Identification of the Uric Acid Thresholds Predicting an Increased Total and Cardiovascular Mortality Over 20 Years

被引：215

作者：

Virdis, Agostino ^{[1
]}

Masi, Stefano ^{[1
]}

Casiglia, Edoardo ^{[16
]}

Tikhonoff, Valerie ^{[15
]}

Cicero, Arrigo F. G. ^{[2
]}

Ungar, Andrea ^{[4
]}

Rivasi, Giulia ^{[4
]}

Salvetti, Massimo ^{[3
]}

Barbagallo, Carlo M. ^{[17
]}

Bombelli, Michele ^{[11
]}

Dell'Oro, Raffaella ^{[11
]}

Bruno, Berardino ^{[7
]}

Lippa, Luciano ^{[8
]}

D'Elia, Lanfranco ^{[12
]}

Verdecchia, Paolo ^{[18
]}

Mallamaci, Francesca ^{[19
]}

Cirillo, Massimo ^{[14
]}

Rattazzi, Marcello ^{[20
]}

Cirillo, Pietro ^{[21
]}

Gesualdo, Loreto ^{[21
]}

Mazza, Alberto ^{[22
]}

Giannattasio, Cristina ^{[23
]}

Maloberti, Alessandro ^{[22
,23
]}

Volpe, Massimo ^{[24
,25
]}

Tocci, Giuliano ^{[24
,25
]}

Georgiopoulos, Georgios ^{[26
]}

Iaccarino, Guido ^{[13
]}

Nazzaro, Pietro ^{[27
]}

Parati, Gianfranco ^{[9
,10
]}

Palatini, Paolo ^{[16
]}

Galletti, Ferruccio ^{[12
]}

Ferri, Claudio ^{[7
]}

Desideri, Giovambattista ^{[7
]}

Viazzi, Francesca ^{[5
,6
]}

Pontremoli, Roberto ^{[5
,6
]}

Muiesan, Maria Lorenza ^{[3
]}

Grassi, Guido ^{[11
]}

Borghi, Claudio ^{[2
]}

机构：

[1] Univ Pisa, Dept Clin & Expt Med, Via Roma 67, I-56100 Pisa, Italy

[2] Alma Mater Studiorum Univ Bologna, Dept Med & Surg Sci, Bologna, Italy

[3] Univ Brescia, Dept Clin & Expt Sci, Brescia, Italy

[4] Careggi Hosp & Univ Florence, Dept Geriatr & Intens Care Med, Florence, Italy

[5] Univ Genoa, Dept Internal Med, Genoa, Italy

[6] Policlin San Martino, Genoa, Italy

[7] Univ Aquila, Dept Life Hlth & Environm Sci, Laquila, Italy

[8] Italian Soc Gen Med, Laquila, Italy

[9] S Luca Hosp, Ist Auxol Italiano, Dept Cardiovasc Neural & Metab Sci, Milan, Italy

[10] Univ Milano Bicocca, Milan, Italy

[11] Univ Milano Bicocca, Dept Med & Surg, Clin Med, Monza, Italy

[12] Federico II Univ Naples, Med Sch, Dept Clin Med & Surg, Naples, Italy

[13] Federico II Univ Naples, Med Sch, Dept Adv Biomed Sci, Naples, Italy

[14] Federico II Univ Naples, Med Sch, Dept Publ Hlth, Naples, Italy

[15] Univ Padua, Dept Med, Padua, Italy

[16] Univ Padua, Studium Patavinum, Dept Med, Padua, Italy

[17] Univ Palermo, Biomed Dept Internal Med & Specialist, Palermo, Italy

[18] Hosp S Maria Misericordia, Perugia, Italy

[19] CNR, IFC, Clin Epidemiol Renal Dis & Hypertens, Reggio Cal Unit, Reggio Di Calabria, Italy

[20] Univ Padua, Ca Foncello Univ Hosp, Dept Med, Med Interna 1, Treviso, Italy

[21] Aldo Moro Univ Bari, Dept Emergency & Organ Transplantat Nephrol, Dialysis & Transplantat Unit, Bari, Italy

[22] Gen Hosp, Hypertens Unit, Dept Internal Med, Rovigo, Italy

[23] Milano Bicocca Univ, Niguarda Ca Granda Hosp, Hlth Sci Dept, A De Gasperis Dept,Cardiol 4, Milan, Italy

[24] Univ Rome Sapienza, St Andrea Hosp, Fac Med & Psychol, Dept Clin & Mol Med,Hypertens Unit,Div Cardiol, Rome, Italy

[25] IRCCS Neuromed, Pozzilli, IS, Italy

[26] Univ Athens, Hippokrat Hosp, Med Sch, Dept Cardiol 1, Athens, Greece

[27] Univ Bari, Med Sch, Dept Med Basic Sci Neurosci & Sense Organs, Bari, Italy

来源：

HYPERTENSION | 2020年 / 75卷 / 02期

关键词：

epidemiology; heart failure; humans; risk; uric acid; RISK; OUTCOMES; DISEASE;

D O I：

10.1161/HYPERTENSIONAHA.119.13643

中图分类号：

R6 [外科学];

学科分类号：

100210 [外科学];

摘要：

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.

引用

页码：302 / 308

页数：7

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