Highlights
- •A large SUA variation was associated with a higher risk of CVD and its subtypes.
- •Both a large rise or fall in SUA was associated with a higher risk of CVD.
- •The harmful effect of a large variation of SUA on CVD was more pronounced in older adults than that in young adults.
- •The hazardous effect of SUA variation on CVD was mainly induced by excessive inflammation and elevated blood pressure.
Abstract
Background
The association of serum uric acid (SUA) with cardiovascular disease (CVD) is inconsistent
and limited by a single measurement of SUA. This study aimed to investigate the association
of SUA variation, considering its magnitude and direction, with the risk of CVD.
Methods
This study included 41,578 participants with four biennial measurements of SUA during
2006–2012 from the Kailuan study. SUA variation was measured using the coefficient
of variation (primary index), standard deviation, average real variability, and variability
independent of mean, and the direction of variation was also assessed. Multivariate-adjusted
Cox regressions were used to assess the associations, and Bayesian network was utilized
to find the most important pathway from SUA variation to CVD.
Results
During a median follow-up of 6.74 (interquartile range: 6.45–7.03) years, we identified
1,852 (4.45%) cases of incident CVD. A large SUA variation (top vs. bottom tertiles)
was associated with a higher risk of CVD (hazard ratio [HR], 1.24; 95% confidence
interval [CI], 1.11–1.40), especially in older adults than that in young adults (Pint=0.0137). The higher risk of CVD was observed with both large rises (HR, 1.24; 95%
CI, 1.10–1.39) and falls (HR, 1.19; 95% CI, 1.03–1.38) in SUA variation. The hazardous
effect of SUA variation on CVD was mainly induced by excessive inflammation and elevated
blood pressure. Similar results were observed for CVD subtypes.
Conclusions
Elevated SUA variation was associated with a higher risk of CVD, irrespective of the
direction of SUA variation, and inflammation played an important role in the pathway.
Keywords
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Article info
Publication history
Published online: February 09, 2023
Accepted:
February 1,
2023
Received in revised form:
January 26,
2023
Received:
December 13,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
