Urinary Uric Acid Index Outperforms Serum Uric Acid in Cardiovascular Risk Prediction: Study

A new study published in the journal of Clinical Cardiology showed that serum uric acid (SUA) levels were found to be less predictive of coronary artery disease (CAD) and all-cause mortality than the urinary uric acid index (UAI).

Serum uric acid has become an important, independent biomarker for cardiovascular and cerebrovascular disease, whereas it was previously largely known for its causative involvement in gout. Elevated uric acid levels are closely associated with increased risk of coronary artery disease, cerebrovascular events, and greater death rates, according to recent clinical findings. Furthermore, when compared to isolated readings, the uric acid index has proved to be an even more sensitive predictive tool.

This score provides doctors with improved prediction accuracy by capturing the complex interplay between oxidative stress, endothelial dysfunction, and systemic inflammation. Therefore, there is significant potential for enhancing early cardiovascular risk stratification and directing focused preventive therapeutic intervention methods by including routine uric acid measurements and the computed index into thorough patient evaluations. Thus, this study assessed the prognostic power of the SUA and UA index in CVD, stroke, and CAD.

The Mashhad Stroke and Heart Atherosclerotic Disorders (MASHAD) research served as the foundation for this investigation. At baseline, SUA and the UA index (Ln [TG (mg/dL) × SUA (mg/dL) × FBG (mg/dL)/2]) were computed. The incidence of the outcomes, such as CAD, cerebrovascular events, and mortality from CAD or cerebrovascular events, was assessed after 10 years.

In the whole population, SUA had a slight but significant connection with CAD (HR = 1.064, 95% CI: 1.010-1.121, p = 0.020). However, it was not linked to stroke or death, and gender-stratified analyses revealed no significant correlations. On the other hand, UAI showed a robust and reliable correlation with CAD in every group. A 54.1% increased risk of CAD was linked to each unit rise in UAI (HR = 1.541, 95% CI: 1.407-1.689, p < 0.001), with larger effects in women.

Additionally, UAI was substantially linked to a higher risk of death, but not stroke. According to ROC analysis, UAI consistently outperformed SUA in terms of discriminative performance for CAD and mortality prediction (AUC: 0.632 vs. 0.561). Overall, these results provide credence to the possibility of using UAI as a more reliable and practical biomarker for long-term prognosis and cardiovascular risk assessment.

Source:

Rezaee, A., Imannezhad, M., Kamrani, F., Moohebati, M., Shahri, B., Alimi, H., Esmaily, H., Mahaki, H., Mehrabzadeh, M., Heidari-Bakavoli, A., Ghayour-Mobarhan, M., & Darroudi, S. (2026). Uric Acid and Uric Acid Index in Predicting Coronary Artery Disease, Cerebrovascular Events, and Mortality: A Sex-Stratified Cohort Study. Clinical Cardiology, 49(6), e70376. https://doi.org/10.1002/clc.70376