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Multicenter Study
. 2021 Jun;10(11):e020419.
doi: 10.1161/JAHA.120.020419. Epub 2021 May 17.

Association Between Uric Acid, Carotid Intima-Media Thickness, and Cardiovascular Events: Prospective Results From the IMPROVE Study

Massimo R Mannarino  1 , Matteo Pirro  1 , Bruna Gigante  2   3 , Kai Savonen  4   5 , Sudhir Kurl  6 , Philippe Giral  7 , Andries Smit  8   9 , Fabrizio Veglia  10 , Elena Tremoli  10 , Damiano Baldassarre  10   11 ; IMPROVE study group †
Collaborators, Affiliations
Multicenter Study

Association Between Uric Acid, Carotid Intima-Media Thickness, and Cardiovascular Events: Prospective Results From the IMPROVE Study

Massimo R Mannarino et al. J Am Heart Assoc. 2021 Jun.

Abstract

Background The association between elevated serum uric acid (SUA), cardiovascular disease (CVD) risk, and carotid atherosclerosis has long been explored, and contrasting results have been reported. Therefore, the role of SUA as an independent risk factor for vascular events (VEs) and carotid atherosclerosis deserves further attention. We investigated the relationship between SUA, incident VEs, carotid intima-media thickness (cIMT), and cIMT progression in subjects at moderate-to-high CVD risk. Methods and Results In the IMPROVE (IMT-Progression as Predictors of VEs) study, 3686 participants (median age 64 years; 48% men) with ≥ 3 vascular risk factors, free from VEs at baseline, were grouped according to SUA quartiles (division points: 244-284-328 µmol/L in women, 295-336-385 µmol/L in men). Carotid-IMT and its 15-month progression, along with incident VEs, were recorded. A U-shaped association between SUA and VEs was observed in men, with 2.4-fold (P = 0.004) and 2.5-fold (P = 0.002) increased CVD risk in the first and fourth SUA quartiles as compared with the second. Adjusted hazard ratios (HRs) for cerebro-VEs in men were the highest (first and fourth quartile versus second: HR, 5.3, P = 0.010 and HR, 4.4, P = 0.023, respectively). SUA level was independently associated with cIMT progression in men (β = 0.068, P = 0.014). No significant association between SUA levels, CVD end points, and cIMT progression were found in women. Conclusions Both low and high SUA levels are associated with an increased risk of VEs in men at moderate-to-high CVD risk but not in women. Only elevated SUA levels predict cIMT progression and at a lesser but not significant extent in women.

Keywords: atherosclerosis; cardiovascular; carotid; intima media thickness; prospective; uric acid.

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Conflict of interest statement

None.

Figures

Figure
Figure. Combined, coronary, and cerebrovascular event‐free survival in all patients and among men and women, across SUA quartiles.
SUA indicates serum uric acid.
See this image and copyright information in PMC

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