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Hyperuricemia as a risk factor on cardiovascular events in Taiwan: The Chin-Shan Community Cardiovascular Cohort Study

      Abstract

      Little is known about uric acid role for cardiovascular events in the Asian-Pacific countries with relatively low coronary heart disease (CHD) but high stroke events. Also, there is scanty evidence for repeated measures of uric acid levels among population. We examined associations of basic and repeated measures of uric acid level with CHD and stroke events in one Taiwanese adult community prospectively. Cox proportional hazards models, treating uric acid as baseline and time-dependent covariates, were used to assess the 11-year risk of CHD and stroke events. Among 3602 adult subjects older than 35 years, 86 incident CHD and 155 incident stroke cases were identified. The rate ratios of hyperuricemia ranged between 2.00 and 3.96, with higher risk ratios in women than in men. The rate differences and population attributable fractions were also higher in women than in men, implying that women had high risk of uric acid on cardiovascular events. After adjustment for age effect, time-dependent uric acid was associated with significant CHD risk in both genders (hazard risk [HR] 1.43, 95% CI: 1.10–1.87 in men and HR 1.22, 95% CI: 1.03–1.44 in women). But the magnitude of hazard risks decreased after adjusting more atherosclerotic risk factors for CHD. For stroke event, the age-adjusted hazard risk of time-dependent continuous uric acid level was 1.23 (95% CI: 1.00–1.54) in men and 1.36 (95% CI: 1.05–1.75) in women. Multiple adjustment by risk factors demonstrated that uric acid was still a significant predictor for stroke in women (HR 1.32, 95% CI: 1.00–1.73). The similar hazard risk patterns existed for binary categories of hyperuricemia. Subgroup analyses demonstrated uric acid had significant risk only in hypertension and metabolic syndrome subgroups, not in their counterparts. We concluded that uric acid, in the baseline and time-dependent variables, could predict cardiovascular events in the community of relatively low CHD but high stroke risk in Taiwan.

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      References

        • Beard J.T.
        Serum uric acid and coronary heart disease.
        Am Heart J. 1983; 106: 397-400
        • Cook D.G.
        • Shaper A.G.
        • Thelle D.S.
        • Whitehead T.P.
        Serum uric acid, serum glucose and diabetes: relationships in a population study.
        Postgraduate Med J. 1986; 62: 1001-1006
        • Chu N.F.
        • Wang D.J.
        • Liou S.H.
        • Shieh S.M.
        Relationship between hyperuricemia and other cardiovascular disease risk factors among adult males in Taiwan.
        Eur J Epidemiol. 2000; 16: 13-17
        • Alderman M.H.
        • Cohen H.
        • Madhavan S.
        • Kivlighn S.
        Serum uric acid and cardiovascular events in successfully treated hypertensive patients.
        Hypertension. 1999; 34: 144-150
        • Freedman D.S.
        • Williamson D.F.
        • Gunter E.W.
        • Byers T.
        Relation of serum uric acid to mortality and ischemic heart disease The NHANES I Epidemiologic Follow-up Study.
        Am J Epidemiol. 1995; 141: 637-644
        • Culleton B.F.
        • Larson M.G.
        • Kannel W.B.
        • Levy D.
        Serum uric acid and risk for cardiovascular disease and death: the Framingham Heart Study.
        Ann Int Med. 1999; 131: 7-13
        • Freedman D.S.
        • Williamson D.F.
        • Gunter E.W.
        • Byers T.
        Relation of serum uric acid to mortality and ischemic heart disease. The NHANES I Epidemiologic Follow-up Study.
        Am J Epidemiol. 1995; 141: 637-644
        • Wannamethee S.G.
        • Shaper A.G.
        • Whincup P.H.
        Serum urate and the risk of major coronary heart disease events.
        Heart. 1997; 78: 147-153
        • Ferrara A.
        • Quesenberry C.P.
        • Karter A.J.
        • Njoroge C.W.
        • Jacobson A.S.
        • Selby J.V.
        Current use of unopposed estrogen and estrogen plus progestin and the risk of acute myocardial infarction among women with diabetes: the Northern California Kaiser Permanente Diabetes Registry.
        Circulation. 2003; 107: 43-48
        • Chang H.Y.
        • Pan W.H.
        • Yeh W.T.
        • Tsai K.S.
        Hyperuricemia and gout in Taiwan: results from the Nutritional and Health Survey in Taiwan.
        J Rheumatol. 2001; 28: 1640-1646
        • Li Y.
        • Stamler J.
        • Xiao Z.
        • Folsom A.
        • Tao S.
        • Zhang H.
        Serum uric acid and its correlates in Chinese adult populations, urban and rural, of Beijing. The PRC-USA Collaborative Study in Cardiovascular and Cardiopulmonary Epidemiology.
        Int J Epidemiol. 1997; 26: 288-296
        • Nakanishi N.
        • Yoshida H.
        • Nakamura K.
        • Suzuki K.
        • Tatara K.
        Predictors for development of hyperuricemia: an 8-year longitudinal study in middle-aged Japanese men.
        Metabolism. 2001; 50: 621-626
        • Lai S.W.
        • Li T.C.
        • Li C.I.
        • et al.
        Association between serum uric acid and cardiovascular risk factors among elderly people in Taiwan.
        Kaohsiung J Med Sci. 1999; 15: 686-690
        • Li Y.
        • Stamler J.
        • Xiao Z.
        • Folsom A.
        • Tao S.
        • Zhang H.
        Serum uric acid and its correlates in Chinese adult populations, urban and rural, of Beijing. The PRC-USA Collaborative Study in Cardiovascular and Cardiopulmonary Epidemiology.
        Int J Epidemiol. 1997; 26: 288-296
        • Chien K.L.
        • Sung F.C.
        • Hsu H.C.
        • Su T.C.
        • Lin R.S.
        • Lee Y.T.
        Apolipoprotein A1 & B, and stroke events in a community-based cohort in Taiwan: Report of Chin-Shan Community Cardiovascular Study.
        Stroke. 2002; 33: 39-44
        • Lee Y.T.
        • Lin R.S.
        • Sung F.C.
        • et al.
        Chin-Shan Community Cardiovascular Cohort in Taiwan: baseline data and five-year follow-up morbidity and mortality.
        J Clin Epidemiol. 2000; 53: 836-846
        • Fossati P.
        • Prencipe L.
        • Berti G.
        Use of 3,5-dichloro-2-hydroxybenzenesulfonic acid/4-aminophenazone chromogenic system in direct enzymic assay of uric acid in serum and urine.
        Clin Chem. 1980; 26: 227-231
      1. The Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Arch Int Med 1997;157:2413–46.

