Association of Elevated Uric Acid to Atrial Fibrillation

Atrial fibrillation (AF) is the most prevalent worldwide cardiac arrhythmia experienced with age.¹ AF is associated with many risk factors including aging, male sex, smoking, obesity, hypertension, hyperlipidemia, and diabetes.² However, all of these risk factors do not seem to contribute to the AF incidence.³

Uric acid has increasingly been a research focus for cardiovascular disease. The final product of purine metabolism is associated with increased risk of hypertension, diabetes, and coronary artery disease.^4-5

A recent study investigated the association between uric acid levels and risk of new-onset AF.⁶ This large study involved 339,604 unique participants from the Swedish AMORIS (Apolipoprotein-Mortality Risk) cohort study. Participants were aged between 30 to 60 years, free from cardiovascular disease at baseline (1985 to 1996), and followed until December 31, 2019, for new-onset AF.  

Participants were separated into four quartiles based on baseline uric acid level. Each of the upper three quartiles (uric acid level: Q2: 265.3±41.1; Q3: 300.2±44.1; and Q4: 366.5±62.5 µmol/L) was associated with increased risk of AF, with the highest quartile showing an adjusted (stratified by incident cardiovascular disease) hazard ratio of 1.45 (95% CI, 1.41-1.49). The association was independent of participants with hypertension, diabetes, heart failure, or coronary artery disease.

Although the exact mechanism of the development of AF from uric acid is unknown, the data do support that uric acid levels should be reviewed routinely for identifying persons at risk of AF, especially older adults. In addition, some foods such as liver, kidney, alcohol, anchovies, sardines, herring, mussels, codfish, scallops, trout, haddock, and sweetbreads have high purine levels that may contribute to high blood levels of uric acid. If high uric acid levels are present, consider counseling patients to limit serving sizes of the foods listed above.  

References:

1. Chugh SS, Havmoeller R, Narayanan K, et al. Worldwide epidemiology of atrial fibrillation: a global burden of disease 2010 study. Circulation. 2014;129:837-47. doi:10.1161/CIRCULATIONAHA.113.005119
2. Allan V, Honarbakhsh S, Casas MP, et al. Are cardiovascular risk factors also associated with the incidence of atrial fibrillation?  A systematic review and field synopsis of 23 factors in 32 population-based cohorts of 20 million participants. Thrombo Haemost. 2017;117:837-50. doi:10.1160/TH16-11-0825. 
3. Schnabel RB, Sullivan LM, Levy D, et al. Development of a risk score for atrial fibrillation (Framingham Heart Study): a community-based cohort study. Lancet. 2009;373:739-45. doi:10.1016/S0140-6736(09)60443-8
4. Lee SJ, Oh BK, Sung K-C. Uric acid and cardiometabolic diseases. Clin Hypertens. 2020;26:13. doi:10.1186/s40885-020-00146-y
5. Feig DI, Kang D-H, Johnson RJ. Uric acid and cardiovascular risk. N Eng J Med. 2008;359:1811-21. doi:10.1056/NEJMra0800885
6. Ding M, Viet Nn, Gigante B, Lind V, Hammar N, Modig K. Elevated uric acid is associated with new-onset atrial fibrillation: Results from the Swedish AMORIS Cohort. J Am Heart Assoc. 2023;12:e027089. doi:10.1161/JAHA.122.027089