Key result
Higher serum uric acid linked to ~8% greater cardiometabolic disease risk per 1 mg/dL.
Why the study?
The study aimed to investigate the role of serum uric acid in disease progression from baseline to first cardiometabolic disease, subsequent cardiometabolic multimorbidity, and mortality.
Do elevated serum uric acid levels increase the risk of progression to first cardiometabolic disease, cardiometabolic multimorbidity, and mortality?
Cohort (n=418,765)
Do elevated serum uric acid levels increase the risk of progression to first cardiometabolic disease, cardiometabolic multimorbidity, and mortality?
Effect estimate: HR 1.08 (95% CI 1.07-1.09)
Elevated serum uric acid levels are associated with an increased risk of developing initial and subsequent cardiometabolic diseases, as well as all-cause mortality.
Should not yet change practice for cardiometabolic prevention; leaves open SUA causality and value of urate-lowering trials.
OBJECTIVE: This study aimed to investigate the role of serum uric acid (SUA) in disease progression from baseline to first cardiometabolic disease (FCMD), subsequent cardiometabolic multimorbidity (CMM), and mortality. METHODS: We conducted a prospective analysis using UK Biobank data (n = 418,765). CMM was defined as the coexistence of at least at least two cardiometabolic conditions out of type 2 diabetes (T2D), ischemic heart disease (IHD), and stroke. Multi-state models were employed to analyze the associations between SUA levels and disease transitions across different stages, including disease-specific analyses for individual cardiometabolic diseases. RESULTS: During follow-up, 54,946 participants developed FCMD, of whom 6,260 progressed to CMM. Each 1 mg/dL increase in SUA was associated with higher risks of FCMD [HR: 1.08 (1.07, 1.09)], transition from FCMD to CMM [HR: 1.07 (1.05, 1.10)], and all-cause mortality from all states [HR 1.04 (1.03, 1.05) from baseline to death; HR 1.03 (1.01, 1.05) from FCMD to death; HR 1.08 (1.03, 1.12) from CMM to death]. When FCMD was further divided into IHD, stroke, and T2D, we found that SUA played different roles in disease-specific transitions even within the same stage, with the strongest associations observed for incident T2D [HR: 1.15 (1.14, 1.17)] and stroke-to-CMM progression [HR: 1.11 (1.04, 1.18)]. These associations remained robust across sensitivity analyses and were stronger in younger participants (< 60 years). CONCLUSIONS: Elevated SUA levels serve as a potential marker across the entire trajectory of cardiometabolic disease progression. These findings suggest the importance of SUA monitoring and management in preventing cardiometabolic disease progression.
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Wu et al. (2026) conducted a cohort in Cardiometabolic multimorbidity (n=418,765). Serum uric acid was evaluated on First cardiometabolic disease (FCMD) (HR 1.08, 95% CI 1.07-1.09). Each 1 mg/dL increase in serum uric acid was associated with a higher risk of first cardiometabolic disease (HR 1.08; 95% CI 1.07-1.09) and transition to cardiometabolic multimorbidity.
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