Association of serum uric acid with risk of stroke in US adults: A cross-sectional study from NHANES 1999–2020

https://doi.org/10.1016/j.jstrokecerebrovasdis.2023.107206Get rights and content
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Highlights

  • Stroke is the second leading cause of death and third leading cause of disability.

  • Whether serum uric acid is a modifiable risk marker for stroke is unclear.

  • Serum uric acid levels and stroke risk exhibited a J-shaped relationship.

  • Low and high serum uric acid levels increase stroke risk in different populations.

  • Early serum uric acid management of high-risk populations of stroke are crucial.

Abstract

Background and aims

The validity of high uric acid levels as an independent cause of stroke remains controversial, and the association between its low concentration and stroke is unclear. This study determines how different serum uric acid (SUA) levels are associated with stroke risk.

Methods

This cross-sectional study used continuous National Health and Nutrition Examination Survey data in the United States during 1999–2020. The SUA levels of 6.0, 6.8, and 9.0 mg/dL were all considered as cut-off points. Restricted cubic spline interpolation and logistic regression models were used to evaluate the different associations. Subgroup analyses and sensitivity analyses were conducted to evaluate the influence of multiple factors on the outcomes.

Results

The study included 23,413 participants aged ≥ 20 years. A J-shaped curve existed between SUA and stroke risk, and the risk of stroke was positively correlated with SUA levels in the overall population. Subgroup analysis of all adults in the SUA 6.8–9.0 mg/dL group showed that stroke risk for non-Hispanic white, obese, ex-smoker, and heavy drinking groups was increased, but for the other Hispanic group was reduced. In the SUA < 6.0 mg/dL group, stroke risk for ex-smoker, heavy drinkers, and no chronic kidney disease groups was increased.

Conclusion

Our findings indicate a J-shaped relationship between SUA levels and stroke risk. Low and high SUA levels increased stroke risk for different populations, except in the other Hispanic population. Early SUA management is highly significant for stroke prevention in high-risk populations.

Keywords

Uric acid
Stroke
Hyperuricemia
Hypouricemia
NHANES

Abbreviations

BMI
body mass index
CHD
coronary heart disease
CI
confidence interval
CKD
chronic kidney disease
eGFR
estimated glomerular filtration rate
Glu
fasting blood glucose
HbA1c
hemoglobin A1c
HDL-C
high-density lipoprotein cholesterol
LDL-C
low-density lipoprotein cholesterol
NHANES
National Health and Nutrition Examination Survey
OR
odds ratio
SUA
Serum Uric Acid
TC
total cholesterol
TG
triglyceride
UA
uric acid
ULT
urate-lowering therapy

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