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Meta-Analysis
. 2009 Jul 15;61(7):885-92.
doi: 10.1002/art.24612.

Hyperuricemia and risk of stroke: a systematic review and meta-analysis

Seo Young Kim  1 , James P Guevara, Kyoung Mi Kim, Hyon K Choi, Daniel F Heitjan, Daniel A Albert
Affiliations
Meta-Analysis

Hyperuricemia and risk of stroke: a systematic review and meta-analysis

Seo Young Kim et al. Arthritis Rheum. .

Abstract

Objective: To assess the association between hyperuricemia and risk of stroke incidence and mortality because hyperuricemia is hypothesized to be a risk factor for stroke and other cardiovascular disease, but, to date, results from observational studies are conflicting.

Methods: A systematic review and meta-analysis were conducted. Studies were identified by searching major electronic databases using the Medical Subject Headings and keywords without restriction in languages. Prospective cohort studies were included only if they contained data on stroke incidences or mortalities related to serum uric acid levels in adults. Pooled risk ratios (RRs) for the association of stroke incidence and mortality with serum uric acid levels were calculated.

Results: A total of 16 studies including 238,449 adults were eligible and abstracted. Hyperuricemia was associated with a significantly higher risk of both stroke incidence (6 studies; RR 1.41, 95% confidence interval [95% CI] 1.05, 1.76) and mortality (6 studies; RR 1.36, 95% CI 1.03, 1.69) in our meta-analyses of unadjusted study estimates. Subgroup analyses of studies adjusting for known risk factors such as age, hypertension, diabetes mellitus, and cholesterol still showed that hyperuricemia was significantly associated with both stroke incidence (4 studies; RR 1.47, 95% CI 1.19, 1.76) and mortality (6 studies; RR 1.26, 95% CI 1.12, 1.39). The pooled estimate of multivariate RRs did not differ significantly by sex.

Conclusion: Hyperuricemia may modestly increase the risks of both stroke incidence and mortality. Future research is needed to determine whether lowering uric acid level has any beneficial effects on stroke.

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Figures

Figure 1
Figure 1
Search strategy
Figure 2
Figure 2
Selection of studies included in the analysis.
Figure 3
Figure 3
Random effects analysis of fully adjusted studies for the association between hyperuricemia and stroke Points (dot) and overall (diamond) estimates are given as risk ratios (RR) with 95% CI. The size of each box represents the weight of the corresponding study in our meta-analysis; Combined: studies which did not have gender specific data, ES: effect size, CI: confidence interval.
Figure 4
Figure 4
Begg’s funnel plot for publication bias in studies for stroke incidence and mortality RR; risk ratio, s.e.; standard error
See this image and copyright information in PMC

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