Association of serum uric acid with all-cause and cardiovascular mortality in diabetes: prospective cohort study and meta-analysis

   Objective: To investigate whether serum uric acid (SUA) level was associated with all-cause and cardiovascular disease (CVD) mortality among individuals with diabetes.  Research design and methods: In this prospective cohort, we included the patients with diabetes from the National Health and Nutritional Examination Survey (NHANES) 1999-2018. Mortality and underlying causes of death were ascertained by linkage to national death records through December 31, 2019. Weighted Cox proportional hazards regression models were used to evaluate hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause and CVD mortality. We further performed a meta-analysis of available cohort studies to combine the association between SUA and mortality in diabetes. Results: Among the 7,101 diabetes from NHANES 1999-2018, the weighted mean of SUA level was 5.7 mg/dL. During 57,926 person-years of follow-up, 1,900 deaths (674 deaths from CVD) occurred. In the fully adjusted model, when compared to patients with diabetes in the lowest SUA quintile, those in the highest SUA quintile had the HRs (95% CIs) of 1.28 (1.03, 1.58) for all-cause mortality and 1.41 (1.03, 1.94) for CVD mortality. We included 13 cohort studies in the meta-analysis, and found that the pooled HRs (95% CIs) were 1.08 (1.05, 1.11) for all-cause mortality and 1.05 (1.03, 1.06) for CVD mortality, with per 1 mg/dL increment of SUA level in diabetes.  Conclusions: This study indicated that higher SUA levels were associated with increased risks of all-cause and CVD mortality in diabetes. Interventional studies are needed to elucidate the health effect of lowering uric acid treatments.</p