Serum uric acid and the risk of mortality during 23 years follow-up in the Scottish Heart Health Extended Cohort Study.

Stephen P Juraschek
Stephen P Juraschek
Johns Hopkins Bloomberg School of Public Health
United States
Hugh Tunstall-Pedoe
Hugh Tunstall-Pedoe
University of Dundee
United Kingdom
Mark Woodward
Mark Woodward
The George Institute for Global Health

Atherosclerosis 2014 Apr 30;233(2):623-9. Epub 2014 Jan 30.

Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore, MD, USA; Cardiovascular Epidemiology Unit, Institute of Cardiovascular Research, University of Dundee, Australia; The George Institute for Global Health, Australia. Electronic address:

Background: Elevated uric acid is a prevalent condition with controversial health consequences. Observational studies disagree with regard to the relationship of uric acid with mortality, and with factors modifying this relationship.

Objective: We examined the association of serum uric acid with mortality in 15,083 participants in the Scottish Heart Health Extended Cohort (SHHEC) Study.

Methods: Serum uric acid was measured at study enrollment. Death was ascertained using both the Scottish death register and record linkage.

Results: During a median follow-up of 23 years, there were 3980 deaths. In Cox proportional hazards models with sexes combined, those in the highest fifth of uric acid had significantly greater mortality (HR 1.18, 95% CI: 1.06, 1.31) compared with the second fifth, after adjustment for traditional cardiovascular risk factors. This relationship was modified by sex (P-interaction=0.002) with adjusted HRs of 1.69 (95% CI: 1.40, 2.04) and 0.99 (95% CI: 0.86, 1.14) in women and men, respectively. Compared with the second fifth, the highest fifth of uric acid was most associated with kidney-related death (HR: 2.08, 95% CI: 1.31, 3.32).

Conclusion: Elevated uric acid is associated with earlier mortality, especially in women. Future studies should evaluate mechanisms for these interactions and explore the strong association with renal-related mortality.
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April 2014
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