Longitudinal association between serum urate and subclinical atherosclerosis: the Coronary Artery Risk Development in Young Adults (CARDIA) study
Article first published online: 2 SEP 2013
© 2013 The Association for the Publication of the Journal of Internal Medicine
Journal of Internal Medicine
Volume 274, Issue 6, pages 594–609, December 2013
How to Cite
University of Minnesota-Twin Cities; Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University; University of Alabama at Birmingham; University of Minnesota: Twin Cities; Wake Forest School of Medicine; University of Colorado-Denver; Wake Forest University Health Sciences and Vanderbilt University Medical Center; USA. Longitudinal association between serum urate and subclinical atherosclerosis: the Coronary Artery Risk Development in Young Adults (CARDIA) study. J Intern Med 2013; 274: 594–609., , , , ,
- Issue published online: 11 NOV 2013
- Article first published online: 2 SEP 2013
- Accepted manuscript online: 19 AUG 2013 12:35AM EST
- CARDIA. Grant Numbers: NO1-HC-48047 to 48050, N01-HC-95095, N01-HC-05187
- New England Medical Center Hospitals, Inc., Ultrasound Reading Center. Grant Number: HHSN268200425204C
- Computed Tomography Reading Center. Grant Number: HHSN268200425205C
- National Heart, Lung, and Blood Institute. Grant Numbers: N01-HC-05187, HHSN268200425204C, HHSN268200425205C
- Computed Tomography Reading Center. Grant Numbers: N01-HC-05187, HHSN268200425204C, HHSN268200425205C, YALTA: NIH 1RO1-HL53560
- calcified plaque;
- intima–media thickness;
- subclinical atherosclerosis;
- uric acid
The aim of the present study was to determine whether serum urate (sUA) concentration is positively associated with subclinical atherosclerosis, independent of body mass index (BMI), amongst generally healthy adults.
Design and setting
The CARDIA study followed 5115 Black and White individuals aged 18–30 years in 1985–1986 (year 0). Subclinical atherosclerosis comprised coronary artery calcified plaque (CAC; years 15, 20 and 25), and maximum common carotid intima–media thickness (IMT; year 20). sUA (years 0, 10, 15 and 20) was modelled as gender-specific quartiles that were pooled. Discrete-time hazard regressions and generalized linear regressions were used for analyses.
Mean sUA concentration was lower in women than in men and increased with age. Adjusting for demographic and lifestyle factors, the highest versus lowest quartile of sUA at year 0 was associated with a 44% [95% confidence interval (CI) 20%, 73%] greater risk of CAC progression from years 15 to 25 (Ptrend < 0.001), which was attenuated by adjustment for BMI at year 0 (Ptrend = 0.45). A stronger association was found between sUA at year 15 and CAC progression at year 20 or 25 (hazard ratio 2.07, 95% CI 1.66, 2.58 for the highest versus lowest sUA quartile Ptrend < 0.001), which was attenuated, but remained significant with additional adjustment for BMI at year 15 (Ptrend = 0.01). A greater increment in sUA concentration from year 0 to year 15, independent of change in BMI, was related to a higher risk of CAC progression (Ptrend < 0.001). Similar associations were found between sUA and IMT, but only in men.
sUA may be an early biomarker for subclinical atherosclerosis in young adults; starting in early middle age, sUA predicts subclinical atherosclerosis independently of BMI.