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Serum uric acid and cardiovascular mortality the NHANES I epidemiologic follow-up study, 1971-1992. National Health and Nutrition Examination Survey.
JAMA 2000; 283(18):2404-10JAMA

Abstract

CONTEXT

Although many epidemiological studies have suggested that increased serum uric acid levels are a risk factor for cardiovascular mortality, this relationship remains uncertain.

OBJECTIVE

To determine the association of serum uric acid levels with cardiovascular mortality.

DESIGN AND SETTING

Cross-sectional population-based study of epidemiological follow-up data from the First National Health and Nutrition Examination Survey (NHANES I) from 1971-1975 (baseline) and data from NHANES I Epidemiologic Follow-up Study (NHEFS).

PARTICIPANTS

A total of 5926 subjects who were aged 25 to 74 years and had serum uric acid level measurements at baseline.

MAIN OUTCOME MEASURES

Ischemic heart disease mortality, total cardiovascular mortality, and all-cause mortality, compared by quartiles of serum uric acid level.

RESULTS

In an average of 16.4 years of follow-up, 1593 deaths occurred, of which 731 (45.9%) were ascribed to cardiovascular disease. Increased serum uric acid levels had a positive relationship to cardiovascular mortality in men and women and in black and white persons. Deaths due to ischemic heart disease in both men and women increased when serum uric acid levels were in the highest quartile compared with the lowest quartile (men, >416 vs <321 micromol/L; risk ratio, 1.77 [95% confidence interval [CI], 1.08-3.98]; women, >333 vs <238 micromol/l; risk ratio, 3.00 [95% CI, 1.45-6.28]). Cox regression analysis showed that for each 59.48-micromol/L increase in uric acid level, cardiovascular mortality and ischemic heart disease mortality increased. Hazard ratios for men were 1.09 (95% CI, 1.02-1.18) and 1.17 (95% CI, 1.06-1.28), and for women were 1.26 (95% CI, 1.16-1.36) and 1.30 (95% CI, 1.17-1.45), respectively, after adjustment for age, race, body mass index, smoking status, alcohol consumption, cholesterol level, history of hypertension and diabetes, and diuretic use. Further analysis, stratifying by cardiovascular risk status, diuretic use, and menopausal status, confirmed a significant association of uric acid and cardiovascular mortality in all subgroups except among men using diuretics (n=79) and men with 1 or more cardiovascular risk factors (n=1140).

CONCLUSION

Our data suggest that increased serum uric acid levels are independently and significantly associated with risk of cardiovascular mortality.

Authors+Show Affiliations

Department of Epidemiology and Social Medicine, Albert Einstein College of Medicine, Bronx, NY 10461, USA.No affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

10815083

Citation

Fang, J, and M H. Alderman. "Serum Uric Acid and Cardiovascular Mortality the NHANES I Epidemiologic Follow-up Study, 1971-1992. National Health and Nutrition Examination Survey." JAMA, vol. 283, no. 18, 2000, pp. 2404-10.
Fang J, Alderman MH. Serum uric acid and cardiovascular mortality the NHANES I epidemiologic follow-up study, 1971-1992. National Health and Nutrition Examination Survey. JAMA. 2000;283(18):2404-10.
Fang, J., & Alderman, M. H. (2000). Serum uric acid and cardiovascular mortality the NHANES I epidemiologic follow-up study, 1971-1992. National Health and Nutrition Examination Survey. JAMA, 283(18), pp. 2404-10.
Fang J, Alderman MH. Serum Uric Acid and Cardiovascular Mortality the NHANES I Epidemiologic Follow-up Study, 1971-1992. National Health and Nutrition Examination Survey. JAMA. 2000 May 10;283(18):2404-10. PubMed PMID: 10815083.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Serum uric acid and cardiovascular mortality the NHANES I epidemiologic follow-up study, 1971-1992. National Health and Nutrition Examination Survey. AU - Fang,J, AU - Alderman,M H, PY - 2000/5/18/pubmed PY - 2000/6/7/medline PY - 2000/5/18/entrez SP - 2404 EP - 10 JF - JAMA JO - JAMA VL - 283 IS - 18 N2 - CONTEXT: Although many epidemiological studies have suggested that increased serum uric acid levels are a risk factor for cardiovascular mortality, this relationship remains uncertain. OBJECTIVE: To determine the association of serum uric acid levels with cardiovascular mortality. DESIGN AND SETTING: Cross-sectional population-based study of epidemiological follow-up data from the First National Health and Nutrition Examination Survey (NHANES I) from 1971-1975 (baseline) and data from NHANES I Epidemiologic Follow-up Study (NHEFS). PARTICIPANTS: A total of 5926 subjects who were aged 25 to 74 years and had serum uric acid level measurements at baseline. MAIN OUTCOME MEASURES: Ischemic heart disease mortality, total cardiovascular mortality, and all-cause mortality, compared by quartiles of serum uric acid level. RESULTS: In an average of 16.4 years of follow-up, 1593 deaths occurred, of which 731 (45.9%) were ascribed to cardiovascular disease. Increased serum uric acid levels had a positive relationship to cardiovascular mortality in men and women and in black and white persons. Deaths due to ischemic heart disease in both men and women increased when serum uric acid levels were in the highest quartile compared with the lowest quartile (men, >416 vs <321 micromol/L; risk ratio, 1.77 [95% confidence interval [CI], 1.08-3.98]; women, >333 vs <238 micromol/l; risk ratio, 3.00 [95% CI, 1.45-6.28]). Cox regression analysis showed that for each 59.48-micromol/L increase in uric acid level, cardiovascular mortality and ischemic heart disease mortality increased. Hazard ratios for men were 1.09 (95% CI, 1.02-1.18) and 1.17 (95% CI, 1.06-1.28), and for women were 1.26 (95% CI, 1.16-1.36) and 1.30 (95% CI, 1.17-1.45), respectively, after adjustment for age, race, body mass index, smoking status, alcohol consumption, cholesterol level, history of hypertension and diabetes, and diuretic use. Further analysis, stratifying by cardiovascular risk status, diuretic use, and menopausal status, confirmed a significant association of uric acid and cardiovascular mortality in all subgroups except among men using diuretics (n=79) and men with 1 or more cardiovascular risk factors (n=1140). CONCLUSION: Our data suggest that increased serum uric acid levels are independently and significantly associated with risk of cardiovascular mortality. SN - 0098-7484 UR - https://www.unboundmedicine.com/medline/citation/10815083/Serum_uric_acid_and_cardiovascular_mortality_the_NHANES_I_epidemiologic_follow_up_study_1971_1992__National_Health_and_Nutrition_Examination_Survey_ L2 - https://jamanetwork.com/journals/jama/fullarticle/vol/283/pg/2404 DB - PRIME DP - Unbound Medicine ER -