IMR Press / RCM / Volume 22 / Issue 3 / DOI: 10.31083/j.rcm2203108
Open Access Original Research
The association between serum uric acid levels and 10-year cardiovascular disease incidence: results from the ATTICA prospective study
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1 First Department of Internal Medicine, Diabetes Center, Division of Endocrinology and Metabolism, AHEPA University Hospital, 54621 Thessaloniki, Greece
2 Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17671 Athens, Greece
3 Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy
4 First Cardiology Clinic, School of Medicine, University of Athens, 15772 Athens, Greece
5 Department of Clinical Biochemistry, Royal Free Hospital campus, University College London Medical School, University College London (UCL), NW3 2QG London, UK

These authors contributed equally.

Rev. Cardiovasc. Med. 2021 , 22(3), 991–1001;
Submitted: 1 June 2021 | Revised: 24 June 2021 | Accepted: 29 July 2021 | Published: 24 September 2021
Copyright: © 2021 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license (

Limited data suggests possible gender-specific association between serum uric acid (SUA) and cardiovascular disease (CVD) incidence. The aim of the present analysis was to evaluate the association between SUA levels and 10-year CVD incidence (2002–2012) in the ATTICA study participants. Overall, 1687 apparently healthy volunteers, with SUA measurements, residing in the greater metropolitan Athens area (Greece), were included. Multivariable Cox-regression models were used to estimate the hazard ratios for SUA in relation to 10-year CVD incidence. Receiver operating curve analysis was conducted to detect optimal SUA cut-off values. Participants in the 2nd and 3rd SUA tertile had 29 and 73% higher 10-year CVD incidence compared with those in the 1st tertile (p < 0.001). In gender-specific analysis, only in women SUA was independently associated with CVD incidence; women in the 3rd SUA tertile had 79% greater 10-year CVD event risk compared to their 1st tertile counterparts. Obese in the 3rd SUA tertile had 2-times higher CVD incidence compared to those in the 1st tertile. Similar findings were observed in metabolically healthy (vs. unhealthy) and metabolically healthy obese. SUA thresholds best predicting 10-year CVD incidence was 5.05 and 4.15 mg/dL (0.30 and 0.25 mmol/L) in men and women, respectively. In conclusion, increased SUA levels were independently related to 10-year CVD event rate in women, obese and metabolically healthy individuals. SUA could predict 10-year CVD incidence even at low levels. Further studies are warranted to identify SUA cut-off values that may improve the detection of individuals at higher CVD risk in clinical practice.

Serum uric acid
Cardiovascular disease
ATTICA study
Metabolic health status
Fig. 1.
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