Association of hyperuricemia with valvular heart disease and the modifying effect of obesity

Background/Aims: Hyperuricemia has been widely associated with cardiovascular health, but its relationship with incident valvular heart disease (VHD) remains uncertain. This study investigated the association between hyperuricemia and VHD, and further explored the role of weight management within this context.Methods: Participants from the UK Biobank cohort were categorized into three groups based on serum uric acid (SUA) level: normal (< 6.0 mg/dL), high (6.0–8.9 mg/dL), and very high (≥ 9.0 mg/dL). The risk of VHD associated with SUA level was assessed in the overall population and across subgroups with differing metabolic profiles. To examine the impact of obesity on VHD development, the relative risk of VHD was analyzed based on body mass index and waist circumference.Results: Among 462,705 participants, 340,793 (73.7%) had normal SUA levels, 118,861 (25.7%) had high levels, and 3,051 (0.7%) had very high levels. Over an average follow-up period of 12.3 years, the adjusted risk of VHD was significantly higher in individuals with very high SUA, followed by those with high and normal SUA (2.31 vs. 1.25 vs. reference, respectively). Stratifying VHD risk by metabolic disorders revealed a dose-response relationship between SUA level and VHD risk. The impact of obesity on VHD development was notable among individuals with SUA below 9.0 mg/dL, but less pronounced in those with SUA exceeding 9.0 mg/dL.Conclusions: This finding suggests a significant association between hyperuricemia and VHD, highlighting the potential relevance of elevated SUA levels in VHD risk stratification.