Association of Serum Uric Acid Level with Risk of Abdominal Aortic Calcification: A Large Cross-Sectional Study

Figures & data

Table 1 Characteristics of the Study Population Based on sUA Quartiles

sUA	Total	Q1	Q2	Q3	Q4	P-value
Age, years	58.19 ± 0.50	57.30 ± 0.69	58.30 ± 0.81	57.86 ± 1.09	59.34 ± 0.87	0.272
Sex, %						< 0.001
Male	1454 (48.2%)	186 (6.2%)	320 (10.6%)	436 (14.5%)	512 (17.0%)
Female	1562 (51.8%)	615 (20.4%)	469 (15.6%)	253 (8.4%)	225 (7.5%)
Race/ethnicity, %						0.376
Mexican American	400 (13.3%)	125 (4.1%)	110 (3.6%)	100 (3.3%)	65 (2.2%)
Other Hispanic	286 (9.5%)	90 (3.0%)	81 (2.7%)	56 (1.9%)	59 (2.0%)
Non-Hispanic Black	576 (19.1%)	120 (4.0%)	127 (4.2%)	138 (4.6%)	191 (6.3%)
Non-Hispanic White	1338 (44.4%)	359 (11.9%)	358 (11.9%)	308 (10.2%)	313 (10.4%)
Other race	416 (13.8%)	107 (3.5%)	113 (3.7%)	87 (2.9%)	109 (3.6%)
Family PIR	3.23 ± 0.15	3.12 ± 0.24	3.23 ± 0.17	3.20 ± 0.17	3.35 ± 0.11	0.768
Education level, %						0.572
High school	689 (22.8%)	193 (6.4%)	180 (6.0%)	158 (5.2%)	158 (5.2%)
College	684 (22.7%)	168 (5.6%)	185 (6.1%)	157 (5.2%)	174 (5.8%)
Graduate	1643 (54.5%)	440 (14.6%)	424 (14.1%)	374 (12.4%)	405 (13.4%)
Marital status, %						0.611
Having a partner	1936 (64.2%)	496 (16.4%)	514 (17.0%)	458 (15.2%)	468 (15.5%)
No partner	841 (27.9%)	241 (8.0%)	214 (7.1%)	180 (6.0%)	206 (6.8%)
Unmarried	239 (7.9%)	64 (2.1%)	61 (2.0%)	51 (1.7%)	63 (2.1%)
Hypertension, %						0.017
No	1382 (45.8%)	452 (15.0%)	385 (12.8%)	314 (10.4%)	231 (7.7%)
Yes	1634 (54.2%)	349 (11.6%)	404 (13.4%)	375 (12.4%)	506 (16.8%)
DM, %						0.025
No	2305 (76.4%)	657 (21.8%)	611 (20.3%)	519 (17.2%)	518 (17.2%)
Yes	711 (23.6%)	144 (4.8%)	178 (5.9%)	170 (5.6%)	219 (7.3%)
Smoker, %						0.067
No	1626 (53.9%)	464 (15.4%)	439 (14.6%)	358 (11.9%)	365 (12.1%)
Former	836 (27.7%)	178 (5.9%)	197 (6.5%)	195 (6.5%)	266 (8.8%)
Now	554 (18.4%)	159 (5.3%)	153 (5.1%)	136 (4.5%)	106 (3.5%)
Alcohol user, %						0.028
Never	449 (14.9%)	153 (5.1%)	117 (3.9%)	80 (2.7%)	99 (3.3%)
Former	605 (20.1%)	144 (4.8%)	157 (5.2%)	158 (5.2%)	146 (4.8%)
Mild	1128 (37.4%)	280 (9.3%)	305 (10.1%)	260 (8.6%)	283 (9.4%)
Moderate	432 (14.3%)	127 (4.2%)	114 (3.8%)	104 (3.4%)	87 (2.9%)
Heavy	402 (13.3%)	97 (3.2%)	96 (3.2%)	87 (2.9%)	122 (4.0%)
PA, %						0.642
Never	1963 (65.1%)	538 (17.8%)	518 (17.2%)	443 (14.7%)	464 (15.4%)
Mild	552 (18.3%)	151 (5.0%)	134 (4.4%)	125 (4.1%)	142 (4.7%)
