Added predictive value of high uric acid for cardiovascular events in the Ambulatory Blood Pressure International Study

Gianpaolo Reboldi, Paolo Verdecchia, Francesca Saladini, Marina Pane, Lawrence J. Beilin, Kazuo Eguchi, Yutaka Imai, Kazuomi Kario, Takayoshi Ohkubo, Sante D. Pierdomenico, Joseph E. Schwartz, Lindon Wing, Paolo Palatini

Research output: Contribution to journalArticle

Abstract

The prognostic value of uric acid (UA) for cardiovascular events (CVE) is still debated. Our purpose was to investigate the association between UA and CVE in 5243 participants of the ABP-International study with the main aim of identifying optimal sex-specific cut-points. In multivariable Cox analyses, the relationship between CVE and UA as a continuous variable was modeled by including both linear and nonlinear terms. Survival models were also estimated with UA as a categorical variable. Optimal UA cut-points were determined using an outcome-oriented approach. During a median follow-up of 5.9 years, there were 423 CVE (93 fatal). In age- and sex-adjusted Cox models, UA as a continuous variable was a significant predictor of CVE in all individuals and in men and women considered separately. The relationship between UA and CVE was linear (P-value for nonlinearity 0.54 and 0.80 for men and women, respectively). For each 1 mg/dL increase in UA, the relative hazard increase was 16% in men and 19% in women. In fully adjusted models, UA remained a significant predictor of CVE in the whole study cohort. The optimal cut-point best separating patients at low and high risk of CVE was 6.3 mg/dL for men and 4.4 mg/dL for women. Subjects with high UA had a 38% greater risk of CVE. In a sex-specific analysis, the association remained significant only in men (hazard ratio, 1.47; P < 0.01). In conclusion, high UA is an independent predictor for subsequent CVE and significantly improves risk discrimination and reclassification over the baseline multivariable model.

Original languageEnglish
Pages (from-to)966-974
Number of pages9
JournalJournal of Clinical Hypertension
Volume21
Issue number7
DOIs
Publication statusPublished - 1 Jul 2019

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Uric Acid
Blood Pressure
Proportional Hazards Models
Cohort Studies
Survival

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Reboldi, Gianpaolo ; Verdecchia, Paolo ; Saladini, Francesca ; Pane, Marina ; Beilin, Lawrence J. ; Eguchi, Kazuo ; Imai, Yutaka ; Kario, Kazuomi ; Ohkubo, Takayoshi ; Pierdomenico, Sante D. ; Schwartz, Joseph E. ; Wing, Lindon ; Palatini, Paolo. / Added predictive value of high uric acid for cardiovascular events in the Ambulatory Blood Pressure International Study. In: Journal of Clinical Hypertension. 2019 ; Vol. 21, No. 7. pp. 966-974.
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abstract = "The prognostic value of uric acid (UA) for cardiovascular events (CVE) is still debated. Our purpose was to investigate the association between UA and CVE in 5243 participants of the ABP-International study with the main aim of identifying optimal sex-specific cut-points. In multivariable Cox analyses, the relationship between CVE and UA as a continuous variable was modeled by including both linear and nonlinear terms. Survival models were also estimated with UA as a categorical variable. Optimal UA cut-points were determined using an outcome-oriented approach. During a median follow-up of 5.9 years, there were 423 CVE (93 fatal). In age- and sex-adjusted Cox models, UA as a continuous variable was a significant predictor of CVE in all individuals and in men and women considered separately. The relationship between UA and CVE was linear (P-value for nonlinearity 0.54 and 0.80 for men and women, respectively). For each 1 mg/dL increase in UA, the relative hazard increase was 16{\%} in men and 19{\%} in women. In fully adjusted models, UA remained a significant predictor of CVE in the whole study cohort. The optimal cut-point best separating patients at low and high risk of CVE was 6.3 mg/dL for men and 4.4 mg/dL for women. Subjects with high UA had a 38{\%} greater risk of CVE. In a sex-specific analysis, the association remained significant only in men (hazard ratio, 1.47; P < 0.01). In conclusion, high UA is an independent predictor for subsequent CVE and significantly improves risk discrimination and reclassification over the baseline multivariable model.",
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author = "Gianpaolo Reboldi and Paolo Verdecchia and Francesca Saladini and Marina Pane and Beilin, {Lawrence J.} and Kazuo Eguchi and Yutaka Imai and Kazuomi Kario and Takayoshi Ohkubo and Pierdomenico, {Sante D.} and Schwartz, {Joseph E.} and Lindon Wing and Paolo Palatini",
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Reboldi, G, Verdecchia, P, Saladini, F, Pane, M, Beilin, LJ, Eguchi, K, Imai, Y, Kario, K, Ohkubo, T, Pierdomenico, SD, Schwartz, JE, Wing, L & Palatini, P 2019, 'Added predictive value of high uric acid for cardiovascular events in the Ambulatory Blood Pressure International Study' Journal of Clinical Hypertension, vol. 21, no. 7, pp. 966-974. https://doi.org/10.1111/jch.13584

