AUTHOR=Zheng Yiying , Ou Jiaman , Huang Dehua , Zhou Ziyou , Dong Xiaoli , Chen Jie , Liang Dandan , Liu Jin , Liu Yong , Chen Jiyan , Huang Xiaoyu , Tan Ning 

TITLE=The U-Shaped Relationship Between Serum Uric Acid and Long-Term All-Cause Mortality in Coronary Artery Disease Patients: A Cohort Study of 33,034 Patients

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.858889

DOI=10.3389/fcvm.2022.858889

ISSN=2297-055X

ABSTRACT=Background: Associations between high serum uric acid (SUA) and cardiovascular diseases have been reported. However, few studies have been conducted to explore the relationship between SUA and long-term all-cause mortality in wholecoronary artery disease (CAD) patients. 
Methods: From Jan. 2007 to Dec. 2018, we divided 33,034 CAD patients admitted in Guangdong Provincial People's Hospital into five groups (Quintile 1: <303µmol/L, Quintile 2: 303µmol/L≤ SUA <357µmol/L, Quintile 3: 357µmol/L ≤SUA <408µmol/L, Quintile 4: 408µmol/L ≤SUA <476µmol/L, Quintile 5: SUA ≥476µmol/L). This study used Kaplan-Meier survival analysis to evaluate patient outcomes with different ranges of SUA. Cox proportional hazards regression models and restricted cubic spline were applied to determine the association between serum uric and long-term all-cause mortality. 
Results: A total of 33,034 participants were recruited, including 24,780 (75.01%) males and 8,254 (24.99) females in this cohort study. Median follow-up was 4.91 years. We found that SUA is an independent risk factor of long-term all-cause mortality according to the result of cox proportional hazards models. This study also illustrated an approximate U-shape association between SUA and all-cause mortality when SUA <303µmol/L and SUA ≥476µmol/L [Compared with Quintile 3, Quintile 1, aHR=1.12, 95%CI: 1.01-1.26, P=0.038; Quintile 2, aHR=0.97, 95%CI: 0.86-1.08, P=0.541; Quintile 4, aHR=1.00, 95%CI: 0.89-1.12, P=0.996; Quintile 5, aHR=1.17, 95%CI: 1.05-1.30, P=0.005]. 
Conclusion: Our study indicated a U-shape relationship between SUA and long-term all-cause mortality in general CAD patients. No matter whether SUA too high or too low, it increased the all-cause mortality in the general CAD population, which deserves to be closely monitored.