151
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Tamargo J, Caballero R, Delpón E. New drugs in preclinical and early stage clinical development in the treatment of heart failure. Expert Opin Investig Drugs 2018; 28:51-71. [DOI: 10.1080/13543784.2019.1551357] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Juan Tamargo
- Department of Pharmacology and Toxicology, School of Medicine, Universidad Complutense, CIBERCV, Madrid,
Spain
| | - Ricardo Caballero
- Department of Pharmacology and Toxicology, School of Medicine, Universidad Complutense, CIBERCV, Madrid,
Spain
| | - Eva Delpón
- Department of Pharmacology and Toxicology, School of Medicine, Universidad Complutense, CIBERCV, Madrid,
Spain
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Abstract
The definition of asymptomatic hyperuricemia remains unclear, as no consensus exists about the serum urate cutoff or the relevance of ultrasound findings. Comorbidities associated with hyperuricemia have increased in frequency over the past two decades. Hyperuricemia (and/or gout) may be a cause or a consequence of a comorbidity. Whereas epidemiological studies suggest that hyperuricemia may be linked to cardiovascular, metabolic, and renal comorbidities, Mendelian randomization studies have not provided proof that these links are causal. Discrepancies between findings from observational studies and clinical trials preclude the development of recommendations about the potential benefits of urate-lowering therapy (ULT) in individual patients with asymptomatic hyperuricemia. The risk/benefit ratio of ULT is unclear. The risk of developing gout, estimated at 50%, must be weighed against the risk of cutaneous and cardiovascular side effects of xanthine oxidase inhibitors. The need for optimal comorbidity management, in contrast, is universally accepted. Medications for comorbidities that elevate urate levels should be discontinued and replaced with medications that have the opposite effect. Therapeutic lifestyle changes, weight loss as appropriate, and sufficient physical activity are useful for improving general health. Whether ULT has beneficial effects on comorbidities will be known only when well-powered interventional trials with relevant primary endpoints are available.
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Affiliation(s)
- Gérard Chalès
- Faculté de Médecine de Rennes, 2, avenue du professeur Léon-Bernard, 35000 Rennes, France.
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153
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Coburn BW, Michaud K, Bergman DA, Mikuls TR. Reply. Arthritis Rheumatol 2018; 70:1697-1698. [DOI: 10.1002/art.40549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Brian W. Coburn
- Veterans Affairs Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center; Omaha NE
| | - Kaleb Michaud
- University of Nebraska Medical Center Omaha, NE and National Data Bank for Rheumatic Diseases; Wichita KS
| | | | - Ted R. Mikuls
- Veterans Affairs Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center; Omaha NE
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154
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National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: Guidelines for the Prevention, Detection, and Management of Heart Failure in Australia 2018. Heart Lung Circ 2018; 27:1123-1208. [DOI: 10.1016/j.hlc.2018.06.1042] [Citation(s) in RCA: 203] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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155
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Effects of uric acid on vascular endothelial function from bedside to bench. Hypertens Res 2018; 41:923-931. [PMID: 30185927 DOI: 10.1038/s41440-018-0095-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Revised: 04/06/2018] [Accepted: 04/10/2018] [Indexed: 12/20/2022]
Abstract
This study was designed to investigate the effects of uric acid on vascular endothelial function in measurements carried out either at the bedside or the laboratory bench. First, we performed reactive hyperemia peripheral arterial tonometry using an EndoPAT 2000 device and measured serum uric acid levels in 92 outpatients with hypertension. The reactive hyperemia index (RHI) showed no correlation with serum uric acid level (R = -0.125, P = 0.235) in either overall patients or in a high-risk group of 51 patients with complications such as cardiovascular and cerebrovascular diseases, chronic kidney disease, and/or diabetes (R = -0.025, P = 0.860). However, in the remaining 41 patients in the low-risk group, RHI correlated negatively with serum uric acid level (R = -0.335, P = 0.032). Multiple regression analysis showed that serum uric acid level predicted RHI (R = -0.321, P = 0.043) in the low-risk group independent of age, body mass index, systolic blood pressure, and low density lipoprotein-cholesterol level. We then performed an in-vitro study using the WST-8 assay in human umbilical vein endothelial cells, which showed that hypoxic conditions reduced cell viability. Treatment with uric acid caused a further reduction in cell viability, while ascorbic acid improved viability. Using Western blot analysis, we observed that uric acid reduced endothelial nitric oxide synthase phosphorylation during hypoxic conditions. Serum uric acid level is associated with peripheral vascular endothelial function in patients with low-risk hypertension and uric acid could directly impair endothelial function under hypoxic conditions. These results are relevant to the interventional studies examining the cardiovascular protective effect of hypouricemic agents.
