• Xue Tian, Shuohua Chen, Yijun Zhang, Xiaoli Zhang, Qin Xu, Penglian Wang, Shouling Wu, Yanxia Luo, and Anxin Wang.
• Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China.
• Eur. J. Intern. Med. 2023 Jun 1; 112: 374437-44.

BackgroundThe association of serum uric acid (SUA) with cardiovascular disease (CVD) is inconsistent and limited by a single measurement of SUA. This study aimed to investigate the association of SUA variation, considering its magnitude and direction, with the risk of CVD.MethodsThis study included 41,578 participants with four biennial measurements of SUA during 2006-2012 from the Kailuan study. SUA variation was measured using the coefficient of variation (primary index), standard deviation, average real variability, and variability independent of mean, and the direction of variation was also assessed. Multivariate-adjusted Cox regressions were used to assess the associations, and Bayesian network was utilized to find the most important pathway from SUA variation to CVD.ResultsDuring a median follow-up of 6.74 (interquartile range: 6.45-7.03) years, we identified 1,852 (4.45%) cases of incident CVD. A large SUA variation (top vs. bottom tertiles) was associated with a higher risk of CVD (hazard ratio [HR], 1.24; 95% confidence interval [CI], 1.11-1.40), especially in older adults than that in young adults (Pint=0.0137). The higher risk of CVD was observed with both large rises (HR, 1.24; 95% CI, 1.10-1.39) and falls (HR, 1.19; 95% CI, 1.03-1.38) in SUA variation. The hazardous effect of SUA variation on CVD was mainly induced by excessive inflammation and elevated blood pressure. Similar results were observed for CVD subtypes.ConclusionsElevated SUA variation was associated with a higher risk of CVD, irrespective of the direction of SUA variation, and inflammation played an important role in the pathway.Copyright © 2023 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

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