Objective: This study investigated the associations between hyperuricemia, pulse pressure (PP) and heart failure (HF) hospitalization among the elders in a community population.
Background: Hyperuricemia and PP have been related to the development of HF. Whether PP acts synergistically with hyperuricemia or mediates the causal relationship of HF, especially in the elderly, remains elucidated.
Methods: This cohort included 1665 adults aged ≥65 years from the National Nutrition and Health Survey in Taiwan Elderly were followed. HF hospitalization (ICD-9-CM:428) was defined by the National Health Insurance Dataset. A Cox proportional hazard model and a Fine and Grays model were adjusted for the conventional cardiovascular risk factors and death as a competing risk to estimate the association between hyperuricemia, PP and HF hospitalization.
Results: A total of 228 elders occurred HF hospitalization, and 692 died during a median of 12 years follow-up period, from 1999 to 2012. The incidence of HF was 14.2 per 1000 person-years. High PP (top quartile) and hyperuricemia (≥6.0 mg/dL [women] and 7.0 mg/dL [Men]) significantly correlated with incident HF (hazard ratio and 95% confidence intervals: 2.131;1.625-2.794 and 1.433;1.071-1.918, respectively). Compared with normal uric acid level and PP, combined hyperuricemia and high PP was additively related to incident HF (4.186:2.874-6.099). The associations remained after accounting for traditional cardiovascular risks, coronary heart disease as a time-dependent covariate, and mortality as a competing risk factor in the study population.
Conclusion: Both hyperuricemia and high PP were associated with HF hospitalization in this elderly population. Combine hyperuricemia and high PP would further improve the risk stratification in the prediction of incident HF.
Keywords: Elders; Heart failure; Hyperuricemia; Prospective study; Pulse pressure.
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