Department of Rheumatology and Immunology, Kailuan General Hospital, Tangshan, China.
Department of Nutrition and Food Hygiene, School of Public Health, Institute of Nutrition, Fudan University, 130 Dong'an Road, Shanghai 200032, China.
Nutr Metab Cardiovasc Dis. 2024 Dec;34(12):2763-2770. doi: 10.1016/j.numecd.2024.09.012. Epub 2024 Sep 17.
Uric acid has been positively associated with the risk of developing heart failure in the general population. Nevertheless, it remains unclear whether hyperuricemia is an independent risk factor for heart failure and further contributes to the risk of heart failure among the already at-risk cardiovascular disease (CVD) population. This study aimed to evaluate the association between uric acid and incident heart failure in individuals with established CVD.
Included were 18,438 adults with established CVD but free of heart failure at baseline, from the Kailuan Study. Incident heart failure cases were ascertained by medical records. Cause-specific Cox proportional hazards regression models were applied to estimate hazard ratios (HRs) and 95 % confidence intervals (CIs) of heart failure according to uric acid tertiles. Over a median follow-up of 6.1 years, we identified 1215 incident heart failure cases. Higher uric acid was associated with a higher risk of incident heart failure, with adjusted HR for the last vs. first tertile of 1.50 (95%CI:1.30-1.73). Higher uric acid concentrations were associated with an increased risk of heart failure in individuals with coronary heart disease, atrial fibrillation, and ischemic stroke, but not in those with hemorrhagic stroke. Moreover, the observed association between uric acid and heart failure risk was more pronounced in individuals diagnosed with heart failure with reduced ejection fraction subtype compared with heart failure with preserved ejection fraction.
In individuals with CVD, uric acid was positively associated with the risk of heart failure, in a dose-response manner.
尿酸与一般人群中心力衰竭的发病风险呈正相关。然而，高尿酸血症是否是心力衰竭的独立危险因素，以及它是否会进一步增加心血管疾病（CVD）高危人群发生心力衰竭的风险仍不清楚。本研究旨在评估在已确诊 CVD 的个体中尿酸与心力衰竭事件之间的关系。
该研究纳入了 18438 名基线时患有已确诊 CVD 但无心力衰竭的成年人。通过病历确定心力衰竭事件。应用特定原因的 Cox 比例风险回归模型来估计根据尿酸三分位值的心力衰竭发生的危险比（HR）和 95%置信区间（CI）。在中位随访 6.1 年期间，我们共确定了 1215 例心力衰竭事件。尿酸水平越高，心力衰竭发生的风险越高，最后与第一三分位相比，调整后的 HR 为 1.50（95%CI：1.30-1.73）。尿酸浓度越高，与冠心病、心房颤动和缺血性卒中患者的心力衰竭风险增加相关，但与出血性卒中患者无关。此外，与射血分数保留型心力衰竭相比，在射血分数降低型心力衰竭患者中，尿酸与心力衰竭风险之间的相关性更为明显。
在 CVD 患者中，尿酸与心力衰竭风险呈正相关，呈剂量反应关系。
