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. 2022 Apr 7:9:865036.
doi: 10.3389/fcvm.2022.865036. eCollection 2022.

Hyperuricemia Is Associated With the Risk of Atrial Fibrillation Independent of Sex: A Dose-Response Meta-Analysis

Jianhua Xiong  1   2 , Wen Shao  3 , Peng Yu  3 , Jianyong Ma  4 , Menglu Liu  5 , Shan Huang  6 , Xiao Liu  7   8 , Kaibo Mei  9
Affiliations

Hyperuricemia Is Associated With the Risk of Atrial Fibrillation Independent of Sex: A Dose-Response Meta-Analysis

Jianhua Xiong et al. Front Cardiovasc Med. .

Abstract

Background: Conflicting findings of the association between serum uric acid (SUA) and atrial fibrillation (AF) have been reported in both men and women. The sex-specific associations between SUA and the risk of AF are unclear, although hyperuricemia is independently associated with the risk of AF. We performed this meta-analysis to assess the sex-specific effect of SUA on the risk of AF.

Methods: The PubMed, EMBASE, and Cochrane Library databases were searched up to October 3, 2021, for studies that reported sex-specific associations of SUA levels with AF. Linear relationships were assessed by the generalized least squares trend estimation. This study was registered with PROSPERO (42020193013).

Results: Ten eligible studies with 814,804 participants (415,779 men and 399,025 women) were identified. In the category analysis, high SUA was associated with an increased risk of AF in both men (OR: 1.42; 95% CI, 1.18-1.71, I2 = 34%) and women (OR: 2.02; 95% CI, 1.29-3.16, I2 = 70%). In the dose-response analysis, for each 60 μmol/L (1 mg/dL) increase in the SUA level, the risk of AF increased by 15% (OR: 1.15; 95% CI, 1.07-1.25, I2 = 74%) in men and 35% (OR: 1.35; 95% CI, 1.18-1.53, I2 = 73%) in women. There was a borderline difference in the impact of SUA on the risk of AF between men and women (P for interaction = 0.05). A significant linear relationship between SUA and the risk of AF was observed in men (P for non-linearity = 0.91) and women (P for non-linearity = 0.92).

Conclusions: This study suggested that there was a significant linear relationship between SUA and the risk of AF among men and women, with a higher risk estimate for women. Additional trials are required to assess the effect of reduced SUA therapy on AF incidence.

Systematic review registration: https:www.crd.york.ac.uk/PROSPERO/, identifier: CRD 42020193013.

Keywords: atrial fibrillation; hyperuricemia; meta-analysis; serum uric acid; sex difference.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of study selection.
Figure 2
Figure 2
Forest plot for the risk of AF with the highest vs. the lowest serum uric acid among men (A) and women (B). AF, atrial fibrillation SE, standard error.
Figure 3
Figure 3
Forest plot of the dose-response association between serum uric acid levels and AF among men (A) and women (B). Serum uric acid was analyzed as per a 60 μmol/L (1 mg/dL) increase. AF, atrial fibrillation SE, standard error.
Figure 4
Figure 4
Dose-response analysis between serum uric acid levels and the risk of AF among men (A) and women (B). The dose-response association was fitted by the restricted cubic splines model, and the solid and dashed lines represent the estimated odds ratio and the 95% confidence interval, respectively. AF, atrial fibrillation OR, odds ratio.
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