Serum uric acid and fatal myocardial infarction: detection of prognostic cut-off values: The URRAH (Uric Acid Right for Heart Health) study

Abstract

Objective: The Working Group on Uric Acid and Cardiovascular Risk of the Italian Society of Hypertension conceived and designed an ad-hoc study aimed at searching for prognostic cut-off values of serum uric acid (SUA) in predicting fatal myocardial infaction (MI) in women and men. Methods: The URic acid Right for heArt Health study is a nationwide, multicentre, observational cohort study involving data on individuals aged 18–95 years recruited on a regional community basis from all the territory of Italy under the patronage of the Italian Society of Hypertension with a mean follow-up period of 122.3 ± 66.9 months. Results: A total of 23 467 individuals were included in the analysis. Cut-off values of SUA able to discriminate MI status were identified by mean of receiver operating characteristic curves in the whole database (>5.70 mg/dl), in women (>5.26 mg/dl) and in men (>5.49 mg/dl). Multivariate Cox regression analyses adjusted for confounders (age, arterial hypertension, diabetes, chronic kidney disease, smoking habit, ethanol intake, BMI, haematocrit, LDL cholesterol and use of diuretics) identified an independent association between SUA and fatal MI in the whole database (hazard ratio 1.381, 95% confidence intervals, 1.096–1.758, P = 0.006) and in women (hazard ratio 1.514, confidence intervals 1.105–2.075, P < 0.01), but not in men. Conclusion: The results of the current study confirm that SUA is an independent risk factor for fatal MI after adjusting for potential confounding variables, and demonstrate that a prognostic cut-off value associated to fatal MI can be identified at least in women.

Therapeutic Strategies for the Treatment of Chronic Hyperuricemia: An Evidence-Based Update

“…Recent evidence coming from the large epidemiological URRAH study shows that SUA is associated with a significantly increased risk of heart failure (hazard ratio, 1.65 [95% confidence interval—CI, 1.28–2.11]), fatal heart failure (hazard ratio, 1.65 [95% CI, 1.28–2.11]), total mortality (hazard ratio, 1.53 [95% CI, 1.21–1.93]), and cardiovascular death (hazard ratio, 2.08 [95% CI, 1.15–2.97]; p < 0.001) [ 8 , 9 ]. The risk seems to increase with SUA levels lower than the ones associated with an increased risk of gout and even lower to the currently considered normal values [ 10 ].…”

Expert consensus for the diagnosis and treatment of patient with hyperuricemia and high cardiovascular risk: 2021 update

“…Therefore, elevation in sUA levels significantly increased risks of all-cause mortality and combined endpoint of death or readmission by 11% and 12%, respectively, for every 1 mg/mL, they were elevated [82]. Also, URRAH researchers adjusted for such confounders as age, arterial hypertension, diabetes, CKD, smoking habits, ethanol intake, BMI, hematocrit, low-density lipoprotein cholesterol, and use of diuretics in multivariate Cox regression analyses and identified an independent association between sUA and fatal myocardial infarction across the whole database (HR 1.381, 95% CI 1.096-1.758, p = 0.006) and in women, specifically (HR 1.514, 95% CI 1.105-2.075, p < 0.01), but not in men [83].…”

Asymptomatic Hyperuricemia and Risk Of Cardiovascular and Renal Diseases

“…По данным крупного Шведского регистра (n=417 734 пациента без анамнеза ССЗ), даже умеренное повышение концентрации МК в сыворотке крови увеличивает риск развития инфаркта миокарда (ИМ), инсульта и застойной СН [58]. Результаты крупного эпидемиологического исследования URRAH (n=23 467) также подтвердили независимые ассоциации между уровнем МК в сыворотке крови и риском развития фатального ИМ [59]. В работе F. Crosta и соавт.…”