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(Arteriosclerosis, Thrombosis, and Vascular Biology. 2008;28:1186.)
© 2008 American Heart Association, Inc.

Clinical and Population Studies

Uric Acid Levels Are Associated With All-Cause and Cardiovascular Disease Mortality Independent of Systemic Inflammation in Men From the General Population

The MONICA/KORA Cohort Study

Christa Meisinger; Wolfgang Koenig; Jens Baumert; Angela Döring

From the Central Hospital of Augsburg (C.M.), MONICA/KORA Myocardial Infarction Registry, Augsburg, Germany; Helmholtz Zentrum München (C.M., J.B., A.D.), German Research Center for Environmental Health (GmbH), Institute of Epidemiology, Neuherberg, Germany; and the University of Ulm Medical Center (W.K.), Department of Internal Medicine-II, Cardiology, Ulm, Germany.

Correspondence to Wolfgang Koenig, MD, FRCP, FESC, FAHA, Department of Internal Medicine II–Cardiology, University of Ulm Medical Center, Robert-Koch Str. 8, D-89081 Ulm/ Germany. E-mail wolfgang.koenig{at}uniklinik-ulm.de

Abstract

Objective— The purpose of this study was to assess whether increasing serum uric acid (UA) levels are related to cardiovascular disease (CVD) mortality, all-cause mortality, and incident (fatal and nonfatal) myocardial infarction (MI) in men from the general population taking into account C-reactive protein (CRP), a sensitive marker of systemic inflammation.

Methods and Results— The study was based on 3604 men (45 to 74 years of age) who participated in 1 of the 3 MONICA Augsburg surveys between 1984 and 1995. All participants were prospectively followed within the framework of the Cooperative Health Research in the Region of Augsburg (KORA). Up to December 31, 2002, there occurred 809 total deaths, 359 CVD deaths, and 297 incident MIs. In a Cox model, comparing extreme quartiles of the UA distribution, the hazard ratio for CVD mortality was 1.44 (95% confidence interval [CI] 1.04 to 2.0), and for all-cause mortality it was 1.40 (95% CI 1.13 to 1.74) after adjustment for conventional cardiovascular risk factors, CRP, and diuretic intake. However, UA was not associated with incident MI after multivariable adjustment.

Conclusions— High UA levels were independently associated with CVD mortality as well as all-cause mortality but not with incident MI in middle-aged men from the general population.

Uric acid levels are associated with CVD mortality and all-cause mortality in middle-aged men from the general population independent of conventional cardiovascular risk factors, C-reactive protein, and diuretic intake. Thus, the measurement of UA may turn out as a useful tool for improved individual cardiovascular risk assessment, in addition to conventional risk factors.

Key Words: men • mortality • risk factors • serum uric acid • C-reactive protein