Hyperuricemia And Risk Of Stroke: A Systematic Review And Meta-Analysis Of Prospective Studies

Objective: Hyperuricemia may be associated with an increased risk of stroke, but to date results from prospective studies have been inconsistent. This study aimed to evaluate the association between hyperuricemia and risk of stroke incidence and mortality by performing a meta-analysis.Materials and Methods: Studies were identified by searching multiple electronic databases through March, 2015, and by reviewing reference lists of obtained articles. Prospective studies reported a multivariate-adjusted estimate, represented as relative risk(RR) with 95% confidence interval(CI) for the association between hyperuricemia and risk of stroke incidence and mortality were eligible. A random-effects model was used to compute the pooled risk estimate. Subgroup analyses, sensitivity analyses, and dose-response analyses were also performed. Funnel plots and Begg’s statistical analyses were used to examine potential publication bias.Results: A total of fifteen articles including results from 16 prospective studies with 23001 cases of stroke and 1048058 participants were included in the meta-analysis. Overall, presence of hyperuricemia was associated with a significantly greater risk of both stroke incidence(RR, 1.21; 95% CI, 1.08 to 1.35) and mortality(RR, 1.33; 95% CI, 1.24 to 1.43). In addition, the pooled estimate of multivariate RRs of stroke incidence and mortality were 1.15(95% CI: 0.92-1.44); 1.26(95% CI: 1.14-1.40) among men and 1.19(95% CI: 1.04-1.36); 1.41(95% CI: 1.31-1.52) among women respectively. In the dose-response analyses, the summary RRs of hyperuricemia were 1.30(95% CI: 1.02-1.67) for every 1mg/dl increase among men and 1.35(95% CI: 1.08-1.70) for every 1 mg/dl increase among women. In the sensitivity analyses, the results supported the robustness of the findings. There was no evidence of publication bias for stroke incidence and mortality. The P values of Begg’s were 0.91 and 0.73 respectively.Conclusions: Results from this meta-analysis indicate that hyperuricemia may modestly increase the risks of both stroke incidence and mortality. Among men and women, these results from stroke mortality were consistent with dose-response relationships. Future studies should explore whether hyperuricemia is a modifiable risk factor for stroke.