The U-Shaped Relationship Between Serum Uric Acid and Long-Term All-Cause Mortality in Coronary Artery Disease Patients: A Cohort Study of 33,034 Patients

Yiying Zheng; Jiaman Ou; Dehua Huang; Ziyou Zhou; Xiaoli Dong; Jie Chen; Dandan Liang; Jin Liu; Yong Liu; Jiyan Chen; Xiaoyu Huang; Ning Tan

doi:10.3389/fcvm.2022.858889

The U-Shaped Relationship Between Serum Uric Acid and Long-Term All-Cause Mortality in Coronary Artery Disease Patients: A Cohort Study of 33,034 Patients

Front Cardiovasc Med. 2022 Jun 22:9:858889. doi: 10.3389/fcvm.2022.858889. eCollection 2022.

Authors

Yiying Zheng^{1

2

3

4}, Jiaman Ou⁴, Dehua Huang⁴, Ziyou Zhou⁵, Xiaoli Dong⁶, Jie Chen⁷, Dandan Liang⁴, Jin Liu^{2

3}, Yong Liu^{1

2

3

5}, Jiyan Chen^{1

2

3

4

5}, Xiaoyu Huang⁴, Ning Tan^{1

2

3

5}

Affiliations

¹ The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.
² Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
³ Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
⁴ Department of Cardiology, People's Hospital of Yangjiang, Yangjiang, China.
⁵ Guangdong Provincial People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China.
⁶ Department of Ultrasound Imaging, Yunnan Fuwai Cardiovascular Hospital, Kunming, China.
⁷ Department of Cardiology, Guangdong Medical University, Zhanjiang, China.

Abstract

Background: Associations between high serum uric acid (SUA) and cardiovascular diseases have been reported. However, few studies have been conducted to explore the relationship between SUA and long-term all-cause mortality in coronary artery disease (CAD) patients. Our study aims to investigate the relationship between SUA and long-term all-cause mortality in patients with CAD.

Methods: From January 2007 to December 2018, we divided 33,034 patients with CAD admitted in the Guangdong Provincial People's Hospital into five groups (quintile 1: SUA <5.05 mg/dl, quintile 2: 5.05 mg/dl ≤ SUA <5.59 mg/dl, quintile 3:5.59 mg/dl ≤ SUA <6.8 mg/dl, quintile 4, 6.8 mg/dl ≤ SUA <7.93 mg/dl, and quintile 5, SUA ≥7.93 mg/d;). This study used Kaplan-Meier survival analysis to evaluate patient outcomes with different ranges of SUA. Cox proportional hazards regression models and restricted cubic spline were applied to determine the association between serum uric and long-term all-cause mortality.

Results: A total of 33,034 participants were recruited, including 24,780 (75.01%) men and 8,254 (24.99) women in this cohort study. Median follow-up was 4.91 years. We found that SUA is an independent risk factor of long-term all-cause mortality according to the result of Cox proportional hazards models. This study also illustrated an approximate U-shape association between SUA and all-cause mortality when compared with 5.95 mg/lL ≤ SUA <6.8 mg/dl, SUA <5.0 5mg/dl (adjusted hazard ratio (aHR) =1.13, 95% CI: 1.01-1.26, p = 0.03), and SUA ≥8 mg/dL (aHR = 1.18, 95% CI: 1.06-1.32, p = 0.003).

Conclusion: Our study indicated a U-shaped relationship between SUA and long-term all-cause mortality in patients with CAD. No matter whether SUA is too high or too low, it increased the all-cause mortality in the CAD population, which deserves to be closely monitored.

Keywords: U-shape; all-cause mortality; cardiovascular diseases; coronary artery disease; serum uric acid.