Moderate	357 (11.8%)	84 (2.8%)	97 (3.2%)	84 (2.8%)	92 (3.1%)
Vigorous	144 (4.8%)	28 (0.9%)	40 (1.3%)	37 (1.2%)	39 (1.3%)
BMI, kg/m^2	28.53 ± 0.31	26.45 ± 0.34	28.34 ± 0.23	29.46 ± 0.47	30.12 ± 0.64	< 0.001
Waist circumference, cm	99.68 ± 0.71	92.82 ± 0.73	98.71 ± 0.65	101.88 ± 0.87	106.17 ± 1.26	< 0.001
SBP, mmHg	124.41 ± 0.88	122.07 ± 1.47	125.68 ± 1.32	125.11 ± 0.87	124.89 ± 2.51	0.173
DBP, mmHg	69.50 ± 0.56	69.43 ± 1.13	69.24 ± 0.93	70.20 ± 0.66	69.19 ± 1.17	0.887
FBG, mg/mL	107.52 ± 1.21	102.30 ± 1.74	105.04 ± 1.48	111.42 ± 2.27	112.29 ± 3.65	0.019
HbA1c, %	5.76 ± 0.04	5.67 ± 0.05	5.71 ± 0.05	5.83 ± 0.11	5.83 ± 0.09	0.257
ALT, U/L	23.89 ± 0.67	20.81 ± 0.79	23.73 ± 1.20	24.12 ± 0.75	27.20 ± 0.97	< 0.001
AST, U/L	25.01 ± 0.78	23.31 ± 0.37	26.18 ± 2.63	24.17 ± 0.44	26.37 ± 0.61	0.006
GGT, U/L	27.75 ± 1.30	23.69 ± 1.82	24.75 ± 2.12	30.98 ± 2.65	32.44 ± 2.29	0.004
Total bilirubin, mg/dL	0.68 ± 0.01	0.65 ± 0.02	0.67 ± 0.02	0.67 ± 0.02	0.74 ± 0.02	0.038
Mean energy intake, kcal	2012.88 ± 37.87	1916.22 ± 73.79	1911.02 ± 52.44	2120.11 ± 103.52	2129.88 ± 85.64	0.026
Calcium intake, mg	928.02 ± 15.67	959.26 ± 40.33	858.28 ± 24.37	974.00 ± 62.49	927.71 ± 24.70	0.049
Phosphorus intake, mg	1352.75 ± 16.66	1296.41 ± 40.27	1281.22 ± 36.78	1416.69 ± 61.50	1433.01 ± 40.90	0.033
Hb, g/dL	14.30 ± 0.06	13.72 ± 0.11	14.24 ± 0.09	14.58 ± 0.15	14.73 ± 0.11	< 0.001
BUN, mg/dL	13.95 ± 0.21	12.43 ± 0.42	13.22 ± 0.22	14.24 ± 0.35	16.15 ± 0.29	< 0.001
Scr, mg/dL	0.92 ± 0.01	0.77 ± 0.01	0.87 ± 0.01	0.98 ± 0.05	1.08 ± 0.02	< 0.001
eGFR, mL/min/1.73m^2	84.74 ± 0.75	91.49 ± 1.09	85.43 ± 1.10	84.39 ± 1.62	76.96 ± 1.45	< 0.001
HDL-C, mg/dL	55.69 ± 0.71	62.46 ± 1.49	56.45 ± 1.13	53.14 ± 1.31	49.85 ± 1.59	0.002
TC, mg/dL	195.91 ± 1.20	194.86 ± 1.59	195.38 ± 2.75	192.64 ± 3.44	200.73 ± 2.16	0.098
TG, mg/dL	124.23 ± 3.27	98.09 ± 3.39	118.69 ± 4.27	126.90 ± 6.55	156.33 ± 8.04	< 0.001
Calcium, mg/dL	9.41 ± 0.01	9.35 ± 0.03	9.41 ± 0.03	9.40 ± 0.03	9.48 ± 0.04	0.196
Phosphorus, mg/dL	3.73 ± 0.02	3.79 ± 0.03	3.73 ± 0.04	3.67 ± 0.04	3.70 ± 0.06	0.078
Degree of calcification	1.51 ± 0.15	1.32 ± 0.33	1.46 ± 0.22	1.39 ± 0.21	1.89 ± 0.28	0.268
AAC, %						0.344
No	2107 (69.9%)	600 (19.9%)	566 (18.8%)	466 (15.5%)	475 (15.7%)
Yes	909 (30.1%)	201 (6.7%)	223 (7.4%)	223 (7.4%)	262 (8.7%)
SAAC, %						0.411
No	2689 (89.2%)	737 (24.4%)	711 (23.6%)	606 (20.1%)	635 (21.1%)
Yes	327 (10.8%)	64 (2.1%)	78 (2.6%)	83 (2.8%)	102 (3.4%)

