Hyperuricemia and incident heart failure

Abstract

Background: Hyperuricemia, a known correlate of oxidative stress, is a marker for adverse prognosis among individuals with heart failure. However, the relationship between hyperuricemia and the risk for incidence of heart failure in a community-based population has not been studied.

Methods and results: We prospectively analyzed the relationship between serum uric acid concentration at baseline and subsequent heart failure among the participants of the Framingham Offspring cohort (n=4912; mean baseline age, 36 years; 52% women). By using Cox regressions, we calculated the risk of heart failure with increasing serum uric acid after adjusting for sex, age, smoking, body mass index, renal dysfunction, diuretics, systolic blood pressure, valvular heart disease, diabetes, alcohol, and use of antihypertensive medications. The incidence rates of heart failure were approximately 6-fold higher among those at the highest quartile of serum uric acid (>6.3 mg/dL) compared with those at the lowest quartile (<3.4 mg/dL). The adjusted hazard ratio for the highest quartile of serum uric acid compared with the lowest was 2.1 (1.04 to 4.22). The relationship between hyperuricemia and heart failure was found in participants without metabolic syndrome and other subgroups as well.

Conclusions: Hyperuricemia is a novel, independent risk factor for heart failure in a group of young general community dwellers. This has implications for development of preventive strategies for heart failure.

Figure 1

Potential epidemiological pathways linking hyperuricemia and heart failure can be direct, mediated through risk factors such as hypertension, confounded by medication use, or a combination of these.

Figure 2

Kaplan-Meier estimates for heart failure-free follow-up among the 4989 participants of the Framingham Offspring Study by quartiles of serum uric acid. For this survival model, the observation started at the first study visit and ended at the time of incident heart failure (n=201). Note that the Y axis scale is adjusted for the sake of clarity.