Prognostic value of hyperuricaemia for cardiovascular events in primary care: sex-specific analysis from the IBERICAN cohort

Atherosclerosis, the pathophysiological basis of cardiovascular disease (CVD), progresses insidiously under the influence of cardiovascular risk factors (CVRFs).1 It is relevant for primary care (PC) to improve the predictive capacity of classical equations due to the underestimation of risk in a non-negligible number of patients.2,3 Serum uric acid (SUA) has been proposed as a potential biomarker to improve cardiovascular risk stratification, but contradictory results have been observed, most likely influenced by the different behaviour of uric acid (UA) depending on sex and age.4,5 The present study aims to evaluate the relationship between UA levels and the incidence of major adverse cardiovascular events (MACE) according to sex and age. A subgroup analysis of the IBERICAN study,6 a prospective cohort of patients recruited from PC centres, was conducted. For this study, 4290 subjects free of prior CVD with baseline UA measurements were included. The sample accumulated a total follow-up of 11 997 person-years (5229 in men and 6768 in women), with a median follow-up of 2.6 years. Hyperuricaemia (HU) was defined using sex-specific cut-off points (≥6 mg/dL in women and ≥7 mg/dL in men). Likewise, the population was stratified into sex-specific quartiles (Q) of SUA: men: Q1 < 4.91 mg/dL; Q2: 4.91–5.85 mg/dL; Q3: 5.86–6.81 mg/dL; and Q4 ≥ 6.82 mg/dL and women: Q1 < 3.81 mg/dL; Q2: 3.81–4.60 mg/dL; Q3: 4.61–5.40 mg/dL; and Q4 ≥ 5.41 mg/dL. The primary outcome variable was the incidence of MACE, which included hospital admission or mortality due to acute myocardial infarction, heart failure, stroke, or peripheral arterial disease.