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156
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Yang X, Lv H, Hidru TH, Wu J, Liu H, Wang Y, Liu K, Xia Y, Zhou Y, Jiang Y. Relation of serum uric acid to asymptomatic proximal extracranial artery stenosis in a middle-aged Chinese population: a community-based cross-sectional study. BMJ Open 2018; 8:e020681. [PMID: 30139894 PMCID: PMC6112387 DOI: 10.1136/bmjopen-2017-020681] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE Serum uric acid (SUA) has been associated with cardiovascular diseases, including atherosclerosis and carotid artery stenosis. However, data on the relationship between SUA level and proximal extracranial artery stenosis (PEAS) are limited. Therefore, this study investigates the association between SUA levels and the risk of PEAS in asymptomatic Chinese population. SETTING This community-based cross-sectional study was conducted in Jidong Community Hospital, Tangshan, Hebei, China between July 2013 and August 2014. PARTICIPANTS The study examined 3325 asymptomatic participants (40-60 years) to evaluate the risk of PEAS. RESULTS For the participants stratified into quartiles based on gender-specific SUA levels, the prevalence of PEAS increased from Q1 to Q4 from 12.3% to 29.8% in the vertebral artery (VA), and from 2.8% to 5.8% in the common carotid artery. The proportion of PEAS relative to the detected number of arterial stenosis was lower in Q1 than in Q2-Q4. The multivariable ORs and 95% CI of PEAS in the second through fourth compared with the lowest quartiles for arterial stenosis were 1.278 (0.980 to 1.665), 1.117 (0.851 to 1.468) and 1.375 (1.033 to 1.830) (ptrend=0.0399); and for VA stenosis, 1.285 (0.966 to 1.709), 1.085 (0.808 to 1.457) and 1.439 (1.061 to 1.952) (ptrend=0.0235). CONCLUSION Elevated SUA concentration is significantly associated with PEAS in an asymptomatic middle-aged Chinese population, and vertebral arteries appeared to be the most vulnerable vessels.
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Affiliation(s)
- Xiaolei Yang
- Department of Cardiology, Institute of Cardiovascular Diseases, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Haichen Lv
- Department of Cardiology, Institute of Cardiovascular Diseases, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Tesfaldet Habtemariam Hidru
- Department of Cardiology, Institute of Cardiovascular Diseases, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Jing Wu
- Department of Technology, Beijing Recdata Technology Co., Ltd, Beijing, China
| | - Henghui Liu
- Department of Technology, Beijing Recdata Technology Co., Ltd, Beijing, China
| | - Youxin Wang
- Beijing Municipal Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China
| | - Kejia Liu
- Department of Technology, Beijing Recdata Technology Co., Ltd, Beijing, China
| | - Yunlong Xia
- Department of Cardiology, Institute of Cardiovascular Diseases, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yong Zhou
- Department of Cardiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vascular Diseases, Beijing, China
| | - Yinong Jiang
- Department of Cardiology, Institute of Cardiovascular Diseases, First Affiliated Hospital of Dalian Medical University, Dalian, China
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157
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Yokota T, Fukushima A, Kinugawa S, Okumura T, Murohara T, Tsutsui H. Randomized Trial of Effect of Urate-Lowering Agent Febuxostat in Chronic Heart Failure Patients with Hyperuricemia (LEAF-CHF). Int Heart J 2018; 59:976-982. [PMID: 30101851 DOI: 10.1536/ihj.17-560] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Hyperuricemia is an independent predictor of mortality in patients with chronic heart failure. The aim of the study is to determine whether a urate-lowering agent febuxostat, an inhibitor of xanthine oxidase, may improve the clinical outcomes in chronic heart failure patients with hyperuricemia when compared to conventional treatment. This multicenter, prospective, randomized, open-label, blinded endpoint study with a follow-up period of 24 weeks will enroll 200 Japanese chronic heart failure patients with hyperuricemia. The eligibility criteria include a diagnosis of chronic heart failure (New York Heart Association functional class II-III with a history of hospitalization due to worsening of heart failure within the last 2 years), reduced left ventricular systolic function (left ventricular ejection fraction < 40%) and increased plasma natriuretic peptide [plasma B-type natriuretic peptide (BNP) ≥ 100 pg/mL or N-terminal pro BNP (NT-proBNP) ≥ 400 pg/mL], and hyperuricemia (serum uric acid >7.0 mg/dL and ≤ 10 mg/dL) at the screening visit. The primary outcome is the difference in the plasma BNP levels between the baseline and 24 weeks of treatment. The plasma BNP levels are measured in the central laboratory in a blinded manner. This study investigates the efficacy and safety of febuxostat in chronic heart failure patients with hyperuricemia.