Abbreviations: sUA, serum uric acid; Q1, 0.7–4.5 mg/dL; Q2, 4.6–5.4 mg/dL; Q3, 5.5–6.3 mg/dL; Q4, 6.4–11.3 mg/dL; DM, diabetes mellitus; PA, physical activity; BMI, body mass index; SBP, systolic blood pressure; DBP, diastolic blood pressure; FBG, fast glucose; HbA1c, glycohemoglobin; ALT, alanine aminotransferase; AST, aspartate aminotransferase; GGT, gamma-glutamyl transferase; Hb, hemoglobin; BUN, blood urea nitrogen; Scr, serum creatinine; eGFR, estimated glomerular filtration rate; TC, total cholesterol; TG, triglyceride; HDL-C, high density lipoprotein-cholesterol; AAC, abdominal aortic calcification; SAAC, severe abdominal aortic calcification.

Table 2 Adjusted ORs for Associations Between sUA and the Risk of AAC

sUA	Model 1	Model 2	Model 3
	OR (95% CI)	OR (95% CI)	OR (95% CI)
Q1	Ref.	Ref.	Ref.
Q2	1.026 (0.695, 1.513)	0.988 (0.663, 1.471)	0.967 (0.632, 1.480)
Q3	1.212 (0.801, 1.834)	1.082 (0.707, 1.656)	1.144 (0.719, 1.821)
Q4	1.442 (0.951, 2.187)	1.269 (0.822, 1.958)	1.275 (0.762, 2.134)
P for trend	0.062	0.249	0.274

Notes: Model 1: age and sex. Model 2: model 1 variables plus race/ethnicity, education level, marital status, family poverty income ratio, hypertension, diabetes mellitus, smoke status, and drink status. Model 3 was adjusted for model 2 variables plus physical activity, body mass index, waist circumference, mean energy intake, dietary phosphorus and calcium intake, hemoglobin, fast glucose, glycohemoglobin, aspartate aminotransferase, alanine aminotransferase, total bilirubin, gamma-glutamyl transferase, blood urea nitrogen, serum creatinine, estimated glomerular filtration rate, serum phosphorus and calcium, total cholesterol, triglyceride, and high-density lipoprotein-cholesterol.

Abbreviations: sUA, serum uric acid; AAC, abdominal aortic calcification; Q1, 0.7–4.5 mg/dL; Q2, 4.6–5.4 mg/dL; Q3, 5.5–6.3 mg/dL; Q4, 6.4–11.3 mg/dL; OR, odd ratio; CI, confidence interval.

