尿酸（UA）是心血管事件的独立预后因素，但没有数据表明女性和男性之间存在不同的风险状况。因此，我们测试了 UA 是否与致死性和非致死性心血管事件中可能存在的性别相关差异相关。在这项基于人群的前瞻性研究中，我们招募了 1,650 名转诊至卡坦扎罗大学医院（意大利）的从未接受治疗的白人高血压门诊患者。纳入标准是新诊断的高血压患者，年龄 20 岁或以上。排除标准为继发性高血压、既往心血管事件、风湿性和非风湿性瓣膜性心脏病、人工瓣膜、心肌病、2型糖尿病、慢性肾病、恶性疾病、痛风关节炎以及继发性高尿酸血症、肝脏疾病、外周血血管疾病和心力衰竭。测量了人体测量、临床和生化参数。通过 Cox 回归分析研究 UA 的预后作用。接受者操作特征曲线分析和曲线下面积用于确定 UA 的预测有效性和最佳截止点。我们研究了以下终点：冠状动脉事件（致死性和非致死性心肌梗塞、不稳定型心绞痛、冠状动脉血运重建手术、冠心病死亡）；致命性和非致命性中风；全因死亡率和主要不良心血管事件 (MACE)。我们招募了 830 名男性和 820 名女性，年龄 52.2±11.3 岁。在9.5±3.1年的随访期间，出现了424例新的临床事件（2.71%）：250例冠心病（1.59%）、118例（0.75%）脑血管事件和56例（0.40%）死亡。组间比较显示，女性MACE（3.08 vs 2.33%，P = 0.001）、冠状动脉（1.82 vs 1.36%，P = 0.014）和脑血管事件（0.93 vs 0.57%，P = 0.006）的发生率较高且差异显着。 ）。多重 Cox 回归分析中的 UA 是冠状动脉事件 (HR = 1.493;95% CI 1.375-1.621)、脑血管事件 (HR = 1.256;95% CI 1.109-1.423)、MACE (HR = 1.415;95) 的强有力且显着的预测因子% CI 1.328- 53 1.508) 和全因死亡率 (HR = 1.469;95% CI 1.237-1.745) 在整个人群中以及在女性 HR 较高的两组中。男性和女性尿酸的最佳估计截止值同样可以很好地预测这些终点，但女性总是低于男性。我们证明，UA 具有与性别相关的影响，并且在预测方面具有最佳截止值心血管结局和全因死亡率，反映了疾病病理生理学中可能存在的性别差异。© 2023。作者。

Uric acid (UA) is an independent prognostic factor for cardiovascular events, but there are no data demonstrating a different risk profile between women and men. Thus, we tested whether UA is associated with a possible sex-related difference in fatal and non-fatal cardiovascular events.In this prospective population-based study we enrolled 1,650 never-treated Caucasian hypertensive outpatients referred to Catanzaro University Hospital (Italy). Inclusion criteria were newly diagnosed hypertensive patients, aged 20 years or more. Exclusion criteria were secondary form of hypertension, previous cardiovascular events, rheumatic and non-rheumatic valvular heart disease, prosthetic valves, cardiomyopathies, type-2 diabetes, chronic kidney disease, malignant diseases, gout arthritis and secondary forms of hyperuricemia, liver diseases, peripheral vascular diseases, and heart failure. Anthropometric, clinical, and biochemical parameters were measured. UA prognostic role was investigated by Cox regression analyses. Receiver-operating characteristic curve analyses and area under the curve were used to determine the predictive validity and the optimal cut-off point of UA. We investigated following endpoints: coronary events (fatal and nonfatal myocardial infarction, unstable angina, coronary revascularization procedures, coronary death); fatal and nonfatal stroke; all-cause mortality and major adverse cardiovascular events (MACE).We enrolled 830 males and 820 females aged 52.2 ± 11.3 years. During 9.5 ± 3.1 years follow-up, there were 424 new clinical events (2.71%): 250 coronary (1.59%), 118 (0.75%) cerebrovascular, and 56 (0.40%) deaths. Comparison between groups demonstrated a higher and significant difference in incidence rate in females for MACE (3.08 vs 2.33%, P = 0.001), coronary (1.82 vs 1.36%, P = 0.014) and cerebrovascular events (0.93 vs 0.57%, P = 0.006). UA at multiple Cox regression analysis resulted a strong and significant predictor of coronary events (HR = 1.493;95% CI 1.375-1.621), cerebrovascular events (HR = 1.256;95% CI 1.109-1.423), MACE (HR = 1.415;95% CI 1.328- 53 1.508), and all-cause mortality (HR = 1.469;95% CI 1.237-1.745) in the whole population and in both groups with a HR higher in females. The best estimated cut-off values of uric acid for males and females predicted these endpoints equally well, but it was always lower in females than males.We demonstrate, that UA operates with a sex-related impact and best cut-off value in predicting cardiovascular outcomes and all-cause mortality, reflecting a possible sex difference in disease pathophysiology.© 2023. The Author(s).