Association between hyperuricemia and incident heart failure among older adults: A propensity-matched study

• Published in: International journal of cardiology 2010-07, Vol.142 (3), p.279-287
• Main Authors: Ekundayo, O. James, Dell'Italia, Louis J, Sanders, Paul W, Arnett, Donna, Aban, Inmaculada, Love, Thomas E, Filippatos, Gerasimos, Anker, Stefan D, Lloyd-Jones, Donald M, Bakris, George, Mujib, Marjan, Ahmed, Ali
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Biological and medical sciences; Biomarkers - blood; Cardiology. Vascular system; Cardiovascular; Female; Heart; Heart Failure - blood; Heart Failure - epidemiology; Heart failure, cardiogenic pulmonary edema, cardiac enlargement; Humans; Hyperuricemia - blood; Hyperuricemia - epidemiology; Incidence; Incident heart failure; Kaplan-Meier Estimate; Kidney function; Male; Medical sciences; Metabolic diseases; Other metabolic disorders; Propensity Score; Purines and pyrimidines (gout, hyperuricemia...); Renal Insufficiency - blood; Renal Insufficiency - epidemiology; Uric acid; Uric Acid - blood; Xanthine Oxidase - metabolism
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2009.01.010

Abstract Background The association between hyperuricemia and incident heart failure (HF) is relatively unknown. Methods Of the 5461 community-dwelling older adults, ≥ 65 years, in the Cardiovascular Health Study without HF at baseline, 1505 had hyperuricemia (baseline serum uric acid ≥ 6 mg/dL for women and ≥ 7 mg/dL for men). Using propensity scores for hyperuricemia, estimated for each participant using 64 baseline covariates, we were able to match 1181 pairs of participants with and without hyperuricemia. Results Incident HF occurred in 21% and 18% of participants respectively with and without hyperuricemia during 8.1 years of mean follow-up (hazard ratio {HR} for hyperuricemia versus no hyperuricemia, 1.30; 95% confidence interval {CI}, 1.05–1.60; P = 0.015). The association between hyperuricemia and incident HF was significant only in subgroups with normal kidney function (HR, 1.23; 95% CI, 1.02–1.49; P = 0.031), without hypertension (HR, 1.31; 95% CI, 1.03–1.66; P = 0.030), not receiving thiazide diuretics (HR, 1.20; 95% CI, 1.01–1.42; P = 0.044), and without hyperinsulinemia (HR, 1.35; 95% CI, 1.06–1.72; P = 0.013). Used as a continuous variable, each 1 mg/dL increase in serum uric acid was associated with a 12% increase in incident HF (HR, 1.12; 95% CI, 1.03–1.22; P = 0.006). Hyperuricemia had no association with acute myocardial infarction or all-cause mortality. Conclusions Hyperuricemia is associated with incident HF in community-dwelling older adults. Cumulative data from our subgroup analyses suggest that this association is only significant when hyperuricemia is a marker of increased xanthine oxidase activity but not when hyperuricemia is caused by impaired renal elimination of uric acid.