Table 3 Adjusted ORs for Associations Between sUA and the Incidence of SAAC

sUA	Model 1	Model 2	Model 3
	OR (95% CI)	OR (95% CI)	OR (95% CI)
Q1	Ref.	Ref.	Ref.
Q2	0.894 (0.491, 1.629)	0.761 (0.405, 1.430)	0.751 (0.378, 1.489)
Q3	1.273 (0.691, 2.344)	1.022 (0.538, 1.940)	0.958 (0.433, 2.121)
Q4	1.441 (0.786, 2.645)	1.117 (0.592, 2.109)	1.084 (0.533, 2.205)
P for trend	0.236	0.649	0.828

Notes: Model 1: age and sex. Model 2: model 1 variables plus race/ethnicity, education level, marital status, family poverty income ratio, hypertension, diabetes mellitus, smoke status, and drink status. Model 3 was adjusted for model 2 variables plus physical activity, body mass index, waist circumference, mean energy intake, dietary phosphorus and calcium intake, hemoglobin, fast glucose, glycohemoglobin, aspartate aminotransferase, alanine aminotransferase, total bilirubin, gamma-glutamyl transferase, blood urea nitrogen, serum creatinine, estimated glomerular filtration rate, serum phosphorus and calcium, total cholesterol, triglyceride, and high-density lipoprotein-cholesterol.

Abbreviations: sUA, serum uric acid; SAAC, severe abdominal aortic calcification; Q1, 0.7–4.5 mg/dL; Q2, 4.6–5.4 mg/dL; Q3, 5.5–6.3 mg/dL; Q4, 6.4–11.3 mg/dL; OR, odd ratio; CI, confidence interval.

Figure 1 RCS curve of the association between sUA and the risk of AAC and SAAC in the NHANES database. (A) the association between sUA and AAC; and (B) the association between sUA and SAAC.

Abbreviations: RCS, restricted cubic spline; sUA, serum uric acid; AAC, abdominal aortic calcification; SAAC, severe abdominal aortic calcification.

Table 4 Subgroups Analysis for the Associations of sUA with the Risk of AAC

sUA	Q1	Q2	Q3	Q4	P for Trend	P for Interaction
	OR (95% CI)	OR (95% CI)	OR (95% CI)	OR (95% CI)
Age						0.009
< 60	1.00	0.648 (0.345, 1.217)	0.599 (0.294, 1.220)	0.787 (0.346, 1.791)	0.648
≥ 60	1.00	1.452 (0.775, 2.720)	2.126 (1.068, 4.233) *	1.884 (0.910, 3.900)	0.067
Sex						0.062
Male	1.00	0.863 (0.370, 2.011)	1.005 (0.447, 2.261)	1.383 (0.581, 3.289)	0.226
Female	1.00	1.014 (0.598, 1.719)	1.415 (0.831, 2.741)	0.847 (0.388, 1.851)	0.902
Hypertension						0.026
No	1.00	0.721 (0.373, 1.394)	0.608 (0.282, 1.308)	0.756 (0.305, 1.874)	0.399
Yes	1.00	1.343 (0.734, 2.460)	2.013 (1.047, 3.873) *	2.077 (1.049, 4.111) *	0.023
DM						0.144
No	1.00	1.102 (0.667, 1.821)	1.032 (0.588, 1.814)	1.342 (0.714, 2.523)	0.441
Yes	1.00	0.735 (0.265, 2.039)	1.569 (0.538, 4.580)	1.152 (0.377, 3.523)	0.519
BMI						0.113
< 30 kg/m^2	1.00	0.984 (0.596, 1.624)	0.812 (0.451, 1.461)	1.153 (0.603, 2.204)	0.852
≥ 30 kg/m^2	1.00	0.725 (0.298, 1.762)	0.950 (0.389, 2.323)	0.848 (0.320, 2.246)	0.986

Notes: *P < 0.05; Analysis was adjusted for age, sex, race/ethnicity, education level, marital status, family poverty income ratio, hypertension, diabetes mellitus, smoke status, and drink status, physical activity, body mass index, waist circumference, mean energy intake, dietary phosphorus and calcium intake, hemoglobin, fast glucose, glycohemoglobin, aspartate aminotransferase, alanine aminotransferase, total bilirubin, gamma-glutamyl transferase, blood urea nitrogen, serum creatinine, estimated glomerular filtration rate, serum phosphorus and calcium, total cholesterol, triglyceride, and high-density lipoprotein-cholesterol.

