title: Gender differences in the association between serum uric acid and prognosis in patients with acute coronary syndrome.
abstract: BACKGROUND
  Increased levels of uric acid (UA) have been associated with cardiovascular disease. This association is generally stronger in women than men. However, gender differences in the prognostic value of UA in patients with acute coronary syndrome (ACS) are unknown. We investigated gender differences in the relationship between UA level and the prognosis in patients with ACS.
  
  
  METHODS
  This was an observational analysis of patients with ACS undergoing percutaneous coronary intervention enrolled in the Ibaraki Cardiac Assessment Study (ICAS) registry. We analyzed 1380 patients (330 women, 1050 men) with ACS who had information on UA. We assessed the association between UA and the incidence of major cardiovascular adverse events (MACE), defined as all-cause death, congestive heart failure, reinfarction, and stroke. Patients were divided according to gender-specific UA quartile.
  
  
  RESULTS
  The mean UA level in women was significantly lower than that in men (4.9mg/dl vs 5.9mg/dl, p<0.001). After a median duration of follow-up period of 437 days (interquartile range 222-801 days), MACE had occurred in 186 (13%) patients [56 (17%) events in women; 130 (12%) events in men]. Kaplan-Meier analysis for MACE-free survival demonstrated that a higher quartile of UA was associated with MACE in both women and men (p<0.001, p=0.002, respectively). Multivariate Cox regression analysis revealed that the highest quartile of UA, as compared with the lowest quartile of UA, was an independent predictor of MACE in women [hazard ratio (HR), 2.84; 95% CI, 1.19-6.77; p=0.018] but not in men (HR, 1.32; 95% CI, 0.66-2.64; p=0.422).
  
  
  CONCLUSIONS
  An increased level of UA was associated with MACE more strongly in women than in men with ACS. These results suggest that there are gender differences in the association of UA level with the prognosis in patients with ACS.
authors.affiliation: Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Kawabe
authors.affiliation: Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan. Electronic address: asato@md.tsukuba.ac.jp.
authors.forename: Akira
authors.initials: A
authors.lastname: Sato
authors.affiliation: Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
authors.forename: Tomoya
authors.initials: T
authors.lastname: Hoshi
authors.affiliation: Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Sakai
authors.affiliation: Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
authors.forename: Daigo
authors.initials: D
authors.lastname: Hiraya
authors.affiliation: Department of Cardiology, Tsukuba Medical Center Hospital, Tsukuba, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Watabe
authors.affiliation: Department of Cardiology, Tsukuba Medical Center Hospital, Tsukuba, Japan.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Kakefuda
authors.affiliation: Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
authors.forename: Mayu
authors.initials: M
authors.lastname: Ishibashi
authors.affiliation: Department of Cardiology, Ibaraki Prefectural Central Hospital, Tomobe, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Abe
authors.affiliation: Department of Cardiology, Ibaraki Prefectural Central Hospital, Tomobe, Japan.
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Takeyasu
authors.affiliation: Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
authors.forename: Kazutaka
authors.initials: K
authors.lastname: Aonuma
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood* / Q000401:mortality / Q000601:surgery; D000368:Aged; D002423:Cause of Death; D005260:Female; D006333:Heart Failure / Q000401:mortality; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000401:mortality; D011379:Prognosis; D016016:Proportional Hazards Models; D012044:Regression Analysis; D012737:Sex Factors; D014527:Uric Acid / Q000097:blood*
chemical_list: D014527:Uric Acid
keywords: Acute coronary syndrome; Gender; Uric acid