Doubts over serum acid-CVD risk link

DOUBTS have been cast over previous reports that serum uric acid concentrations are an independently prognostic marker of cardiovascular disease (CVD) or all-cause mortality in patients with type 2 diabetes.

An Australian observational study of 1268 patients with type 2 diabetes revealed serum uric acid levels more than 0.40 mmol/l were not an independent predictor of CVD or all-cause mortality when compared with concentrations of 0.28 mmol/l or less, after an average of 10 years. 

Previous studies had indicated a positive association between high serum uric acid concentrations and risk of CVD mortality.

Professor Tim Davis, of the school of medicine and pharmacology at Fremantle Hospital and the University of Western Australia, said the latest findings supported the predictive power of traditional cardiovascular risk factors including age, gender, blood pressure, glycaemic control and microalbuminuria over serum uric acid levels.   

“If GPs have the conventional risk factors available, serum uric acid adds nothing useful,” he said.

A separate analysis in patients aged 65 years and older with a southern European background also found serum uric acid did not independently predict CVD or all-cause mortality.

The authors said differences in variables such as age, renal function and CVD therapies that affected both serum uric acid concentrations and independently mediated CVD risk might have driven the conflicting findings.

The authors said the 28% increased risk of CVD death per 0.1 mmol/l rise in serum uric acid declined to a “non significant” 11% excess after adjusting for cardiovascular risk factors. In the study, 525 (41%) of the participants died, of which 271 (51.6%) were attributed to CVD.

Diabetologia 2010; 53:1288-94