ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 91

Risk Factors For Incident Hyperuricemia During Mid-Adulthood In African American and White Men and Women Enrolled In The Atherosclerosis Risk In Communities Study

Mara McAdams DeMarco1, Andrew Law2, Janet W. Maynard3, Josef Coresh1 and Alan N. Baer4, 1Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 2Epidemiology, Johns Hopkins, Baltimore, MD, 3Rheum/Mason F Lord Bldg/CtrTow, Johns Hopkins University School of Medicine, Division of Rheumatology, Baltimore, MD, 4Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD

Meeting: 2013 ACR/ARHP Annual Meeting

Keywords:

Session Information

Title: Epidemiology and Health Services I

Session Type: Abstract Submissions (ACR)

Background/Purpose : Increased serum urate levels are associated with poor outcomes including but not limited to gout. Better understanding of which patients are at risk of developing hyperuricemia may aid in clinical decision-making about treatment of asymptomatic hyperuricemia. However, hyperuricemia risk prediction has been limited because previously published studies were not prospective in nature. The objective of this study is to identify risk factors for the development of hyperuricemia over 9 years in a population-based study, ARIC.

Methods: This cohort recruited 15,792 individuals in 1987-1989 from 4 US communities and contained 9-years of follow-up; 8,212 participants who had serum urate levels <7.0 mg/dL were included in this analysis. Risk factors for 9-year incident hyperuricemia (plasma urate level of ³ 7.0 g/dL at visit 4) were identified using an AIC-based selection approach in a modified Poisson regression model. We considered baseline, 3-year, and change in serum urate level over 3 years.

Results: The 9-year cumulative incidence of hyperuricemia was 4% and subgroup cumulative incidences were: 5% for men; 3% for women; 6% for African Americans and; 3% for whites. The final adjusted model included 8 predictors for incident hyperuricemia over 9 years: male sex (RR=1.78, 95% CI: 1.39-2.27), African-American race (RR=1.54, 95% CI: 1.19-2.00), current smoking (RR=1.36, 95% CI: 1.04-1.79), as well as basic education (RR=1.28, 95% CI: 0.99-1.64), hypertension (RR=1.73, 95% CI: 1.37-2.19), coronary heart disease (RR=1.57, 95% CI: 0.97-2.54), obesity (class I obesity: RR=2.82, 95% CI: 1.97-4.04 and ³class II, RR= 3.93, 95% CI: 2.62-5.91) and eGFR<60 (RR=3.04, 95% CI: 1.73-5.34). In separate models, serum urate levels at baseline, 3 years after baseline, and change in serum urate level over 3 years in addition to demographic and clinical risk factors were all associated with the development of hyperuricemia (Table).

Conclusion: Our results suggest that demographic and clinical risk factors that re routinely collected as part of regular medical care predict the development of hyperuricemia in middle-aged adults.

Table: Predictors of incident hyperuricemia over 9 years.

Risk Factor

Model 1: Baseline Serum Urate Adjusted

Model 2: 3 Year Serum Urate Adjusted

Model 3: Change in Serum Urate Adjusted

Male sex

1.09 (0.84, 1.42)

1.02 (0.80, 1.31)

1.57 (1.24, 2.01)

Black race

1.54 (1.20, 1.99)

1.38 (1.08, 1.77)

1.43 (1.11, 1.84)

High school education or higher

1.28 (0.99, 1.64)

1.16 (0.90, 1.50)

1.26 (0.98, 1.61)

Hypertension

1.49 (1.17, 1.90)

1.29 (1.01, 1.65)

1.51 (1.18, 1.93)

Coronary heart disease

1.56 (0.96, 2.54)

1.53 (0.94, 2.50)

1.52 (0.93, 2.48)

Smoking status

            Current smoker

            Former smoker

            Never smoker

1.34 (1.03, 1.75)

0.82 (0.62, 1.08)

Reference

1.31 (1.00, 1.71)

0.78 (0.59, 1.03)

Reference

1.34 (1.02, 1.75)

0.83 (0.63, 1.10)

Reference

Body mass index, kg/m2

            BMI >= 35

            30 <= BMI < 35

            25 <= BMI < 30

            BMI < 25

2.14 (1.40, 3.27)

1.92 (1.34, 2.77)

1.72 (1.25, 2.36)

Reference

2.33 (1.54, 3.52)

2.04 (1.42, 2.94)

1.85 (1.35, 2.54)

Reference

3.75 (2.50, 5.63)

2.72 (1.90, 3.89)

2.19 (1.59, 3.00)

Reference

eGFR, ml/min/1.73m2

           <60

            60-90

             >=90

2.02 (1.15, 3.54)

0.94 (0.75, 1.19)

Reference

2.10 (1.27, 3.45)

1.04 (0.83, 1.31)

Reference

2.97 (1.75, 5.04)

1.19 (0.95, 1.50)

Reference

Serum urate level at baseline, 1 mg/dL

2.43 (2.02, 2.93)

–

–

Serum urate level at 3 year follow-up, 1 mg/dL

–

1.94 (1.80, 2.09)

–

3-year change in serum urate level, 1 mg/dL

–

–

1.62 (1.49, 1.76)

Source of support: This study was funded by Takeda Pharmaceuticals U.S.A., Inc. The Atherosclerosis Risk in Communities Study is carried out as a collaborative study supported by National Heart, Lung, and Blood Institute contracts (HHSN268201100005C, HHSN268201100006C, HHSN268201100007C, HHSN268201100008C, HHSN268201100009C, HHSN268201100010C, HHSN268201100011C, and HHSN268201100012C). Alan Baer was supported by the Donald B. and Dorothy Stabler Foundation.

Disclosure:

M. McAdams DeMarco,
None;

A. Law,
None;

J. W. Maynard,
None;

J. Coresh,
None;

A. N. Baer,
None.

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