The role of serum uric acid as a predictor of stroke among the general Japanese population remains controversial. We conducted a prospective cohort study of 5235 men and 8185 women aged 40–79 years at baseline between 1985 and 1994 in four Japanese communities, who were initially free from stroke, coronary heart disease, and medication for hyperuricemia or gout. Cox proportional hazards models were used to estimate sex-specific hazard ratios of stroke and its types in relation to serum uric acid level. During a median follow-up of 23.1 years, we recorded 1018 (488 men and 530 women) incident strokes, including 222 (99 and 123) intraparenchymal hemorrhages, 113 (33 and 80) subarachnoid hemorrhages and 667 (347 and 320) ischemic strokes. After adjustment for age, community and known cardiovascular risk factors, the multivariable hazard ratios (95% CIs) in the highest vs. lowest quintile of serum uric acid were 1.45 (1.07–1.96) for total stroke, 1.20 (0.65–2.20) for intraparenchymal hemorrhage, 1.46 (0.69–3.09) for subarachnoid hemorrhage and 1.61 (1.07–2.41) for ischemic stroke in women. The corresponding multivariable hazard ratios (95% CIs) in men were 1.02 (0.74–1.35), 0.83 (0.40–1.72), 1.19 (0.38–3.75) and 1.00 (0.70–1.41). Furthermore, those positive associations with risks of total and ischemic strokes in women were more evident in nonusers of antihypertensive medication than the users. In conclusion, elevated serum uric acid level is an independent predictor of total stroke in women but not in men. The positive association in women was mostly attributable to ischemic stroke and was more pronounced among nonusers of antihypertensive medication.

中文翻译：

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血清尿酸和中风风险及其类型：社区循环风险研究 (CIRCS)

在日本一般人群中，血清尿酸作为卒中预测因子的作用仍存在争议。我们在 1985 年至 1994 年期间在四个日本社区对 5235 名 40-79 岁男性和 8185 名女性进行了一项前瞻性队列研究，这些人最初没有中风、冠心病和高尿酸血症或痛风的药物治疗。Cox 比例风险模型用于估计与血清尿酸水平相关的卒中及其类型的性别特异性风险比。在中位随访 23.1 年期间，我们记录了 1018 例（488 例男性和 530 例女性）卒中事件，包括 222 例（99 例和 123 例）脑实质内出血、113 例（33 例和 80 例）蛛网膜下腔出血和 667 例（347 例和 320 例）缺血性脑卒中. 在调整年龄、社区和已知的心血管危险因素后，血清尿酸最高与最低五分位数的多变量风险比 (95% CI) 总卒中为 1.45 (1.07–1.96)，实质内出血为 1.20 (0.65–2.20)，蛛网膜下腔出血为 1.46 (0.69–3.09) 1.61 (1.07–2.41) 用于女性缺血性中风。男性相应的多变量风险比 (95% CI) 为 1.02 (0.74–1.35)、0.83 (0.40–1.72)、1.19 (0.38–3.75) 和 1.00 (0.70–1.41)。此外，这些与女性总卒中和缺血性卒中风险的正相关在不使用抗高血压药物的人中比使用人更明显。总之，血清尿酸水平升高是女性总卒中的独立预测因素，但不是男性。女性中的正相关主要归因于缺血性中风，并且在未使用抗高血压药物的人群中更为明显。