A gender-specific analysis of association between hyperuricaemia and cardiovascular events in patients with coronary artery disease

SummaryBackground and aimsGender-related differences in the association between hyperuricaemia and cardiovascular events remain poorly understood. The objective of this study was to assess gender-related differences in the association between hyperuricaemia and cardiovascular events in patients with coronary artery disease (CAD).Methods and resultsThis study included 13,273 patients with CAD. Hyperuricaemia was defined as a plasma uric acid >7.0 mg dl−1 in men and >5.7 mg dl−1 in women. The primary outcome was 1-year all-cause mortality. Hyperuricaemia was found in 3745 men (36.5%) and 1562 women (50.3%); odds ratio (OR) = 1.76, 95% confidence interval (CI) 1.62–1.91; P < 0.001. Women with hyperuricaemia were older, had higher proportions of patients with diabetes and arterial hypertension and had reduced renal function and higher C-reactive protein levels compared with men with hyperuricaemia. One-year all-cause mortality was 9.3% (n = 143) in women with hyperuricaemia versus 6.9% (n = 252) in men with hyperuricaemia (P = 0.002). After adjustment in multivariable Cox proportional hazards model, uric acid predicted 1-year mortality with an adjusted hazard ratio (HR) = 1.17, 95% CI (1.03–1.31), P = 0.012 in men and HR = 1.25, 95% CI (1.06–1.48), P = 0.007 in women, for each standard deviation increase in the natural logarithm. Uric acid predicted 1-year mortality with an area under the receiver-operating characteristic curve = 0.625, 95% CI (0.594–0.656) in men and 0.676, 95% CI (0.635–0.717) in women (P = 0.044, for women versus men).ConclusionHyperuricaemia predicts an increased risk of 1-year mortality in both genders with a stronger association in women. Differences in cardiovascular risk profile may explain the stronger association between hyperuricaemia and cardiovascular events in women.