Association of Normal Serum Uric Acid Level and Cardiovascular Disease in People Without Risk Factors for Cardiac Diseases in China

BACKGROUND: Healthy individuals with normal level of serum uric acid (SUA) may not be truly at the lowest risk of cardiovascular disease (CVD). This study aimed to assess the association of SUA levels with CVD and its subtypes in people without CVD risk factors and determine a suitable target of SUA to prevent CVD. METHODS AND RESULTS: We enrolled 25 284 participants who were free of CVD, absent of CVD risk factors, and with an SUA level between 180 and 359 μmol/L (3–6 mg/dL) at baseline from the Kailuan study. Cox proportional hazards models were applied to calculated adjusted hazard ratio (HR) and 95% CI for the risk of CVD and its subtypes. During a median follow‐up of 12.97 years (interquartile range, 12.68–13.16 years), we identified 1007 cases of CVD. There was an increase in the risk of incident CVD with increasing SUA levels (P (trend)=0.0011). Compared with participants with SUA levels of 180 to 239 μmol/L (3–4 mg/dL), the HR of CVD was 1.12 (95% CI, 0.96–1.31) and 1.28 (95% CI, 1.08–1.52) for SUA levels of 240 to 299 μmol/L (4–5 mg/dL) and 300 to 359 μmol/L (5–6 mg/dL), respectively. A multivariable‐adjusted spline regression model showed a J‐shaped association between SUA and the risk of CVD. Similar results were observed for stroke and myocardial infarction. CONCLUSIONS: The risk of incident CVD increased with elevating SUA levels among individuals without hyperuricemia or other traditional CVD risk factors. These findings highlighted the importance of primordial prevention for SUA level increase along with other traditional CVD risk factors.