First Clinical Medical College of Lanzhou University, Lanzhou, Gansu, China.
Geriatric Cardiovascular Department and Gansu Clinical Research Center for Geriatric Disease, First Hospital of Lanzhou University, Lanzhou, Gansu, China.
Sci Rep. 2024 Nov 4;14(1):26675. doi: 10.1038/s41598-024-76970-1.
The relationship between serum uric acid (SUA) and mortality in patients with cardiovascular disease (CVD) remains controversial. We aimed to explore the relationship between SUA and all-cause mortality (ACM) and cardiovascular mortality (CVM) in adult patients with CVD. This cohort study included 3977 patients with CVD from the National Health and Nutrition Examination Survey (2005-2018). Death outcomes were determined by linking National Death Index (NDI) records through December 31, 2019. We explored the association of SUA with mortality using weighted Cox proportional hazards regression models, subgroup analysis, Kaplan-Meier survival curves, weighted restricted cubic spline (RCS) models, and weighted threshold effect analysis among patients with CVD. During a median follow-up of 68 months (interquartile range, 34-110 months), 1,360 (34.2%) of the 3,977 patients with cardiovascular disease died, of which 536 (13.5%) died of cardiovascular deaths and 824 (20.7%) died of non-cardiovascular deaths. In a multivariable-adjusted model (Model 3), the risk of ACM (HR 1.38, 95% CI 1.16-1.64) and the risk of CVM (HR 1.39, 95% CI 1.04-1.86) for participants in the SUA Q4 group were significantly higher. In patients with CVD, RCS regression analysis revealed a nonlinear association (p < 0.001 for all nonlinearities) between SUA, ACM, and CVM in the overall population and in men. Subgroup analysis showed a nonlinear association between ACM and CVM with SUA in patients with CVD combined with chronic kidney disease (CKD), with thresholds of 5.49 and 5.64, respectively. Time-dependent ROC curves indicated areas under the curve of 0.61, 0.60, 0.58, and 0.55 for 1-, 3-, 5-, and 10-year survival for ACM and 0.69, 0.61, 0.59, and 0.56 for CVM, respectively. We demonstrate that SUA is an independent prognostic factor for the risk of ACM and CVM in patients with CVD, supporting a U-shaped association between SUA and mortality, with thresholds of 5.49 and 5.64, respectively. In patients with CVD combined with CKD, the association of the ACM and the CVM with SUA remains nonlinear.
血清尿酸（SUA）与心血管疾病（CVD）患者的死亡率之间的关系仍存在争议。我们旨在探讨成年 CVD 患者中 SUA 与全因死亡率（ACM）和心血管死亡率（CVM）之间的关系。这项队列研究纳入了来自全国健康与营养检查调查（2005-2018 年）的 3977 例 CVD 患者。通过与截至 2019 年 12 月 31 日的国家死亡指数（NDI）记录进行链接，确定死亡结局。我们使用加权 Cox 比例风险回归模型、亚组分析、Kaplan-Meier 生存曲线、加权限制立方样条（RCS）模型和 CVD 患者中的加权阈值效应分析来探讨 SUA 与死亡率之间的关联。在中位随访 68 个月（四分位间距，34-110 个月）期间，3977 例 CVD 患者中有 1360 例（34.2%）死亡，其中 536 例（13.5%）死于心血管死亡，824 例（20.7%）死于非心血管死亡。在多变量调整模型（模型 3）中，SUA Q4 组参与者的 ACM 风险（HR 1.38，95%CI 1.16-1.64）和 CVM 风险（HR 1.39，95%CI 1.04-1.86）显著升高。在 CVD 患者中，RCS 回归分析显示，SUA 与 ACM 和 CVM 之间存在非线性关联（所有非线性检验的 p 值均<0.001）。亚组分析显示，SUA 与合并慢性肾脏病（CKD）的 CVD 患者的 ACM 和 CVM 之间存在非线性关联，其阈值分别为 5.49 和 5.64。时间依赖性 ROC 曲线显示，ACM 的曲线下面积分别为 0.61、0.60、0.58 和 0.55，用于预测 1、3、5 和 10 年生存率；CVM 的曲线下面积分别为 0.69、0.61、0.59 和 0.56。我们证明，SUA 是 CVD 患者 ACM 和 CVM 风险的独立预后因素，SUA 与死亡率之间呈 U 型关联，其阈值分别为 5.49 和 5.64。在合并 CKD 的 CVD 患者中，ACM 和 CVM 与 SUA 之间的关联仍然是非线性的。
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