The association between serum uric acid levels and ischemic stroke in essential hypertension patients

Objectives: The association between serum uric acid (SUA) and ischemic stroke is still inconsistent across population. This study aimed to examine the association between SUA and ischemic stroke in essential hypertension patients. Methods: This retrospective study recruited participants from September 2011 to December 2012, in the Liao-bu community, Guangdong Province, China, and followed them until 31 December 2016. Participants were divided into quartiles based on SUA concentrations. Hazard ratio (HR) and confidence intervals (CIs) was estimated from Cox proportional hazards models, and propensity score analysis, Kaplan-Meier survival curves and receiver operating characteristic (ROC) curve were performed to evaluate the relationship between SUA and the risk of ischemic stroke. Results: A total of 5473 eligible hypertensive subjects were enrolled in this study, 2666 (48.71%) of them were males with an average age of 62.02 +/- 13.76 years. A total of 155 (2.83%) ischemic stroke occurred after the mean follow-up period of 4.5 years. After adjusting for potential confounders, comparing with the lowest quartiles of SUA, multivariable HR (95%CI) for ischemic stroke for participants with SUA at the second, third and fourth quartiles were 1.13 (95%CI: 1.10, 1.81), 1.39 (95%CI: 1.18, 1.89), and 1.64 (95%CI: 1.19, 1.95), respectively (P < 0.0001 for trend). Elevated SUA was positively associated with ischemic stroke (HR = 1.41, 95%CI: 1.16, 1.84; P < 0.01) and the propensity scores analysis (HR = 1.45, 95%CI: 1.17, 1.90; P < 0.01) showed the similar results. Gender subgroup analysis showed SUA was an independent risk of ischemic stroke in female (HR = 1.35, 95%CI: 1.11, 1.81, P = 0.002) and male (HR = 1.53, 95%CI: 1.14, 1.92, P < 0.001). ROC curve demonstrated that SUA yielded an AUC of 0.7476 (95%CI: 0.7098, 0.7855, P < 0.001) for predictive of ischemic stroke. Conclusions: SUA was an independent risk factor for ischemic stroke, and also have a good predictive value ischemic stroke among hypertensive patients in Chinese community.