Added predictive value of high uric acid for cardiovascular events in the Ambulatory Blood Pressure International Study. / Reboldi, Gianpaolo; Verdecchia, Paolo; Saladini, Francesca; Pane, Marina; Beilin, Lawrence J.; Eguchi, Kazuo; Imai, Yutaka; Kario, Kazuomi; Ohkubo, Takayoshi; Pierdomenico, Sante D.; Schwartz, Joseph E.; Wing, Lindon; Palatini, Paolo.

In: Journal of Clinical Hypertension, Vol. 21, No. 7, 01.07.2019, p. 966-974.

Research output: Contribution to journalArticle

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T1 - Added predictive value of high uric acid for cardiovascular events in the Ambulatory Blood Pressure International Study

AU - Reboldi, Gianpaolo

AU - Verdecchia, Paolo

AU - Saladini, Francesca

AU - Pane, Marina

AU - Beilin, Lawrence J.

AU - Eguchi, Kazuo

AU - Imai, Yutaka

AU - Kario, Kazuomi

AU - Ohkubo, Takayoshi

AU - Pierdomenico, Sante D.

AU - Schwartz, Joseph E.

AU - Wing, Lindon

AU - Palatini, Paolo

PY - 2019/7/1

Y1 - 2019/7/1

N2 - The prognostic value of uric acid (UA) for cardiovascular events (CVE) is still debated. Our purpose was to investigate the association between UA and CVE in 5243 participants of the ABP-International study with the main aim of identifying optimal sex-specific cut-points. In multivariable Cox analyses, the relationship between CVE and UA as a continuous variable was modeled by including both linear and nonlinear terms. Survival models were also estimated with UA as a categorical variable. Optimal UA cut-points were determined using an outcome-oriented approach. During a median follow-up of 5.9 years, there were 423 CVE (93 fatal). In age- and sex-adjusted Cox models, UA as a continuous variable was a significant predictor of CVE in all individuals and in men and women considered separately. The relationship between UA and CVE was linear (P-value for nonlinearity 0.54 and 0.80 for men and women, respectively). For each 1 mg/dL increase in UA, the relative hazard increase was 16% in men and 19% in women. In fully adjusted models, UA remained a significant predictor of CVE in the whole study cohort. The optimal cut-point best separating patients at low and high risk of CVE was 6.3 mg/dL for men and 4.4 mg/dL for women. Subjects with high UA had a 38% greater risk of CVE. In a sex-specific analysis, the association remained significant only in men (hazard ratio, 1.47; P < 0.01). In conclusion, high UA is an independent predictor for subsequent CVE and significantly improves risk discrimination and reclassification over the baseline multivariable model.

AB - The prognostic value of uric acid (UA) for cardiovascular events (CVE) is still debated. Our purpose was to investigate the association between UA and CVE in 5243 participants of the ABP-International study with the main aim of identifying optimal sex-specific cut-points. In multivariable Cox analyses, the relationship between CVE and UA as a continuous variable was modeled by including both linear and nonlinear terms. Survival models were also estimated with UA as a categorical variable. Optimal UA cut-points were determined using an outcome-oriented approach. During a median follow-up of 5.9 years, there were 423 CVE (93 fatal). In age- and sex-adjusted Cox models, UA as a continuous variable was a significant predictor of CVE in all individuals and in men and women considered separately. The relationship between UA and CVE was linear (P-value for nonlinearity 0.54 and 0.80 for men and women, respectively). For each 1 mg/dL increase in UA, the relative hazard increase was 16% in men and 19% in women. In fully adjusted models, UA remained a significant predictor of CVE in the whole study cohort. The optimal cut-point best separating patients at low and high risk of CVE was 6.3 mg/dL for men and 4.4 mg/dL for women. Subjects with high UA had a 38% greater risk of CVE. In a sex-specific analysis, the association remained significant only in men (hazard ratio, 1.47; P < 0.01). In conclusion, high UA is an independent predictor for subsequent CVE and significantly improves risk discrimination and reclassification over the baseline multivariable model.

KW - ambulatory

KW - blood pressure

KW - cardiovascular

KW - hypertension

KW - risk

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