P6230Gender disparities in serum uric acid levels associated increased cardiovascular risk. The Czech Post-MONICA study

Background Recent European Society of Hypertension (ESH) guidelines have implemented serum uric acid (SUA) levels as cardiovascular (CV) risk factor and recommend routine SUA levels measurement in hypertensive patients. However, what is the appropriate SUA level threshold and whether all patients with so called asymptomatic hyperuricemia should be treated remain unclear. Objective To evaluate longitudinal trends and determinants of mean serum uric acid (SUA) levels in two representative Czech population surveys (2006–09 and 2015–18) and to determine the SUA levels associated with increased 10-year risk of cardiovascular (CV) death. Methods Two independent cross-sectional surveys of major CV risk factors were performed in the Czech Republic in 2006–09 and 2015–18; 1% percent random samples aged 25–64 years stratified by age and gender were examined. The number of participants was 3612 in 2006–09, and 2621 in 2015–18. Ten-year risk of CV death was categorized using the SCORE algorithm as low (<1%), intermediate (1% to <5%), high (≥5% to 10%), and very high (≥10%). Results Final analyses included 3542 individuals (48.2% men; mean age 47.1±11.3) in 2006–09, and 2304 individuals (47.4% men; mean age 47.9±10.9) in 2015–18. Over the past decade, there was a highly significant increase in SUA levels (μmol/l) from 344.6±81.1 to 374.4±73.3 in men, and from 250.1±73.8 to 278.9±66.1 in women. In gender-specific multivariate linear regression analyses conducted in the 2015–18 survey, SUA levels increased with use of diuretics, an increase in waist-to-height ratio, serum triglycerides, and aspartate aminotransferase, and a decrease in estimated glomerular filtration rate in both genders, whereas in men SUA levels increased also with an increase in quartiles of alcohol intake and gamma-glutamyl transferase, and a decrease in glycated haemoglobin. When analysing pooled data of the two surveys, mean SUA levels increased with each increase in 10-year CV risk category in women (P<0.001), but not in men (P=0.21). In receiver operating characteristic (ROC) curve analysis, the cut-off value of SUA levels discriminating between low/intermediate and high/very high CV risk category in women was 306 μmol/l (sensitivity 53%; specificity 82%; area under the ROC curve 0.713 [95% CI 0.683–0.743]). Conclusions Over the past decade, there was a significant increase in uricemia in the Czech adult population. However, increasing SUA levels were associated with increased 10-year CV death risk only in women. The SUA levels associated with high/very high CV risk were substantially lower in Czech women than the currently used cut-off values for hyperuricemia. Acknowledgement/Funding Grant number 15-27109A from Czech health research council