Objective: Elevated serum uric acid (UA) level has been associated with increased coronary heart disease mortality. The optimal UA level in patients with diabetes remains uncertain. We compared the mortality risk across UA levels among adults with and without diabetes.

Methods: We analyzed data from adults aged >18 years without coronary heart disease and chronic renal disease (n= 29,226) from the National Health and Nutrition Examination Survey (1999-2010) and the associated mortality data (up to December 2011). We used the Cox proportional hazards models to examine the risk of all-cause and cause-specific (cardiovascular disease [CVD] and cancer) mortality at different UA levels between adults with diabetes and without diabetes.

Results: Over a median follow-up of 6.6 years, 2,069 participants died (495 from CVD and 520 from cancers). Compared with nondiabetes adults with UA level of 5-7mg/dL (reference), the hazard ratios (HR) for all-cause mortality were significantly greater for adults without diabetes at UA levels of 7-9mg/dL (HR=1.39) and ≥9mg/dL (HR=2.31). In diabetes patients, HRs were 2.10 (95% CI 1.61, 2.73), 1.28 (95% CI 0.93, 1.77), 2.88 (95% CI 2.13, 3.89), and 2.65 (95% CI 1.18, 5.96) for UA <5mg/dL, 5-7mg/dL, 7-9mg/dL, and ≥9mg/dL, respectively. Compared to reference, CVD mortality risk in diabetes participants were significantly higher at every UA category (HR=2.33, 2.24, 5.03, and 1.70 for UA <5mg/dL, 5-7mg/dL, 7-9mg/dL, and ≥9mg/dL, respectively). In diabetes adults, the participants with UA 7-9mg/dL had higher risk than those with UA 5-7mg/dL (p=0.038). Regarding cancer mortality risk, no significant difference was found at different UA levels no matter with or without diabetes.

Conclusions: At UA level of >7mg/dL, increased risk of all-cause and CVD mortality occurred in both diabetes and nondiabetes participants. Without accounting for the effect of glycemic control, our results support all-cause mortality risk in diabetes adults was lowest at UA level of 5-7mg/dL.


P. Chen: None. C. Lee: None. C. Chen: None.

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