Table_1_Change of serum uric acid and progression of cardiometabolic multimorbidity among middle aged and older adults: A prospective cohort study.DOCX

BackgroundHyperuricemia is prevalent and associated with individual cardiometabolic diseases, highlighting the potential role of serum uric acid (SUA) in the development and progression of cardiometabolic multimorbidity (CMM, the coexistence of diabetes, heart disease, or stroke). This study aimed to examine the role of SUA change in the progression of CMM.MethodsThis prospective cohort study used data from the China Health and Retirement Longitudinal Study, included 4,820 participants aged 45 years or above with three complete surveys at 2011 (baseline), 2015, and 2018. SUA level at survey 2011 and 2015 was used to measure SUA change as keeping or rising to hyperuricemia, and keeping or declining to non-hyperuricemia. CMM progression was defined as the first report of CMM or additional report of cardiometabolic diseases during survey 2015 and 2018. We used logistic regression models to estimate the odds ratios (ORs) and 95% confidence intervals (95% CIs) of SUA change on CMM progression.ResultsDuring the follow-up of around 7 years, 519 (10.8%) of the participants kept or rose to hyperuricemia from survey 2011 to 2015, and 311 (6.5%) experienced CMM progression from survey 2015 to 2018. Participants who kept or rose to hyperuricemia had 1.86 (95% CI, 1.29, 2.68) increased odds of CMM progression compared with those who kept or declined to non-hyperuricemia. Specifically, keeping or rising to hyperuricemia (vs. keeping or declining to non-hyperuricemia) was associated with 2.01 times higher odds (95% CI, 1.18, 3.43) of incident diabetes and 1.67 times higher odds (OR:1.67; 95% CI, 1.15, 2.43) of incident cardiovascular diseases following diabetes.ConclusionKeeping or rising to hyperuricemia was associated with CMM progression, particularly with incident cardiovascular diseases following diabetes. These findings suggest that monitoring SUA change may provide innovative insights into the prevention of CMM, especially in the secondary prevention of CMM (i.e., preventing further progression to cardiovascular diseases among patients with diabetes).

背景高尿酸血症普遍存在，并与个体的心血管代谢性疾病相关联，凸显了血清尿酸（SUA）在心血管代谢多病共存（CMM，即糖尿病、心脏病或卒中的共存）的发展与进展中的潜在作用。本研究旨在探讨SUA变化在CMM进展中的作用。方法本前瞻性队列研究利用了中国健康与养老追踪调查的数据，纳入了2011年（基线）、2015年和2018年进行了三次完整调查的4,820名45岁及以上的参与者。2011年和2015年的SUA水平被用于衡量SUA变化，即保持或上升至高尿酸血症，以及保持或下降至非高尿酸血症。CMM进展被定义为2015年和2018年首次报告CMM或报告了额外的心血管代谢性疾病。我们使用逻辑回归模型来估计SUA变化对CMM进展的比值比（ORs）和95%置信区间（95% CI）。结果在约7年的随访期间，从2011年到2015年，519名（10.8%）的参与者保持或上升至高尿酸血症，从2015年到2018年，311名（6.5%）经历了CMM进展。与保持或下降至非高尿酸血症的参与者相比，保持或上升至高尿酸血症的参与者CMM进展的几率增加了1.86倍（95% CI，1.29，2.68）。具体而言，保持或上升至高尿酸血症（与保持或下降至非高尿酸血症相比）与糖尿病发生几率增加2.01倍（95% CI，1.18，3.43）相关，并且在糖尿病发生后，与心血管疾病发生几率增加1.67倍（OR：1.67；95% CI，1.15，2.43）相关。结论保持或上升至高尿酸血症与CMM进展相关，尤其是在糖尿病后发生的心血管疾病。这些发现表明，监测SUA变化可能为预防CMM提供创新的见解，特别是在CMM的二级预防中（即防止糖尿病患者在心血管疾病方面的进一步进展）。