Background: The role of serum uric acid (SUA) as an independent risk factor for coronary artery disease (CAD) remains controversial, particularly in understudied Middle Eastern populations with distinct metabolic and dietary profiles.
Objective: To investigate the association between SUA levels and 10-year CAD incidence in a healthy Iranian cohort, adjusting for cardiometabolic confounders and exploring sex-specific relationships.
Methods: A 10-year prospective cohort study was conducted using data from the Yazd Healthy Heart Project. Cluster-random sampling recruited adults aged 20-74 years free of baseline cardiovascular disease. Participants with existing coronary artery disease, insufficient data, or loss to follow-up were excluded. Serum uric acid levels were stratified into quartiles, and Cox proportional hazards models adjusted for demographic, lifestyle, and metabolic variables were analyzed using SPSS (version 27.0).
Results: Over 15,420 person-years, 225 incident CAD cases occurred (14.5% cumulative incidence). In crude analysis, the highest SUA quartile (Q4: > 5.2 mg/dL) was associated with increased CAD risk (HR = 1.66, 95% CI: 1.14-2.43). However, this association attenuated after adjustment for confounders (fully adjusted HR = 1.03, 95% CI: 0.62-1.69). Sex-stratified analysis revealed a transient association in women (crude HR = 2.13, 95% CI: 1.14-3.96), which dissipated post-adjustment, while no significant association was observed in men.
Conclusion: Elevated SUA levels were not independently associated with CAD risk in this healthy Middle Eastern cohort. Initial associations were attributable to confounding by metabolic factors such as obesity, dyslipidemia, and hypertension. These findings underscore the importance of contextualizing SUA's role within population-specific risk profiles and highlight the need for nuanced risk stratification strategies.
Keywords: Cohort study; Coronary artery disease; Metabolic risk factors; Middle East; Serum uric acid.
© 2025. The Author(s).