Serum Uric Acid and the Risk of Cardiovascular and All-Cause Mortality in Community-Dwelling Older Adults

Background: Several observational studies have shown moderate-to-strong associations between serum uric acid (SUA) and the risk of adverse cardiovascular outcomes and death. However, data on these associations among older adults are scarce. This is an important knowledge gap given the common use of SUA lowering drugs in this group, which are associated with several toxicities. Thus, we conducted a preliminary assessment of the association between SUA and the risk of cardiovascular and all-cause mortality among older adults. Methods: We conducted a population-based prospective cohort study using data from the Berlin Initiative Study (BIS) linked to administrative healthcare data. Participants were followed from cohort entry until the occurrence of a study outcome or two years after their last individual visit, whichever occurred first. We created four exposure groups based on quartiles of SUA distribution at cohort entry – from low to high in mg/dL: Q1 [1.7,4.8], Q2 (4.8,5.8], Q3 (5.8,6.8], Q4 (6.8,13.0] – and used an intention-to-treat exposure definition (Q2 as reference group). Cox proportional hazards model estimated age- and sex-adjusted hazard ratios and 95% confidence intervals of cardiovascular and all-cause mortality. Results: Overall, 2058 of the 2069 BIS participants were included. Mean age was 80 years, 53% were female, and the mean eGFR was 58 mL/min/1.73m2. BIS participants with high SUA levels (Q4) were more likely to be male, obese, smokers, and to have prior cardiovascular or chronic kidney disease than those with lower SUA levels (Q1-Q3). During a median follow-up of 8 years, Q1 and Q3 were not associated with the risk of either outcome, when compared to Q2 (Table). Q4 was associated with a numerical, statistically non-significant increase in the risk of cardiovascular mortality and with a 30% increased risk of all-cause mortality, compared to Q2. Conclusion: Our prospective cohort study suggests that high SUA is associated with the risk of all-cause, but not with cardiovascular mortality in older adults. Funding: Private Foundation Support