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Original Articles

Hyperuricemia and Incident Heart Failure

Eswar Krishnan, MD, MPhil

From the Department of Medicine, Stanford University School of Medicine, Stanford, Calif.

Correspondence to Eswar Krishnan, MD, 1000 Welch Rd, Suite 203, Stanford, CA 94304. E-mail e.krishnan{at}stanford.edu

Received June 9, 2008; accepted July 22, 2009.

Background— Hyperuricemia, a known correlate of oxidative stress, is a marker for adverse prognosis among individuals with heart failure. However, the relationship between hyperuricemia and the risk for incidence of heart failure in a community-based population has not been studied.

Methods and Results— We prospectively analyzed the relationship between serum uric acid concentration at baseline and subsequent heart failure among the participants of the Framingham Offspring cohort (n=4912; mean baseline age, 36 years; 52% women). By using Cox regressions, we calculated the risk of heart failure with increasing serum uric acid after adjusting for sex, age, smoking, body mass index, renal dysfunction, diuretics, systolic blood pressure, valvular heart disease, diabetes, alcohol, and use of antihypertensive medications. The incidence rates of heart failure were 6-fold higher among those at the highest quartile of serum uric acid (>6.3 mg/dL) compared with those at the lowest quartile (<3.4 mg/dL). The adjusted hazard ratio for the highest quartile of serum uric acid compared with the lowest was 2.1 (1.04 to 4.22). The relationship between hyperuricemia and heart failure was found in participants without metabolic syndrome and other subgroups as well.

Conclusions— Hyperuricemia is a novel, independent risk factor for heart failure in a group of young general community dwellers. This has implications for development of preventive strategies for heart failure.

Key Words: heart failure • risk • uric acid • incidence • hyperuricemia • prospective studies • biological markers

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