Elsevier

Atherosclerosis

Volume 183, Issue 1, November 2005, Pages 147-155
Atherosclerosis

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

https://doi.org/10.1016/j.atherosclerosis.2005.01.018Get rights and content

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.

Introduction

Hyperuricemia is the consequence of metabolic derangement, and associated with hypertension, hyperlipidemia, obesity and insulin resistance [1], [2], [3]. Its role as a risk factor for cardiovascular diseases in specific population was demonstrated among women and hypertensive patients [4], [5], [6]. But debates still existed for hyperuricemia as an independent role, especially after controlling other traditional atherosclerotic risk [7], [8]. Possible explanations for controversial results were two-fold. First, uric acid level fluctuated with time and baseline measurements could not represent whole risk of hyperuricemia. Second, there was ethnic variation in coronary heart disease (CHD) and stroke events. Further strategies incorporated with time-dependent covariate [9] in specific ethnic population were mandatory to explore the role of hyperuricemia in cardiovascular events.

Among the Asian-Pacific countries of higher stroke and lower CHD rates, hyperuricemia becomes epidemics recently and strongly related metabolic syndrome [10], [11], [12]. In Taiwan, although there were many association studies on uric acid risk factor [3], [10], [13], [14], the prospective cohort data was still unavailable in the community. The Chin-Shan Community Cardiovascular Cohort Study, a prospective cohort including 3602 adult aged 35 years and older since 1990, with regular measures of uric acid levels, can provide important evidence for CHD and stroke events and uric acid roles.

Section snippets

Study design and population

Briefly, The Chin-Shan Community Cardiovascular Cohort Study began in 1990 as a long-term prospective study of cardiovascular disease and was described elsewhere [15], [16]. In brief, the purpose of this study was not only to detect newly developed cardiovascular disease but also to regularly reassess those risk factors that substantially contributed to risk estimation. The cohort consisted of 1703 men and 1899 women aged 35 years old and above, homogenous in Chinese ethnicity, located in the

Results

The distribution of uric acid levels and proportions of hyperuricemia were in Table 1. Men had higher level of uric acid and higher prevalence of hyperuricemia than women. When age increased, people were likely to have higher uric acid and hyperuricemia prevalence. The prevalence rates of hyperuricemia were 12.2% in women and 20.5% in men in baseline examination, increasing by examination year. In 1997–1998 follow-up, the prevalence can reach up to nearly 40%. In each period, mean values of

Discussion

Hyperuricemia was clearly demonstrated with increasing risk of CHD and stroke events in this Taiwanese cohort. After adjusting for multiple risk factors, the magnitude of hazard risk diminished somewhat, but still persisted significantly among women. Uric acid can be considered as an important risk factor on this relatively low risk of CHD but high risk of stroke population.

We found the uric acid level had associations with atherosclerotic risk factors, especially with the components of

Acknowledgments

We thank cardiologists at National Taiwan University Hospital for their assistance in this study. The study was partly supported by National Science Council in Taiwan (NSC.91-2314-B-002-192, NSC.92-2314-B-002-197) and National Taiwan University Hospital (NTUH.91A02, NTUH.92A10-6, NTUH.93S023).

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