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Serum uric acid and risk of stroke and its types: the Circulatory Risk in Communities Study (CIRCS)

Hypertension Research volume 43, pages 313–321 (2020)Cite this article

Abstract

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.

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Acknowledgements

We thank our colleagues from Osaka University Center of Medical Data Science, Advanced Clinical Epidemiology Investigator’s Research Project for providing their insight and expertise for our research.

Appendix

The CIRCS Investigators are: Takeo Okada, Yuji Shimizu, Yasuhiko Kubota, Shinichi Sato, Mina Hayama-Terada and Masahiko Kiyama, Osaka Center for Cancer and Cardiovascular Disease Prevention; Hironori Imano, Renzhe Cui, Isao Muraki, Akihiko Kitamura, Hiroshige Jinnouchi, Mizuki Sata and Hiroyasu Iso, Osaka University; Kazumasa Yamagishi, Mitsumasa Umesawa and Tomoko Sankai, University of Tsukuba; Koutatsu Maruyama, Ehime University; Ai Ikeda and Takeshi Tanigawa, Juntendo University, and Masanori Nagao and Tetsuya Ohira, Fukushima Medical University.

Author information

Authors and Affiliations

  1. Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University, Suita, Japan

    Jiaqi Li, Isao Muraki, Hironori Imano, Renzhe Cui & Hiroyasu Iso

  2. Osaka Center for Cancer and Cardiovascular Diseases Prevention, Osaka, Japan

    Isao Muraki, Hironori Imano, Mina Hayama-Terada, Masahiko Kiyama & Takeo Okada

  3. Department of Public Health Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan

    Kazumasa Yamagishi, Mitsumasa Umesawa & Hiroyasu Iso

  4. Department of Public Health, Dokkyo Medical University, School of Medicine, Tochigi, Japan

    Mitsumasa Umesawa

  5. Yao City Public Health Center, Yao, Japan

    Mina Hayama-Terada

  6. Department of Epidemiology School of Medicine, Fukushima Medical University, Fukushima, Japan

    Tetsuya Ohira

  7. Department of Public Health and Nursing, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan

    Tomoko Sankai

  8. Department of Public Health, Graduate School of Medicine, Juntendo University, Tokyo, Japan

    Takeshi Tanigawa

  9. Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan

    Akihiko Kitamura

  10. Osaka Center for Cancer and Cardiovascular Disease Prevention, Osaka, Japan

    Takeo Okada, Yuji Shimizu, Yasuhiko Kubota, Shinichi Sato, Mina Hayama-Terada & Masahiko Kiyama

  11. Osaka University, Suita, Japan

    Hironori Imano, Renzhe Cui, Isao Muraki, Akihiko Kitamura, Hiroshige Jinnouchi, Mizuki Sata & Hiroyasu Iso

  12. University of Tsukuba, Tsukuba, Japan

    Kazumasa Yamagishi, Mitsumasa Umesawa & Tomoko Sankai

  13. Ehime University, Matsuyama, Japan

    Koutatsu Maruyama

  14. Juntendo University, Tokyo, Japan

    Ai Ikeda & Takeshi Tanigawa

  15. Fukushima Medical University, Fukushima, Japan

    Masanori Nagao & Tetsuya Ohira

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  1. Jiaqi Li
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Consortia

CIRCS investigators

  • Takeo Okada
  • , Yuji Shimizu
  • , Yasuhiko Kubota
  • , Shinichi Sato
  • , Mina Hayama-Terada
  • , Masahiko Kiyama
  • , Hironori Imano
  • , Renzhe Cui
  • , Isao Muraki
  • , Akihiko Kitamura
  • , Hiroshige Jinnouchi
  • , Mizuki Sata
  • , Hiroyasu Iso
  • , Kazumasa Yamagishi
  • , Mitsumasa Umesawa
  • , Tomoko Sankai
  • , Koutatsu Maruyama
  • , Ai Ikeda
  • , Takeshi Tanigawa
  • , Masanori Nagao
  •  & Tetsuya Ohira

Corresponding author

Correspondence to Hiroyasu Iso.

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The authors declare that they have no conflict of interest.

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Members of the CIRCS investigators are listed below the Acknowledgements.

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Li, J., Muraki, I., Imano, H. et al. Serum uric acid and risk of stroke and its types: the Circulatory Risk in Communities Study (CIRCS). Hypertens Res 43, 313–321 (2020). https://doi.org/10.1038/s41440-019-0385-5

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  • DOI: https://doi.org/10.1038/s41440-019-0385-5

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