Michael H. Alderman, MD
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Alderman M.; Serum Uric Acid and Cardiovascular Disease Risk. Ann Intern Med. 2000;132:591. doi: 10.7326/0003-4819-132-7-200004040-00014
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Published: Ann Intern Med. 2000;132(7):591.
TO THE EDITOR:
Culleton and colleagues' carefully performed and valuable observational study from the Framingham Heart Study reports that the positive association between a single baseline uric acid level and cardiovascular events was not sustained after accounting for other variables (1).
Other epidemiologic studies, arguably performed with equal care and with at least equally detailed knowledge of potential confounders, have found just the opposite (2, 3). The National Health and Nutrition Examination Survey (NHANES) I epidemiologic follow-up study reported a significant, independent association between increasing uric acid levels and cardiovascular events in women (2). More recently, among 7978 hypertensive participants with an average of 5.6 uric acid determinations per year, a robust, dose-dependent, specific, independent, and significant association with cardiovascular events was observed (3). After adjustment for the variables assessed in the Framingham Study and also for serum creatinine levels (which were not considered in the Framingham Heart Study), a difference of 1 standard deviation (0.086 mmol/L) in serum uric acid level was associated with a 22% difference in cardiovascular events. This effect was greater than that associated with a 40-mg/dL difference in cholesterol level or a 10-mm Hg difference in systolic blood pressure. Similar independent and significant associations of serum uric acid with cardiovascular events have recently been found in analysis of the Systolic Hypertension in the Elderly Program (SHEP) study (4) and other population studies (5).
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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