Association of serum uric acid with all cause and cardiovascular disease mortality and incident myocardial infarction in the MONICA Augsburg cohort

Because previous findings have been inconsistent, we explored the associati on of serum concentrations of uric acid with all cause and cardiovascular d isease mortality and myocardial infarction prospectively. We used data from 1,044 men who are members of the World Health Organization Monitoring Tren ds and Determinants in Cardiovascular Diseases (MONICA) Augsburg cohort. Th e men, 45-64 years of age in 1984-1985, were followed through 1992. There w ere 90 deaths, 44 of which were related to cardiovascular disease; 60 men d eveloped incident nonfatal or fatal myocardial infarction. We estimated haz ard rate ratios from Cox proportional hazard models. Uric acid levels great er than or equal to 373 mu mol/liter (fourth quartile) us less than or equa l to 319 mu mol/liter (first and second quartile) independently predicted a ll-cause mortality [hazard rate ratio = 2.8; 95% confidence interval (CI) = 1.6-5.0] after adjustment for alcohol, total cholesterol/high-density lipo protein cholesterol ratio, hypertension, use of diuretic drugs, smoking, bo dy mass index, and education. The adjusted risk of cardiovascular disease m ortality was 2.2 (95% CI = 1.0-4.8), and that of myocardial infarction was 1.7 (95% CI = 0.8-3.3). Although residual confounding cannot be excluded, o ur results are among the few, in men, demonstrating a strong positive assoc iation of elevated serum uric acid with all cause mortality. Future investi gations may be able to evaluate whether uric acid contributes independently to the development of cardiovascular disease or is simply a component of t he atherogenic metabolic condition known as the insulin resistance syndrome .