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Affiliation(s)
- Takashi Yokota
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University
| | - Arata Fukushima
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University
| | - Shintaro Kinugawa
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University
| | - Takahiro Okumura
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Hiroyuki Tsutsui
- Department Cardiovascular Medicine, Faculty of Medical Sciences, Kyusyu University
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158
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Black-Maier E, Daubert JP. Editorial Commentary: Prevention and treatment of atrial fibrillation: Is hyperuricemia the next target? Trends Cardiovasc Med 2018; 29:48-49. [PMID: 30057151 DOI: 10.1016/j.tcm.2018.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Accepted: 07/09/2018] [Indexed: 01/07/2023]
Affiliation(s)
- Eric Black-Maier
- Duke Center for Atrial Fibrillation, Electrophysiology Section, Division of Cardiology, Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | - James P Daubert
- Duke Center for Atrial Fibrillation, Electrophysiology Section, Division of Cardiology, Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA.
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159
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Haghikia A, Landmesser U. Lipoproteins and Cardiovascular Redox Signaling: Role in Atherosclerosis and Coronary Disease. Antioxid Redox Signal 2018; 29:337-352. [PMID: 28817963 DOI: 10.1089/ars.2017.7052] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
SIGNIFICANCE Lipoproteins, such as low-density lipoprotein, play a causal role in the development of atherosclerosis and coronary disease. Recent Advances: Lipoproteins can stimulate vascular production of reactive oxygen species, which act as important signaling molecules in the cardiovascular system contributing to the pathophysiology of endothelial dysfunction, hypertension, and atherosclerosis. CRITICAL ISSUES Modified lipoproteins have emerged as important regulators of redox signaling, such as oxidized or carbamylated low-density lipoprotein or modified high-density lipoproteins, that contain oxidized lipids, an altered protein cargo, and associated small molecules, such as symmetric dimethylarginine. FUTURE DIRECTIONS In this review, we provide an overview on signaling pathways stimulated by modified lipoproteins in the cardiovascular system and their potential role in cardiovascular disease development. Moreover, we highlight novel aspects of how gut microbiome-related mechanisms-a growing research field-may contribute to lipoprotein modification with subsequent impact on cardiovascular redox signaling. Antioxid. Redox Signal. 29, 337-352.
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Affiliation(s)
- Arash Haghikia
- 1 Department of Cardiology, Charité Universitätsmedizin Berlin , Berlin, Germany
- 2 German Center for Cardiovascular Research (DZHK) , partner site Berlin, Berlin, Germany
| | - Ulf Landmesser
- 1 Department of Cardiology, Charité Universitätsmedizin Berlin , Berlin, Germany
- 2 German Center for Cardiovascular Research (DZHK) , partner site Berlin, Berlin, Germany
- 3 Berlin Institute of Health (BIH) , Berlin, Germany
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160
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Katsi V, Georgiopoulos G, Laina A, Koutli E, Parissis J, Tsioufis C, Nihoyannopoulos P, Tousoulis D. Left ventricular ejection fraction as therapeutic target: is it the ideal marker? Heart Fail Rev 2018; 22:641-655. [PMID: 28601914 DOI: 10.1007/s10741-017-9624-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Heart failure (HF) consists the fastest growing clinical cardiac disease. HF patients are categorized on the basis of underlying left ventricular ejection fraction (LVEF) into HF with preserved EF (HFpEF), reduced LVEF (HFrEF), and mid-range LVEF (HFmrEF). While LVEF is the most commonly used surrogate marker of left ventricular (LV) systolic function, the implementation of two-dimensional echocardiography in estimating this parameter imposes certain caveats on current HF classification. Most importantly, LVEF could fluctuate in repeated measurements or even recover after treatment, thus blunting the borders between proposed categories of HF and enabling upward classification of patients. Under this prism, we sought to summarize possible procedures to improve systolic function in patients with HFrEF either naturally or by the means of pharmacologic and non-pharmacologic treatment and devices. Therefore, we reviewed established pharmacotherapy, including beta-blockers, inhibitors of renin-angiotensin-aldosterone axis, statins, and digoxin as well as novel treatments like sacubitril-valsartan, ranolazine, and ivabradine. In addition, we assessed evidence in favor of cardiac resynchronization therapy and exercise training programs. Finally, innovative therapeutic strategies, including stem cells, xanthine oxidase inhibitors, antibiotic regimens, and omega-3 polyunsaturated fatty acids, were also taken into consideration. We concluded that LVEF is subject to changes in HF after intervention and besides the aforementioned HFrEF, HFpEF, and HFmrEF categories, a new entity of HF patients with recovered LVEF should be acknowledged. An improved global and refined LV function assessment by sophisticated imaging modalities and circulating biomarkers is expected to render HF classification more accurate and indicate patients with viable-yet dysfunctional-myocardium and favorable characteristics as the ideal candidates for LVEF recovery by individualized HF therapy.
