Serum uric acid levels and risk for acute ischaemic nonembolic stroke in elderly subjects

Background. Elevated serum uric acid (SUA) levels have been proposed as an independent risk factor for cardiovascular (CV) morbidity and mortality. Recent evidence suggests that treatments with a hypouricaemic action have a favourable effect on CV event prevention. Objectives. The association between SUA and acute ischaemic/nonembolic stroke was assessed in a population-based case-control study in the prefecture of Ioannina, Epirus, Greece. Subjects and methods. A total of 163 patients aged older than 70 years (88 men and 75 women) admitted due to a first-ever-in-a-lifetime acute ischaemic/nonembolic stroke and 166 volunteers (87 men and 79 women) without a history of CV disease were included. The association between SUA and stroke was determined by multivariate logistic regression modelling after adjusting for potential confounding factors. Results. Stroke patients showed higher concentrations of SUA compared with controls (333.1 +/- 101.1 mu mol L-1 vs. 285.5 +/- 83.3 mu mol L-1; P < 0.001). In univariate analysis elevated SUA levels were associated with increased risk for ischaemic stroke [odds ratio (OR) 1.42, 95% confidence interval (CI) 1.21-1.64, P < 0.0001]. Compared to patients with SUA levels in the lowest quintile, those within the highest quintile had a 2.8-time increase in the odds of suffering an ischaemic stroke (OR 2.81, 95% CI 1.67-4.73, P < 0.001). This association was strong even after controlling for gender, age, body mass index, the presence of hypertension and diabetes mellitus, drug treatment and lipids (OR 2.90, 95% CI 1.59-5.30, P = 0.001). Conclusion. Elevated SUA is associated with an increased risk for acute ischaemic/nonembolic stroke in a strictly defined population of elderly individuals independently of concurrent metabolic derangements. This association may need to be considered when treating the elderly.