS
  sUA was not predictive of either CVD mortality [model 4: hazards ratio (HR) 1.06, 95% confidence interval (CI) 0.96-1.16, p = 0.27] or CHD mortality (model 4: HR 1.06, 95% CI 0.94-1.19, p = 0.32). Addition of sUA to traditional CVD risk factors resulted in no significant increment in c-statistic, receiver-operating characteristics-area under curve, absolute NRI (0.5%, 95% CI -1.9 to 2.9%, p = 0.68), or intermediate NRI (2.5%, 95% CI -1.6 to 6.6%, p = 0.24) for prediction of hard CHD deaths.
  
  
  CONCLUSIONS
  sUA was not an independent predictor of both CVD and CHD mortality. Ethnicity did not influence the association of sUA with CVD mortality. Furthermore, sUA did not add to risk assessment beyond traditional CVD risk factors.
authors.affiliation: Department of Internal Medicine, Division of Cardiology, Wayne State University, Detroit Medical Center, Detroit, USA.
authors.forename: Sandip K
authors.initials: SK
authors.lastname: Zalawadiya
authors.affiliation: Department of Internal Medicine, Division of Cardiology, Wayne State University, Detroit Medical Center, Detroit, USA.
authors.forename: Vikas
authors.initials: V
authors.lastname: Veeranna
authors.affiliation: Department of Internal Medicine, Division of Cardiology, Wayne State University, Detroit Medical Center, Detroit, USA.
authors.forename: Sagar
authors.initials: S
authors.lastname: Mallikethi-Reddy
authors.affiliation: Department of Internal Medicine, St Luke's Roosevelt Hospital Center, New York, USA.
authors.forename: Chirag
authors.initials: C
authors.lastname: Bavishi
authors.affiliation: Department of Internal Medicine, Division of Cardiology, Wayne State University, Detroit Medical Center, Detroit, USA.
authors.forename: Abhishekh
authors.initials: A
authors.lastname: Lunagaria
authors.affiliation: Department of Internal Medicine, Division of Cardiology, Wayne State University, Detroit Medical Center, Detroit, USA.
authors.forename: Anupama
authors.initials: A
authors.lastname: Kottam
authors.affiliation: Department of Internal Medicine, Division of Cardiology, Wayne State University, Detroit Medical Center, Detroit, USA lafonso@med.wayne.edu.
authors.forename: Luis
authors.initials: L
authors.lastname: Afonso
mesh_terms: D000328:Adult; D000368:Aged; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000097:blood* / Q000145:classification / Q000175:diagnosis / Q000208:ethnology / Q000401:mortality; D016002:Discriminant Analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009749:Nutrition Surveys; D011379:Prognosis; D016016:Proportional Hazards Models; D012372:ROC Curve; D018570:Risk Assessment; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D014527:Uric Acid / Q000097:blood*
chemical_list: D015415:Biomarkers; D014527:Uric Acid
keywords: Cardiovascular risk; risk reclassification; uric acid