6533b826fe1ef96bd12853ab
RESEARCH PRODUCT
Identification of the Uric Acid Thresholds Predicting an Increased Total and Cardiovascular Mortality Over 20 Years
Marcello RattazziFrancesca ViazziMaria Lorenza MuiesanPietro CirilloPietro NazzaroPaolo VerdecchiaAndrea UngarGeorgios GeorgiopoulosGiulia RivasiBerardino BrunoAlberto MazzaClaudio BorghiAgostino VirdisMassimo VolpeLoreto GesualdoAlessandro MalobertiGiovambattista DesideriGiuliano TocciValérie TikhonoffMichele BombelliCristina GiannattasioRoberto PontremoliPaolo PalatiniCarlo M. BarbagalloRaffaella Dell'oroLanfranco D'eliaMassimo CirilloFerruccio GallettiGianfranco ParatiLuciano LippaStefano MasiGuido GrassiFrancesca MallamaciMassimo SalvettiClaudio FerriEdoardo CasigliaGuido IaccarinoArrigo F G Cicerosubject
Malemedicine.medical_specialtySettore MED/09 - Medicina Internaepidemiology; heart failure; humans; risk; uric acid; Cause of Death; Female; Humans; Italy; Male; Middle Aged; Mortality; Practice Patterns Physicians'; Quality Improvement; Risk Assessment; Risk Factors; Uric Acid; Cardiovascular Diseases; Hypertension; Hyperuricemiaheart failurePractice PatternsHyperuricemia030204 cardiovascular system & hematologyepidemiology; heart failure; humans; risk; uric acidRisk AssessmentSudden cardiac death03 medical and health sciences0302 clinical medicineuric acidRisk FactorsInternal medicineCause of DeathEpidemiologyInternal MedicineMedicine030212 general & internal medicineHyperuricemiaMyocardial infarctionhumanMortalityPractice Patterns Physicians'humansStrokeriskEpidemiology heart failure humans risk uric acid.Physicians'business.industryProportional hazards modelHazard ratioUric acid cardiovascular mortality epidemiologyMiddle Agedmedicine.diseaseQuality ImprovementItalyCardiovascular DiseasesHeart failureHypertensionFemaleepidemiologybusinessdescription
Serum uric acid (SUA) levels discriminating across the different strata of cardiovascular risk is still unknown. By utilizing a large population-based database, we assessed the threshold of SUA that increases the risk of total mortality and cardiovascular mortality (CVM). The URRAH study (Uric Acid Right for Heart Health) is a multicentre retrospective, observational study, which collected data from several large population-based longitudinal studies in Italy and subjects recruited in the hypertension clinics of the Italian Society of Hypertension. Total mortality was defined as mortality for any cause, CVM as death due to fatal myocardial infarction, stroke, sudden cardiac death, or heart failure. A total of 22 714 subjects were included in the analysis. Multivariate Cox regression analyses identified an independent association between SUA and total mortality (hazard ratio, 1.53 [95% CI, 1.21–1.93]) or CVM (hazard ratio, 2.08 [95% CI, 1.146–2.97]; P <0.001). Cutoff values of SUA able to discriminate total mortality (4.7 mg/dL [95% CI, 4.3–5.1 mg/dL]) and CVM status (5.6 mg/dL [95% CI, 4.99–6.21 mg/dL]) were identified. The information on SUA levels provided a significant net reclassification improvement of 0.26 and of 0.27 over the Heart Score risk chart for total mortality and CVM, respectively ( P <0.001). Sex-specific cutoff values for total mortality and CVM were also identified and validated. In conclusion, SUA levels increasing the risk of total mortality and CVM are significantly lower than those used for the definition of hyperuricemia in clinical practice. Our data provide evidence of a cardiovascular SUA threshold that might contribute in clinical practice to improve identification of patients at higher risk of CVM.
| year | journal | country | edition | language |
|---|---|---|---|---|
| 2020-02-01 |