U-Shaped Association Between Serum Uric Acid Level and Risk of Mortality: A Cohort Study
- Authors
- Cho, Sung Kweon; Chang, Yoosoo; Kim, Inah; Ryu, Seungho
- Issue Date
- Jul-2018
- Publisher
- John Wiley and Sons Ltd
- Citation
- Arthritis and Rheumatology, v.70, no.7, pp.1122 - 1132
- Indexed
- SCIE
SCOPUS
- Journal Title
- Arthritis and Rheumatology
- Volume
- 70
- Number
- 7
- Start Page
- 1122
- End Page
- 1132
- URI
- https://scholarworks.bwise.kr/hanyang/handle/2021.sw.hanyang/149736
- DOI
- 10.1002/art.40472
- ISSN
- 2326-5191
- Abstract
- Objective. In addition to the controversy regarding the association of hyperuricemia with cardiovascular disease (CVD) mortality, few studies have examined the impact of a low uric acid level on mortality. We undertook the present study to evaluate the relationship between both low and high uric acid levels and the risk of all-cause and cause-specific mortality in a large sample of Korean adults over a full range of uric acid levels. Methods. A cohort study was performed in 375,163 South Korean men and women who underwent health check-ups from 2002 to 2012. Vital status and cause of death were ascertained from the national death records. Hazard ratios (HRs) and 95% confidence intervals (95% CIs) for mortality outcomes were estimated using Cox proportional hazards regression analysis. Results. During a total of 2,060,721.9 person-years of follow-up, 2,020 participants died, with 287 CVD deaths and 963 cancer deaths. Low and high uric acid levels were associated with increased all-cause, CVD, and cancer mortality. The multivariable-adjusted HRs for all-cause mortality in the lowest uric acid categories (<3.5 mg/dl for men and <2.5 mg/dl for women) compared with the sex-specific reference category were 1.58 (95% CI 1.18-2.10) and 1.80 (95% CI 1.10-2.93), respectively. Corresponding HRs in the highest uric acid categories (>= 9.5 mg/dl for men and >= 8.5 mg/dl for women) were 2.39 (95% CI 1.57-3.66) and 3.77 (95% CI 1.17-12.17), respectively. Conclusion. In this large cohort study of men and women, both low and high uric acid levels were predictive of increased mortality, supporting a U-shaped association between serum uric acid levels and adverse health outcomes.
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