The effects of cardiometabolic factors on the association between serum uric acid and risk of all-cause mortality in adults with congestive heart failure

ABSTRACT

Background

Serum uric acid (SUA) has been shown to increase all-cause mortality from cardiovascular disease. However, limited studies have examined the mediating effect of dyslipidemia, hyperglycemia, or hypertension on the association between SUA and all-cause mortality in patients with congestive heart failure (CHF).

Methods

Participants in the present investigation were 620 US adults with CHF from the NHANES database (1999–2014). The relationship between SUA and all-cause mortality was evaluated utilizing multivariable Cox proportional hazards models. Additionally, the nonlinearity between SUA and mortality was investigated utilizing Restricted Cubic Splines (RCS) and 2-piecewise Cox proportional hazards models. Finally, the mediating role of cardiometabolic factors on the relationship between SUA and all-cause mortality was investigated utilizing the mediation analysis.

Results

During a mean follow-up of 7.6 years, 391 (63.1%) all-cause deaths occurred. Furthermore, we found a U-shaped association between SUA and all-cause mortality. The inflection point for the RCS curve was found at a SUA level of 363 umol/L. The hazard ratios (95% confidence intervals) for all-cause mortality were 0.998 (0.995–1.000) and 1.003 (1.002–1.005) to the left and right of the inflection point, respectively. This U-shaped association was also observed in both subgroups of sex and age. Moreover, the effect of SUA on all-cause mortality was not mediated by hypertension, hyperglycemia, or dyslipidemia (all P-values>0.05).

Conclusion

The association between SUA level and all-cause mortality followed a U-shaped curve, and this association was not mediated by hypertension, hyperglycemia, or dyslipidemia.

KEYWORDS:

• Cardiometabolic factors
• serum uric acid
• congestive heart failure
• all-cause mortality
• NHANES

Declaration of financial/other relationships

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

Tao Liu: investigation, formal analysis; writing-original draft and funding; Jia Song and Ronghua Zuo: methodology, software, validation; Lifang Sun, Zhijian Zhu, Bing Wang and Zhigang Lu: conceptualization, investigation and resources; Yesheng Pan: conceptualization, supervision, project administration and funding.

Ethics statement

As a freely available database, the NHANES database was approved by the CDC/NCHS Institutional Review Board, and all participants signed the informed consent. Therefore, this study did not require approval from the institutional review board.

Data availability statement

The data of the present study come from https://www.cdc.gov/nchs/nhanes/. The data supporting the findings of the present paper could be provided by contacting the author, without reservation.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/00325481.2023.2210933.

Additional information

Funding

This work was supported by the Shanghai Jinshan District Health Commission Project Fund (grant number: JSKJ-KTQN-2022-11), Shanghai University of Medical & Health Sciences Research Fund Project (grant number: SSF-23-25-002), and the Shanghai Jinshan District Medical and Health Science and Technology Innovation Fund Project (grant number: 2022-WS-61).