Serum uric acid levels and the risk of recurrent venous thromboembolism

BACKGROUND: The link between serum uric acid (SUA) and the risk of cardiovascular disease is well established. However, the impact of SUA levels on the risk of venous thromboembolism (VTE) recurrence is unknown.OBJECTIVES: to investigate the association between SUA and the risk of VTE recurrence.PATIENTS AND METHODS: We performed a monocenter, prospective study on 280 patients with a previous episode of VTE that completed the oral anticoagulant period. SUA levels at enrollment were correlated with the risk of VTE recurrence (mean follow-up 71.1 ± 29.2 months).RESULTS: Patients were stratified according to SUA tertiles distribution at baseline (tertiles cut-off: I ≤ 4.37 mg/dl, II 4.38 - 5.54 mg/dl, III ≥ 5.55 mg/dl). Fifty episodes of VTE recurrence occurred during the follow-up and Kaplan-Meyer survival analysis showed that subjects in the lower tertile of SUA distribution had significant lower risk of future VTE recurrence (p=0.003). No difference were seen among patients belonging to the second and the third tertile of SUA distribution. A multivariate Cox regression analysis showed that higher tertiles of SUA distribution had about 3-fold increase in the risk of VTE recurrence as compared to subjects with SUA ≤ 4.37, independently from potential confounders (HR 3.04, IC95% 1.15 - 8.05 p=0.025). Moreover, we observed that the adjusted hazard of VTE recurrence increases by 30% for each additional unit of SUA (mg/dl) (HR 1.30, IC95% 1.01 - 1.22, p=0.040).CONCLUSION: Elevated SUA levels are associated with increased risk of future VTE recurrence independently from traditional risk factors.