Risk factors for incident hyperuricemia during mid-adulthood in African American and White men and women enrolled in the ARIC cohort study

BACKGROUND: Increased serum urate levels are associated with poor outcomes including but not limited to gout. It is unclear whether serum urate levels are the sole predictor of incident hyperuricemia or whether demographic and clinical risk factors also predict the development of hyperuricemia. The goal of this study was to identify risk factors for incident hyperuricemia over 9 years in a population-based study, ARIC. METHODS: ARIC recruited individuals from 4 US communities; 8,342 participants who had urate levels <7.0 mg/dL were included in this analysis. Risk factors (including baseline, 3-year, and change in urate level over 3 years) for 9-year incident hyperuricemia (urate level of >7.0 g/dL) were identified using an AIC-based selection approach in a modified Poisson regression model. RESULTS: The 9-year cumulative incidence of hyperuricemia was 4%; men = 5%; women = 3%; African Americans = 6% and whites = 3%. The adjusted model included 9 predictors for incident hyperuricemia over 9 years: male sex (RR = 1.73 95% CI: 1.36-2.21), African-American race (RR = 1.79 95% CI: 1.37-2.33), smoking (RR = 1.27, 95% CI: 0.97-1.67), <HS education (RR = 1.27, 95% CI: 0.99-1.63), hypertension (RR = 1.65, 95% CI: 1.30-2.09), CHD (RR = 1.57, 95% CI: 0.99-2.50), obesity (class I RR = 2.37, 95% CI: 1.65-3.41 and ≥ class II RR = 3.47, 95% CI: 2.33-5.18), eGFR < 60 (RR = 2.85, 95% CI: 1.62-5.01) and triglycerides (Quartile 4 vs. Quartile 1: RR = 2.00, 95% CI: 1.38-2.89). In separate models, urate levels at baseline (RR 1 mg/dL increase = 2.33, 95% CI: 1.94-2.80) and 3 years after baseline (RR for a 1 mg/dL increase = 1.92, 95% CI: 1.78-2.07) were associated with incident hyperuricemia after accounting for demographic and clinical risk factors. CONCLUSION: Demographic and clinical risk factors that are routinely collected as part of regular medical care are jointly associated with the development of hyperuricemia.