Perticone Maria, Tripepi Giovanni, Maio Raffaele, Cimellaro Antonio, Addesi Desirée, Baggetta Rossella, Sciacqua Angela, Sesti Giorgio, Perticone Francesco
Department of Experimental and Clinical Medicine, University Magna Græcia of Catanzaro, Italy.
CNR-IFC, National Research Council-Institute of Biomedicine, Clinical Epidemiology and Physiopathology of Renal Disease and Hypertension, Reggio Calabria, Italy.
Int J Cardiol. 2017 Sep 15;243:473-478. doi: 10.1016/j.ijcard.2017.05.051. Epub 2017 May 13.
Hyperuricemia is associated with incident cardiovascular events in different settings of patients. We tested whether the inclusion of uric acid (UA) in Cox models including standard risk factors allows to better stratify cardiovascular risk in a cohort of 1522 naïve hypertensives with preserved renal function.
We used multiple Cox regression models to assess the independent effect of UA on cardiovascular outcomes, and Harrell'C index, Net Reclassification Index (NRI), and Integrated Discrimination Improvement (IDI) as indicators of the additional prognostic value of UA beyond and above that provided by standard risk factors and estimated glomerular filtration rate (e-GFR). Study outcomes were fatal and nonfatal cardiovascular events and fatal and nonfatal coronary outcomes/death due to other cardiovascular events.
UA resulted strongly related to both outcomes in unadjusted Cox regression analyses (P<0.001). Inclusion of UA into multiple Cox regression models including Framingham risk factors and e-GFR did not affect the association between UA and outcomes (fatal and nonfatal cardiovascular events, HR=1.44, 95% CI=1.36-1.55, P<0.001; fatal and nonfatal coronary outcomes/death due to other cardiovascular events, HR=1.48, 95% CI=1.36-1.61, P<0.001). Inclusion of UA into basic Cox models provided an increase in all indexes of prognostic accuracy for both outcomes: Harrell'C index: +5%; NRI: +24.9%; IDI: +7.6%, all P<0.001; and Harrell'C index: +5%; NRI: +25%; IDI: +6.3%, all P<0.001, respectively.
UA is an independent predictor of cardiovascular outcomes and increases prognostic accuracy of Cox models, including Framingham risk factors and e-GFR, in hypertensives with normal renal function, allowing a risk reclassification.
高尿酸血症与不同患者群体发生心血管事件相关。我们测试了在包含标准危险因素的Cox模型中纳入尿酸（UA）是否能更好地对1522例初发高血压且肾功能正常患者的心血管风险进行分层。
我们使用多个Cox回归模型评估UA对心血管结局的独立影响，并将Harrell'C指数（H指数）、净重新分类指数（NRI）和综合判别改善指数（IDI）作为UA超出标准危险因素和估计肾小球滤过率（e-GFR）所提供的额外预后价值的指标。研究结局为致命和非致命性心血管事件以及因其他心血管事件导致的致命和非致命性冠状动脉结局/死亡。
在未调整的Cox回归分析中，UA与两种结局均密切相关（P<0.001）。将UA纳入包含弗明汉姆危险因素和e-GFR的多个Cox回归模型中，并未影响UA与结局之间的关联（致命和非致命性心血管事件，风险比[HR]=1.44，95%置信区间[CI]=1.36-1.55，P<0.001；因其他心血管事件导致的致命和非致命性冠状动脉结局/死亡，HR=1.48，95%CI=1.36-1.61，P<0.001）。将UA纳入基本Cox模型中，两种结局的所有预后准确性指标均有所提高：H指数：提高5%；NRI：提高24.9%；IDI：提高7.6%，P均<0.001；以及H指数：提高5%；NRI：提高25%；IDI：提高6.3%，P均<0.001。
UA是心血管结局的独立预测因子，并且在肾功能正常的高血压患者中，提高了包含弗明汉姆危险因素和e-GFR的Cox模型的预后准确性，从而实现风险重新分类。
