High Serum Uric Acid Trajectories Are Associated with Risk of Myocardial Infarction and All-cause Mortality in General Chinese Population

Background: Long-term patterns of serum uric acid (SUA) and their association with the risk of myocardial infarction (MI) and mortality are poorly characterized as prior studies measured SUA at a single time point. This study aimed to identify SUA trajectories and determine their associations with incident MI and all-cause mortality.

Methods: We included 85,503 participants who were free of MI in or prior 2012 from the Kailuan study. SUA trajectories during 2006-2012 were identified by group-based trajectory modeling. Cox proportional hazard models were used to assess the association of SUA trajectories with MI and all-cause mortality.

Results: We identified three SUA trajectories during 2006-2012: low-stable (n=44,124, mean SUA: 236-249 μmol/L), moderate-stable (n=34,431, mean SUA: 324-354 μmol/L) and high-stable (n=6,984, mean SUA: 425-463 μmol/L). During a median follow-up of 6.8 years, we documented 817 (0.96%) incident MI and 6498 (7.60%) mortality. Compared with the low-stable group, high-stable group experienced a higher risk of MI (hazard ratio [HR], 1.35; 95% confidence [CI], 1.07-1.71) and all-cause mortality (HR, 1.22; 95% CI, 1.12-1.33). Multiple sensitivity analyses yielded similar results. Additionally, the association of SUA trajectory with MI and all-cause mortality was more pronounced in individuals without a history of hypertension (P-interaction=0.0359) and those aged <60 years (P-interaction<0.0001), respectively.

Conclusions: Higher SUA trajectories were associated with altered risk of MI and all-cause mortality, suggesting that monitoring SUA trajectory may assist in identifying subpopulations at higher risk of MI and all-cause mortality.