The Relationship Between Elevated Serum Uric Acid and Risk of Stroke in Adult: An Updated and Dose-Response Meta-Analysis.
Level 3 - non-randomized controlled study
Systematic review and meta-analysis of prospective cohort studies
PubMed 34526951 · doi:10.3389/fneur.2021.674398
What was done
A systematic review and dose-response meta-analysis was performed on prospective cohort studies evaluating the association between serum uric acid (SUA) levels and stroke risk (including ischemic and hemorrhagic stroke). Effect-size estimates were pooled as hazard ratios (HR) with 95% confidence intervals (CI) per 1 mg/dl increase in SUA, alongside subgroup and sensitivity analyses.
What was found
The meta-analysis included 19 prospective cohort studies involving 37,386 males and 31,163 females (68,549 total participants). Each 1 mg/dl increase in SUA was associated with an increased risk of total stroke (HR 1.13; 95% CI: 1.09–1.18; P < 0.001), ischemic stroke (HR 1.15; 95% CI: 1.10–1.21; P < 0.001), and hemorrhagic stroke (HR 1.07; 95% CI: 1.00–1.15; P = 0.046). Total stroke risk was higher in females (HR 1.19; 95% CI: 1.12–1.26; P < 0.001) than in males (HR 1.11; 95% CI: 1.05–1.17; P < 0.001). For ischemic stroke, risk was elevated in both females (HR 1.26; 95% CI: 1.17–1.36; P < 0.001) and males (HR 1.12; 95% CI: 1.06–1.19; P < 0.001). Hemorrhagic stroke was significantly associated with SUA only in females (HR 1.19; 95% CI: 1.04–1.35; P = 0.01). Dose-response analyses demonstrated a J-shaped relationship between increasing SUA levels and stroke risk.
Why it matters
This review establishes a non-linear, J-shaped association between elevated serum uric acid and stroke incidence, indicating that hyperuricemia is an independent risk marker with stronger effects in women.
Limits
The meta-analysis is based entirely on observational prospective cohorts, precluding causal conclusions due to potential residual confounding from hypertension, metabolic syndrome, or medication use. The association with hemorrhagic stroke was borderline overall (P = 0.046) and absent in men. The abstract does not report specific covariate adjustments, follow-up durations, or geographic distribution of the included cohorts.
Cited by
- supports Elevated serum uric acid levels are associated with an increased risk of stroke.