      2. Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care 1997;20:1183–97.

      3. Executive Summary of the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 2001;285:2486–97.

        • Breslow N.E.
        • Day N.E.
        Statistical methods in cancer research, vol. II. The design and analysis of cohort studies.
        IARC, Lyon1987
        • Aalen O.O.
        Nonparametric inference for a family of counting processes.
        Annu Statist. 1987; 6: 701-726
        • Cox D.R.
        Regression models and life-tables.
        J R Statist Soc B. 1972; : 187-202
        • Lin D.Y.
        • Wei L.J.
        The robust inference for the Cox proportional hazards model.
        J Am Statist Assoc. 1989; 84: 1074-1078
        • SAS Institute Inc.
        SAS/STAT user's guide, Version 8.
        SAS Institute Inc., Cary, NC1999
      4. Stata Corp..
        Stata statistical software: Release 7.0. Stata Corporation, College Station, TX2001
        • Collantes E.E.
        • Pineda P.M.
        • Anon B.J.
        • Sanchez G.P.
        Hyperuricemia–hyperlipidemia association in the absence of obesity and alcohol abuse.
        Clin Rheumatol. 1990; 9: 28-31
        • Cappuccio F.P.
        • Strazzullo P.
        • Farinaro E.
        • Trevisan M.
        Uric acid metabolism and tubular sodium handling. Results from a population-based study.
        JAMA. 1993; 270: 354-359
        • Vuorinen-Markkola H.
        • Yki-Jarvinen H.
        Hyperuricemia and insulin resistance.
        J Clin Endocrinol Metab. 1994; 78: 25-29
        • Zavaroni I.
        • Mazza S.
        • Fantuzzi M.
        • et al.
        Changes in insulin and lipid metabolism in males with asymptomatic hyperuricemia.
        J Int Med. 1993; 234: 25-30
        • Lehto S.
        • Niskanen L.
        • Ronnemaa T.
        • Laakso M.
        Serum uric acid is a strong predictor of stroke in patients with non-insulin-dependent diabetes mellitus.
        Stroke. 1998; 29: 635-639
        • Ward H.J.
        Uric acid as an independent risk factor in the treatment of hypertension.
        Lancet. 1998; 352: 670-671
        • Bengtsson C.
        • Lapidus L.
        • Stendahl C.
        • Waldenstrom J.
        Hyperuricaemia and risk of cardiovascular disease and overall death. A 12-year follow-up of participants in the population study of women in Gothenburg, Sweden.
        Acta Med Scand. 1988; 224: 549-555
        • Modan M.
        • Halkin H.
        • Karasik A.
        • Lusky A.
        Elevated serum uric acid—a facet of hyperinsulinaemia.
        Diabetologia. 1987; 30: 713-718
        • Bansal B.C.
        • Gupta R.R.
        • Bansal M.R.
        • Prakash C.
        Serum lipids and uric acid relationship in ischemic thrombotic cerebrovascular disease.
        Stroke. 1975; 6: 304-307
        • Wannamethee S.G.
        • Shaper A.G.
        • Whincup P.H.
        Serum urate and the risk of major coronary heart disease events.
        Heart. 1997; 78: 147-153
        • Altman D.G.
        • DeStavola B.L.
        Practical problems in fitting a proportional hazards model to data with updated measurements of the covariates.
        Statist Med. 1994; 13: 301-341
        • Liang K.Y.
        • Self S.G.
        • Liu X.
        The Cox proportional hazards model with change point: an epidemiologic application.
        Biometrics. 1990; 46: 783-793
        • Poullis M.
        Serum uric acid and cardiovascular disease risk.
        Ann. Int. Med. 2000; 132: 591-592
        • Iribarren C.
        • Sharp D.S.
        • Curb J.D.
        • Yano K.
        High uric acid: a metabolic marker of coronary heart disease among alcohol abstainers.
        J. Clin. Epidemiol. 1996; 49: 673-678
        • Crouse J.R.
        • Toole J.F.
        • Mckinney W.M.
        • et al.
        Risk factors for extracranial carotid artery atherosclerosis.
        Stroke. 1987; 18: 990-996
        • Torng P.L.
        • Su T.C.
        • Sung F.C.
        • et al.
        Effects of menopause and obesity on lipid profiles in middle-aged Taiwanese women: the Chin-Shan Community Cardiovascular Cohort Study.
        Atherosclerosis. 2000; 153: 413-421