Objectives: In older individuals, the role of serum uric acid (SUA) as risk factor for mortality is debated. This study investigated the association of SUA with all-cause and cardiovascular (CV) mortality in older adults participating in the large multicentre observational uric acid right for heart health (URRAH) study. Methods: Eight thousand URRAH participants aged 65+ were included in the analysis. The predictive role of SUA was assessed using Cox regression models stratified according to the cut-off age of 75. SUA was tested as continuous and categorical variable (age-specific quartiles). The prognostic threshold of SUA for mortality was analysed using receiver operating characteristic curves. Results: Among participants aged 65-74, multivariate Cox regression analysis adjusted for CV risk factors and comorbidities identified an independent association of SUA with both all-cause mortality (hazard ratio [HR] 1.169, 95% confidence interval [CI] 1.107-1.235) and CV mortality (HR 1.146, 95% CI 1.064-1.235). The cut-off value of 4.8 mg/dl discriminated mortality status. In participants aged 75+, we observed a J-shaped relationship of SUA with all-cause and CV mortality, with risk increasing at extreme SUA levels. Conclusions: These results confirmed the predictive role of SUA for all-cause and CV mortality in older adults, while revealing considerable age-related differences. Mortality risk increased at higher SUA levels in participants aged 65-74, with a prognostic threshold of 4.8 mg/dl. The relationship between SUA and mortality was J-shaped in oldest participants. Large interventional studies are needed to clarify the benefits and possible risks of urate-lowering treatments in older adults.

The association of uric acid with mortality modifies at old age: data from the uric acid right for heart health (URRAH) study

Virdis, Agostino;Masi, Stefano;Mengozzi, Alessandro;Ferri, Claudio;Muiesan, Maria Lorenza;Grassi, Guido;
2021-01-01

Abstract

Objectives: In older individuals, the role of serum uric acid (SUA) as risk factor for mortality is debated. This study investigated the association of SUA with all-cause and cardiovascular (CV) mortality in older adults participating in the large multicentre observational uric acid right for heart health (URRAH) study. Methods: Eight thousand URRAH participants aged 65+ were included in the analysis. The predictive role of SUA was assessed using Cox regression models stratified according to the cut-off age of 75. SUA was tested as continuous and categorical variable (age-specific quartiles). The prognostic threshold of SUA for mortality was analysed using receiver operating characteristic curves. Results: Among participants aged 65-74, multivariate Cox regression analysis adjusted for CV risk factors and comorbidities identified an independent association of SUA with both all-cause mortality (hazard ratio [HR] 1.169, 95% confidence interval [CI] 1.107-1.235) and CV mortality (HR 1.146, 95% CI 1.064-1.235). The cut-off value of 4.8 mg/dl discriminated mortality status. In participants aged 75+, we observed a J-shaped relationship of SUA with all-cause and CV mortality, with risk increasing at extreme SUA levels. Conclusions: These results confirmed the predictive role of SUA for all-cause and CV mortality in older adults, while revealing considerable age-related differences. Mortality risk increased at higher SUA levels in participants aged 65-74, with a prognostic threshold of 4.8 mg/dl. The relationship between SUA and mortality was J-shaped in oldest participants. Large interventional studies are needed to clarify the benefits and possible risks of urate-lowering treatments in older adults.
2021
Ungar, Andrea; Rivasi, Giulia; Di Bari, Mauro; Virdis, Agostino; Casiglia, Edoardo; Masi, Stefano; Mengozzi, Alessandro; Barbagallo, Carlo M; Bombelli, Michele; Bruno, Bernardino; Cicero, Arrigo F G; Cirillo, Massimo; Cirillo, Pietro; Desideri, Giovambattista; D'Elia, Lanfranco; Ferri, Claudio; Galletti, Ferruccio; Gesualdo, Loreto; Giannattasio, Cristina; Iaccarino, Guido; Ciccarelli, Michele; Lippa, Luciano; Mallamaci, Francesca; Maloberti, Alessandro; Mazza, Alberto; Muiesan, Maria Lorenza; Nazzaro, Pietro; Palatini, Paolo; Parati, Gianfranco; Pontremoli, Roberto; Quarti-Trevano, Fosca; Rattazzi, Marcello; Salvetti, Massimo; Tikhonoff, Valérie; Tocci, Giuliano; Cianci, Rosario; Verdecchia, Paolo; Viazzi, Francesca; Volpe, Massimo; Grassi, Guido; Borghi, Claudio
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11568/1137324
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