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Determinants of serum uric acid levels in an adult general population: results from the Moli-sani Study

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Abstract

Objectives

High levels of serum uric acid (UA) are associated with cerebro-cardiovascular disease risk factors. This study aimed at evaluating the main determinants of serum UA levels in relation to biochemical, lifestyle, and clinical variables.

Methods

The study population included 15,594 participants (48% men, age ≥ 35 years) to the Moli-sani Study, for whom data on serum UA levels were available. Association of UA with dependent variables was investigated by multivariable linear regression analysis separately for men and women.

Results

Average serum UA levels were higher in men than in women (6.1 ± 1.3 vs 4.6 ± 1.2 mg/dL, respectively). Cystatin C, creatinine, albumin, triglycerides, body mass index (BMI), and diuretic therapy were the major determinants of the heterogeneity of UA levels. In women, the final model, resulting from the stepwise analysis, explained 41.6% of the UA variability. In particular, cystatin C explained 22.5% of UA variance, followed by BMI (7.2%), albumin (4.0%), and creatinine (1.9%). The final model in men fitted the data less than in women (total R2 = 29.1%), and creatinine was found to be the main determinant of UA levels (10.1%), followed by triglycerides (7.6%), BMI (3.7%), and albumin (2.0%).

Conclusions

In a general adult population, the major determinants of serum UA levels are cystatin C, creatinine, BMI, triglycerides, albumin, and the use of diuretics. Knowledge of its main determinants will be useful to better evaluate the relationship between UA levels and detrimental health outcomes and to clarify if an increase in uricemia is a marker or an independent risk factor.

Key Points

• Increased serum uric acid (UA) levels are reportedly associated with cardiovascular disease risk factors.

• The major determinants of heterogeneity of UA levels are cystatin C, creatinine, BMI, triglycerides, albumin, and the use of diuretics, in a general adult population.

• Studying the main determinants associated with high levels of serum uric acid would help better understanding if uric acid is a marker or an independent cardiovascular risk factor.

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Acknowledgments

The Moli-sani research group thanks the Associazione Cuore Sano Onlus (Campobasso, Italy) for its financial and cultural support.

Funding

The present analyses were partially supported by a grant from Menarini Spa.

The enrolment phase of the Moli-sani Study was supported by research grants from the Pfizer Foundation (Rome, Italy), the Italian Ministry of University and Research (MIUR, Rome, Italy)–Programma Triennale di Ricerca, Decreto no.1588 and Instrumentation Laboratory, Milan, Italy.

Laboratory analyses of the Moli-sani Study were partially supported by: Werfen Instrumentation Laboratory Spa, Milan, Italy; BiomarCaRE (Biomarkers for Cardiovascular Risk Assessment in Europe): European Commission Seventh Framework Programme FP7/2007–2013 (HEALTH-F2-2011-278913) (L.I.); the Italian Ministry of Health, Grant 2018 (PI G.d.G, CoPI S.C., number grant: RF-2018-12367074).

Author information

Authors and Affiliations

  1. Mediterranea Cardiocentro, Naples, Italy

    Sara Magnacca & Augusto Di Castelnuovo

  2. Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, IS, Italy

    Simona Costanzo, Amalia De Curtis, Chiara Cerletti, Giovanni de Gaetano, Maria Benedetta Donati & Licia Iacoviello

  3. Computer Service, University of Molise, Campobasso, Italy

    Marco Olivieri

  4. Research Center in Epidemiology and Preventive Medicine (EPIMED), Department of Medicine and Surgery, University of Insubria, Varese, Italy

    Licia Iacoviello

Authors
  1. Sara Magnacca
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  2. Simona Costanzo
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  3. Amalia De Curtis
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  4. Augusto Di Castelnuovo
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  5. Marco Olivieri
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  6. Chiara Cerletti
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  7. Giovanni de Gaetano
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  8. Maria Benedetta Donati
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  9. Licia Iacoviello
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Consortia

on behalf of the Moli-sani Study Investigators

Contributions

M.B.D, L.I., S.M., and S.C. contributed to the concept and design of the work and interpretation of data; S.C., A.De.C., and M.O. managed data collection; S.C. analyzed the data and reviewed the manuscript; S.M. wrote the paper; M.B.D., C.C., G.d.G., A.Di.C., and L.I. originally inspired the research and critically reviewed the manuscript.

Corresponding author

Correspondence to Licia Iacoviello.

Ethics declarations

The Moli-sani Study complies with the Declaration of Helsinki and was approved by the Catholic University ethical committee, Rome, Italy. All participants provided written informed consent.

Disclaimer

Funders had no role in study design; collection, analysis, or interpretation of data; the writing of the manuscript; or the decision to submit the article for publication.

Conflict of interest

None.

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Moli-sani Study Investigators are listed in the Supplementary file, Appendix S1.

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Magnacca, S., Costanzo, S., De Curtis, A. et al. Determinants of serum uric acid levels in an adult general population: results from the Moli-sani Study. Clin Rheumatol 40, 857–865 (2021). https://doi.org/10.1007/s10067-020-05288-w

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