Abbreviations: sUA, serum uric acid; AAC, abdominal aortic calcification; Q1, 0.7–4.5 mg/dL; Q2, 4.6–5.4 mg/dL; Q3, 5.5–6.3 mg/dL; Q4, 6.4–11.3 mg/dL; OR, odd ratio; CI, confidence interval.

Table 5 Subgroups Analysis for the Associations of sUA with the Risk of SAAC

sUA	Q1	Q2	Q3	Q4	P for Trend	P for Interaction
	OR (95% CI)	OR (95% CI)	OR (95% CI)	OR (95% CI)
Age						0.056
< 60	1.00	0.245 (0.029, 2.058)	0.472 (0.051, 4.332)	0.011 (0.001, 1.437)	0.112
≥ 60	1.00	0.893 (0.396, 2.011)	1.487 (0.628, 3.517)	1.276 (0.507, 3.215)	0.410
Sex						0.051
Male	1.00	0.395 (0.105, 1.485)	0.632 (0.183, 2.187)	0.601 (0.160, 2.257)	0.822
Female	1.00	1.134 (0.466, 2.758)	1.819 (0.656, 5.044)	1.573 (0.480, 5.153)	0.298
Hypertension						0.014
No	1.00	0.298 (0.060, 1.488)	0.121 (0.014, 1.064)	0.504 (0.037, 6.845)	0.214
Yes	1.00	1.095 (0.453, 2.645)	1.812 (0.731, 4.491)	1.276 (0.484, 3.361)	0.491
DM						0.095
No	1.00	0.702 (0.272, 1.810)	1.369 (0.529, 3.540)	1.115 (0.376, 3.306)	0.532
Yes	1.00	0.996 (0.250, 3.969)	0.754 (0.165, 3.432)	1.156 (0.208, 6.432)	0.966
BMI						0.488
< 30 kg/m^2	1.00	0.755 (0.343, 1.663)	1.087 (0.446, 2.647)	0.815 (0.299, 2.218)	0.864
≥ 30 kg/m^2	1.00	1.025 (0.119, 8.792)	0.811 (0.113, 5.798)	1.729 (0.175, 1.706)	0.653

Notes: Analysis was adjusted for age, sex, race/ethnicity, education level, marital status, family poverty income ratio, hypertension, diabetes mellitus, smoke status, and drink status, physical activity, body mass index, waist circumference, mean energy intake, dietary phosphorus and calcium intake, hemoglobin, fast glucose, glycohemoglobin, aspartate aminotransferase, alanine aminotransferase, total bilirubin, gamma-glutamyl transferase, blood urea nitrogen, serum creatinine, estimated glomerular filtration rate, serum phosphorus and calcium, total cholesterol, triglyceride, and high-density lipoprotein-cholesterol.

Abbreviations: sUA, serum uric acid; SAAC, serve abdominal aortic calcification; Q1, 0.7–4.5 mg/dL; Q2, 4.6–5.4 mg/dL; Q3, 5.5–6.3 mg/dL; Q4, 6.4–11.3 mg/dL; OR, odd ratio; CI, confidence interval.

Figure 2 RCS curve for the association between sUA with the risk of AAC. (A) the association between sUA and AAC stratified by age; (B) the association between sUA and AAC stratified by sex; (C) the association between sUA and AAC stratified by hypertension; (D) the association between sUA and AAC stratified by DM; and (E) the association between SUA and AAC stratified by BMI.

Abbreviations: RCS, restricted cubic spline; sUA, serum uric acid; AAC, abdominal aortic calcification; BMI, body mass index.

Figure 3 RCS curve for the association between sUA with the risk of SAAC. (A) the association between sUA and SAAC stratified by age; (B) the association between sUA and SAAC stratified by sex; (C) the association between SUA and SAAC stratified by hypertension; (D) the association between SUA and SAAC stratified by DM; and (E) the association between SUA and SAAC stratified by BMI.

Abbreviations: RCS, restricted cubic spline; sUA, serum uric acid; SAAC, severe abdominal aortic calcification; BMI, body mass index.

Figure 4 The association between sUA and the degree of AAC.

Abbreviations: sUA, serum uric acid; AAC, abdominal aortic calcification.