Relation of Serum Uric Acid With the Risk of Coronary Heart Disease: An updated Systematic Review and Dose-Response Meta-analysis of Epidemiologic Studies

Zhen Zhou¹Guancheng Ye²Xiaoqiao Ren¹Yaxing Cheng¹Yuzhen Cang¹Jingbo Zhao^1*Huihui Zhao^1*

• ¹Beijing University of Chinese Medicine, Beijing, China
• ²Department of Rheumatology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China

Background: Over the past decade, multiple recent studies have investigated the relationship between serum uric acid(SUA) levels and the risk of coronary heart disease (CHD). This meta-analysis aims to assess the dose-response relationship between SUA levels and CHD by integrating the latest relevant studies from the past decade. Methods: Epidemiological studies such as cohort studies, which aim to explore the association between SUA levels and the risk of CHD, were included. Papers unrelated to the aforementioned topics, non-original works or studies, were not conducted with humans, were not published between 2015 to 2025 or that could not provide the specific numerical data required for analysis were excluded. We systematically searched the PubMed, Web of Science, EMBASE, and Cochrane Library databases until September 2025 for relevant studies. We performed a systematic review of relevant original studies and conducted both overall analysis and dose-response analysis. Data were pooled using a random-effects model, heterogeneity was assessed with the I² statistic, and the robustness of findings was evaluated via model comparison and sequential exclusion. Results: 8 cohort studies were included. Among 574, 815 participants, there were 11,009 cases of CHD. An increased risk of CHD was associated with elevated SUA (HR = 1.38 95% CI = 1.30–1.47) in the overall meta-analysis. In the subgroup analysis, a consistent positive correlation was observed between SUA and the risk of CHD in all the pre-defined subgroups (including gender, sample size, publication year and outcome type). The dose-response meta-analysis demonstrated that elevated SUA levels were associated with increased CHD risk in a dose-dependent manner, with a non-linear pattern in males and a linear pattern in females. Conclusion: Dose-response analysis showed a positive, non-linear association between SUA and CHD in males, and a linear association in females, highlighting its role as a risk marker. Definitive evidence for causality requires future randomized controlled trials. Systematic review registration: http://www.crd.york.ac.uk/PROSPERO, CRD420251240886