Supplemental Digital Content is available in the text. Serum uric acid (SUA) levels discriminating across the different strata of cardiovascular risk is still unknown. By utilizing a large population-based database, we assessed the threshold of SUA that increases the risk of total mortality and cardiovascular mortality (CVM). The URRAH study (Uric Acid Right for Heart Health) is a multicentre retrospective, observational study, which collected data from several large population-based longitudinal studies in Italy and subjects recruited in the hypertension clinics of the Italian Society of Hypertension. Total mortality was defined as mortality for any cause, CVM as death due to fatal myocardial infarction, stroke, sudden cardiac death, or heart failure. A total of 22 714 subjects were included in the analysis. Multivariate Cox regression analyses identified an independent association between SUA and total mortality (hazard ratio, 1.53 [95% CI, 1.21–1.93]) or CVM (hazard ratio, 2.08 [95% CI, 1.146–2.97]; P<0.001). Cutoff values of SUA able to discriminate total mortality (4.7 mg/dL [95% CI, 4.3–5.1 mg/dL]) and CVM status (5.6 mg/dL [95% CI, 4.99–6.21 mg/dL]) were identified. The information on SUA levels provided a significant net reclassification improvement of 0.26 and of 0.27 over the Heart Score risk chart for total mortality and CVM, respectively (P<0.001). Sex-specific cutoff values for total mortality and CVM were also identified and validated. In conclusion, SUA levels increasing the risk of total mortality and CVM are significantly lower than those used for the definition of hyperuricemia in clinical practice. Our data provide evidence of a cardiovascular SUA threshold that might contribute in clinical practice to improve identification of patients at higher risk of CVM.

中文翻译：

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确定预测 20 年总死亡率和心血管死亡率增加的尿酸阈值

补充数字内容在文本中可用。区分心血管风险不同层次的血清尿酸 (SUA) 水平仍然未知。通过利用基于人群的大型数据库，我们评估了增加总死亡率和心血管死亡率 (CVM) 风险的 SUA 阈值。URRAH 研究（尿酸有益于心脏健康）是一项多中心回顾性观察性研究，该研究收集了意大利几项基于人群的大型纵向研究的数据，以及在意大利高血压学会高血压诊所招募的受试者。总死亡率定义为任何原因的死亡率，CVM 定义为致命性心肌梗塞、中风、心源性猝死或心力衰竭导致的死亡。共有 22 714 名受试者被纳入分析。多变量 Cox 回归分析确定了 SUA 与总死亡率（风险比，1.53 [95% CI，1.21-1.93]）或 CVM（风险比，2.08 [95% CI，1.146-2.97]；P<0.001）之间的独立关联。确定了能够区分总死亡率（4.7 mg/dL [95% CI, 4.3–5.1 mg/dL]）和 CVM 状态（5.6 mg/dL [95% CI, 4.99–6.21 mg/dL]）的 SUA 临界值. 与总死亡率和 CVM 的心脏评分风险图表相比，SUA 水平的信息分别提供了 0.26 和 0.27 的显着净重分类改善（P<0.001）。还确定并验证了总死亡率和 CVM 的性别特异性临界值。总之，增加总死亡率和 CVM 风险的 SUA 水平显着低于临床实践中用于定义高尿酸血症的水平。