# Serum uric acid and the risk of major adverse cardiovascular events and death among older adults: a population-based prospective cohort study

## TL;DR

This study found that serum uric acid levels in older adults are not strongly linked to heart events or death.

## Contribution

It clarifies the relationship between serum uric acid and cardiovascular outcomes in older adults using a large population-based study.

## Key findings

- Lower SUA levels were not associated with increased MACE or mortality risk.
- Higher SUA levels showed a slight increase in mortality risk but not for MACE.
- Sensitivity analyses confirmed no strong associations between SUA and outcomes.

## Abstract

The relationship between serum uric acid (SUA) and adverse outcomes in advanced age remains poorly understood. Our population-based prospective cohort study assessed the potential association between SUA levels and the risk of major adverse cardiovascular events (MACE) and all-cause mortality among community-dwelling older adults.

We used data from the Berlin Initiative Study linked to administrative claims and vital statistics. Cohort members were followed from cohort entry (2009) until the occurrence of a study outcome or the end of the study period (2021). We created three exposure groups according to the baseline SUA distribution (in mg/dL; lower: 1.68–5.16, intermediate: 5.17–6.83, higher: 6.84-13.0); SUA levels were updated biennially. Time-dependent Cox models yielded hazard ratios (HRs) and 95% confidence intervals (CIs) of MACE and all-cause mortality adjusted for potential confounders. Sensitivity analyses addressed time-dependent confounding.

Our cohort included 2,058 individuals (mean age 80 years, 53% female). Lower vs. intermediate SUA levels were not associated with the risk of MACE (HR, 1.16; 95% CI, 0.88–1.54) or all-cause mortality (HR, 1.06; 95% CI, 0.86–1.31). Higher vs. intermediate SUA levels were not associated with the risk of MACE (HR, 1.11; 95% CI, 0.85–1.45) but with an increased risk of all-cause mortality (HR, 1.26; 95% CI, 1.03–1.53). Sensitivity analyses showed no statistically significant associations between higher vs. intermediate SUA levels and the risk of mortality (HR [95% CI]: 1.09 [0.89–1.34] & 1.07 [0.86–1.34]).

Lower or higher SUA levels are not associated with the risk of MACE or all-cause mortality in older adults.

The online version contains supplementary material available at 10.1186/s12877-025-06479-3.