Hyperuricemia as risk factor for coronary heart disease incidence and mortality in the general population : a systematic review and meta-analysis

Previous meta-analyses reported no significant or weak association between hyperuricemia (HU) and coronary heart disease (CHD). We updated the literature search, systematically reviewing retrieved papers. The peer-reviewed literature published from 1965 to Decem- ber 2014 was searched using Medline and Embase. We included prospective cohort studies involving adults (sample size  ≥ 100) with no cardiovascular disease (CVD) and a follow-up of at least 1 year. Studies were excluded if they considered as outcome the CVD incidence/mortality without separately reporting data on CHD, did not adjusted for major confounders and if the 95% confidence interval (CI) for risk ratio (RR) was not available. Relative risk or hazard ratio estimates, with the corresponding CIs, were obtained. For CHD incidence 12 populations were included (457,915 subjects [53.7% males]). For CHD mortality seven populations were included (237,433 subjects [66.3% males]). The overall combined RR were 1.206 (CI 1.066–1.364, p = 0.003) for CHD incidence and 1.209 (CI 1.003–1.457, p = 0.047) for CHD mortality, respectively. Subgroup analysis showed a marginal (incidence) and not significant (mortality) association between HU and CHD in men, but an increased risk for CHD incidence and mortality in hyperuricemic women (RR 1.446, CI 1.323–1.581, p < 0.0001, and RR 1.830, CI 1.066–3.139, p = 0.028, respectively). The risk markedly increases for urate concentrations  > 7.0 mg/dL. HU appears to increase the risk of CHD events in the general population, mainly in adult women. This finding requires, however, further investigation.