An early accumulation of serum uric acid confers more risk of heart failure: a 10-year prospective cohort study

Evidence on the longitudinal association of serum uric acid (SUA) with the risk of heart failure (HF) was limited and controversial. This study aimed to investigate the associations of cumulative SUA (cumSUA), incorporating its time course of accumulation, with the risk of HF.

This prospective study enrolled 54 606 participants from the Kailuan study. The magnitude of SUA accumulation was expressed as cumSUA, exposure duration, and cumulative burden from baseline to the third survey, with cumSUA, calculated by multiplying mean values between consecutive examinations by time intervals between visits, as the primary exposure.

During a median follow-up of 10 years, 1260 cases of incident HF occurred. A higher risk of HF was observed in participants with the highest vs. the lowest quartile of cumSUA [adjusted hazard ratio (aHR), 1.54; 95% confidence interval (CI), 1.29–1.84], 6-year vs. 0-year exposure duration (aHR, 1.87; 95% CI, 1.43–2.45), cumulative burden >0 vs. = 0 (aHR, 1.55; 95 CI, 1.29–1.86), and those with a negative vs. positive SUA slope (aHR, 1.12; 95% CI, 1.02–1.25). When cumSUA was incorporated with its time course, those with cumSUA ≥median and a negative SUA slope had the highest risk of HF (aHR, 1.55; 95% CI, 1.29–1.86).

Incident HF risk was associated with the magnitude and time course of cumSUA accumulation. Early accumulation resulted in a greater risk of HF compared with later accumulation, indicating the importance of optimal SUA control earlier in life.