Objective. To evaluate whether hyperuricemia is a risk factor for cardiovascular disease (CVD) in patients with rheumatoid arthritis (RA). Methods. A population-based inception cohort of patients diagnosed between 1980 and 2007 with adult-onset RA was assembled. A comparison cohort of age- and sex-matched subjects without RA (non-RA) was also assembled. All clinically obtained uric acid values were collected. CVD and noncardiac vascular events were recorded for each patient. Cox proportional hazards models were used to assess the impact of hyperuricemia on development of CVD, mortality, and noncardiac vascular disease. Results. In patients without RA, hyperuricemia was associated with heart failure (HR: 1.95; 95% CI: 1.13–3.39) and CVD (HR: 1.59; 95% CI: 0.99–2.55). In patients with RA, hyperuricemia was not significantly associated with CVD but was significantly associated with peripheral arterial events (HR: 2.52; 95% CI: 1.17–5.42). Hyperuricemia appeared to be more strongly associated with mortality among RA patients (HR: 1.96; 95% CI: 1.45–2.65) than among the non-RA subjects (HR: 1.57; 95% CI: 1.09–2.24). Conclusion. In patients with RA, hyperuricemia was a significant predictor of peripheral arterial events and mortality but not of CVD. 1. Introduction Patients with rheumatoid arthritis (RA) are at increased risk to develop cardiovascular disease (CVD) [1, 2] and experience cardiovascular mortality [3, 4]. Although treatments for RA have improved over time, cardiovascular mortality has remained relatively unchanged [4] and is responsible for 50 percent of premature deaths in patients with RA [5, 6]. Traditional cardiovascular risk factors including smoking, hypertension, hyperlipidemia, obesity, and diabetes are important factors but do not adequately account for the excess burden of CVD in RA patients [7]. There is growing evidence that serum uric acid (SUA) may play a role in CVD in the general population [8, 9]. Indeed epidemiologic studies have found that hyperuricemia appears to be an independent risk factor for hypertension [10], heart failure (HF) [11], coronary artery disease [12], and stroke [13]. Experimental studies have also shown that uric acid is a functionally active molecule that can contribute to proatherogenic processes including inflammation, endothelial dysfunction, and oxidative stress [14]. The role of hyperuricemia in RA has not been well studied and only a few papers have addressed the subject [15, 16]. However, hyperuricemia is common in the general population with a prevalence of 6–8% among healthy adults and as many as
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