Hyperuricemia and the risk for subclinical coronary atherosclerosis--data from a prospective observational cohort study

Abstract

Introduction: Our purpose was to test the hypothesis that hyperuricemia is associated with coronary artery calcification (CAC) among a relatively healthy population, and that the extent of calcification is directly proportional to the serum uric acid (sUA) concentration.

Methods: Data from 2,498 participants in the Coronary Artery Risk Development in Young Adults (CARDIA) study were analyzed using logistic regression models. Subjects were free of clinical heart disease, diabetes, and renal impairment. The main measure was the presence of any CAC by computerized tomography (Agatston score >0).

Results: Forty-eight percent of the study participants were male and 45% were African-American. Mean (± SD) age was 40 ± 4 years, body mass index 28 ± 6 kg/m2, Framingham risk score -0.7 ± 5%, blood pressure 113 ± 14/75 ± 11 mmHg, alcohol consumption 12 ± 27 ml/day, and sUA 297 ± 89 μmol/L (5.0 ± 1.5 mg/dL). Prevalence of CAC increased with sUA concentration among both men and women. Adjusted for age, gender, race, lipoproteins, triglycerides, smoking, blood pressure, presence of metabolic syndrome, C-reactive protein, waist circumference, alcohol use, creatinine, and serum albumin, the highest quartile of sUA (>393 μmol/L [6.6 mg/dL] for men and >274 μmol/L [4.6 mg/dL] for women) was associated with an odds ratio of 1.87 (1.19-2.93) compared to the lowest quartile (<291 μmol/L [4.9 mg/dL] for men and <196 μmol/L [3.3 mg/dL] for women). Among those with any CAC, each unit increase in sUA was associated with a 22% increase in Agatston score (P = 0.008) after adjusting for the above covariates.

Conclusions: Hyperuricemia is an independent risk factor for subclinical atherosclerosis in young adults.

Figure 1

Prevalence of any coronary artery calcification (Agatston score >0) by serum uric acid concentration among participants in the CARDIA study cohort at year 15. A detailed description of these patients (1,211 men and 1,287 women) is provided in Table 1. P values are for trend test. CAC, coronary artery calcification; CARDIA, Coronary Artery Risk Development in Young Adults; SUA, serum uric acid.

Figure 2

Relationship between burden of coronary artery calcification (unmodified Agatston score) and serum uric acid concentrations. These analyses included only those subjects who had an Agatston score of greater than zero (n = 238). P values are for trend test. SUA, serum uric acid.