Department of Advanced Biomedical Sciences, Federico II University, Via Pansini 5, I-80131 Naples, Italy.
Nutr Metab Cardiovasc Dis. 2013 Aug;23(8):707-14. doi: 10.1016/j.numecd.2013.03.001. Epub 2013 May 28.
The association between serum uric acid (SUA) levels and cardiovascular (CV) risk or all-cause death has been repeatedly reported. However, it has not been assessed whether reduction of SUA levels is associated with reduced CV risk. The aim of the current study was to evaluate the relationship between changes of SUA levels and CV events as well as all-cause death.
Randomised trials reporting SUA at baseline and at the end of follow-up and clinical end-points (all-cause death, myocardial infarction (MI), stroke, heart failure (HF) and CV death) were included in the study. Meta-regression analysis was performed to test the relationship between SUA changes and clinical end-points. Eleven trials enrolling 21,373 participants followed up for 2.02 ± 1.76 years and reporting 4533 events were included. In meta-regression analysis, no relationship between SUA changes from baseline to end of follow-up and the composite outcome including CV death, stroke, MI and HF was found (change in Tau(2) (t) = -0.64; p Tau (p) = 0.541). Similarly, no relationship was found between SUA changes and single components of the composite outcome (MI: t = -0.83; p = 0.493; stroke: t = 0.46; p = 0.667; HF: t = 2.44; p = 0.162; CV death: t = -0.54; p = 0.614) and all-cause death (t = -0.72; p = 0.496). Results were confirmed by sensitivity analysis. No heterogeneity among studies or publication bias was detected.
Changes in SUA levels observed during pharmacologic treatments do not predict the risk of all-cause death or CV events. As SUA levels are associated with increased CV risk, additional studies with direct xanthine-oxidase inhibitors are requested.
血清尿酸（SUA）水平与心血管（CV）风险或全因死亡之间的关联已被反复报道。然而，尚未评估 SUA 水平的降低是否与降低 CV 风险相关。本研究旨在评估 SUA 水平变化与 CV 事件和全因死亡之间的关系。
本研究纳入了报告基线和随访结束时 SUA 水平以及临床终点（全因死亡、心肌梗死（MI）、卒中和心力衰竭（HF）和 CV 死亡）的随机试验。进行了荟萃回归分析以检验 SUA 变化与临床终点之间的关系。纳入了 11 项试验，共纳入 21373 名参与者，随访时间为 2.02±1.76 年，报告了 4533 例事件。在荟萃回归分析中，未发现基线至随访结束时 SUA 变化与包括 CV 死亡、卒中和 MI 及 HF 的复合结局之间存在关系（变化的 Tau(2)（t）=-0.64；pTau（p）=0.541）。同样，未发现 SUA 变化与复合结局的单个组成部分之间存在关系（MI：t=-0.83；p=0.493；卒：t=0.46；p=0.667；HF：t=2.44；p=0.162；CV 死亡：t=-0.54；p=0.614）和全因死亡（t=-0.72；p=0.496）之间存在关系。敏感性分析证实了这些结果。未检测到研究间的异质性或发表偏倚。
在药物治疗期间观察到的 SUA 水平变化不能预测全因死亡或 CV 事件的风险。由于 SUA 水平与增加的 CV 风险相关，需要开展更多使用直接黄嘌呤氧化酶抑制剂的研究。
