The Relation of Postmenopausal Hormone Therapy to Serum Uric Acid and the Risk of Coronary Heart Disease Events: The Heart and Estrogen–Progestin Replacement Study (HERS)

Purpose To determine whether baseline serum uric acid (UA) levels and estrogen–progestin (E + P)-associated change in serum UA in postmenopausal women with coronary disease are associated with recurrent coronary heart disease (CHD) events. Methods 2763 postmenopausal women enrolled in the Heart and Estrogen–Progestin Replacement Study (HERS) were randomly assigned to take conjugated E + P or placebo in a secondary CHD prevention study. The primary outcome for these analyses was nonfatal myocardial infarction or CHD death during a mean follow up of 4.1 years. Results The baseline serum UA for the cohort was 5.4 mg/dl and, compared with placebo, E + P on average lowered serum UA levels slightly (0.2 mg/dl) at one year of follow up (p <0.0001). Baseline serum UA levels were associated in simple proportional hazards models with CHD events; each standard deviation increase (1.3 mg/dl) was associated with a 22% increased risk of primary CHD events (p = .0001). This association, however, was no longer statistically significant after multivariable adjustment (p = 0.36). There was no association between on-study change in serum UA level and any CHD outcome. Conclusion Treatment with E + P lowered serum UA levels slightly, but neither baseline UA nor change in UA affected CHD risk.