Which serum uric acid levels are associated with increased cardiovascular risk in the general adult population?

Abstract Our aim was to determine the serum uric acid (SUA) levels associated with an increased risk of cardiovascular (CV) and all‐cause death in the general adult population. We analyzed data obtained in two independent cross‐sectional surveys performed in the Czech Republic in 2006‐09 and 2015‐18, involving 1% population random samples in nine districts, aged 25‐64 years, stratified by age and gender. Ten‐year mortality data were obtained in a cohort with examination in 2006‐09. Final analyses included 3542 individuals (48.2% men) examined in 2006‐09, and 2304 (47.4% men) examined in 2015‐18. From a cohort examined in 2006‐09, 122 men and 60 women were reported dead (33% and 27% from CV disease). In men, there was no association of baseline SUA levels with baseline SCORE category or 10‐year mortality rates. In women, each 10 µmol/L increase in baseline SUA levels was associated with an increase in baseline SCORE category ( P  < .001). Receiver operating characteristic curve analyses in women identified the baseline SUA cutoff values discriminating: 1. between low/intermediate and high/very high SCORE categories (309 µmol/L), 2. CV mortality (325 µmol/L), and 3. all‐cause mortality (298 µmol/L). After adjusting for confounders including SCORE, Cox regression analysis confirmed that the baseline SUA cutoffs of 309 µmol/L and 325 µmol/L were associated with 4‐times ( P  = .010) and 6‐times ( P  = .036) greater risk of CV mortality, whereas the cutoff of 298 µmol/L was associated with 87% greater risk of all‐cause mortality ( P  = .025). In conclusion, the SUA cutoff value of 309 µmol/L identified women at high/very high SCORE category and was associated with 4‐times greater risk of observed CV mortality over 10 years.