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Affiliation(s)
- V Katsi
- 1st Cardiology Department, National and Kapodistrian University of Athens, University Medical School, Hippokration Hospital, Vasilissis Sofias 114, 11528, Athens, Greece
| | - G Georgiopoulos
- 1st Cardiology Department, National and Kapodistrian University of Athens, University Medical School, Hippokration Hospital, Vasilissis Sofias 114, 11528, Athens, Greece.
| | - A Laina
- 1st Cardiology Department, National and Kapodistrian University of Athens, University Medical School, Hippokration Hospital, Vasilissis Sofias 114, 11528, Athens, Greece
| | - E Koutli
- 1st Cardiology Department, National and Kapodistrian University of Athens, University Medical School, Hippokration Hospital, Vasilissis Sofias 114, 11528, Athens, Greece
| | - J Parissis
- 1st Cardiology Department, National and Kapodistrian University of Athens, University Medical School, Hippokration Hospital, Vasilissis Sofias 114, 11528, Athens, Greece
| | - C Tsioufis
- 1st Cardiology Department, National and Kapodistrian University of Athens, University Medical School, Hippokration Hospital, Vasilissis Sofias 114, 11528, Athens, Greece
| | - P Nihoyannopoulos
- 1st Cardiology Department, National and Kapodistrian University of Athens, University Medical School, Hippokration Hospital, Vasilissis Sofias 114, 11528, Athens, Greece
| | - D Tousoulis
- 1st Cardiology Department, National and Kapodistrian University of Athens, University Medical School, Hippokration Hospital, Vasilissis Sofias 114, 11528, Athens, Greece
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161
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Singh TP, Skalina T, Nour D, Murali A, Morrison S, Moxon JV, Golledge J. A meta-analysis of the efficacy of allopurinol in reducing the incidence of myocardial infarction following coronary artery bypass grafting. BMC Cardiovasc Disord 2018; 18:143. [PMID: 29996770 PMCID: PMC6042232 DOI: 10.1186/s12872-018-0881-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 07/03/2018] [Indexed: 01/28/2023] Open
Abstract
Background The xanthine oxidase inhibitor allopurinol that is commonly used to treat gout, has been suggested to have pleiotropic effects that are likely to reduce the incidence of myocardial infarction (MI) in at risk individuals. The aim of this meta-analysis was to assess the efficacy of allopurinol treatment in reducing the incidence of MI. Method MEDLINE, Scopus, Web of Science, and Cochrane Library databases were searched for randomised controlled trials examining the efficacy of allopurinol in reducing the incidence of MI. The quality of study methodology was assessed by two independent reviewers using the Cochrane Collaboration’s tool for assessing risk of bias. This meta-analysis was conducted using a fixed-effects model, and heterogeneity was assessed with the I2 index. Results One thousand one hundred twenty-three citations were screened and only six studies satisfied the inclusion criterion. Published between 1988 and 1995, all studies examined the cardioprotective efficacy of allopurinol in the setting of coronary artery bypass graft (CABG). From a total pooled sample size of 229, MI was reported in 2 (1.77%) allopurinol and 14 (12.07%) control patients. A fixed-effects meta-analysis (I2 = 0%) identified a statistically significant reduced incidence of myocardial infarction (RR 0.21, 95% CI: 0.06, 0.70, p = 0.01) in patients allocated to allopurinol. However, in the leave-one-out sensitivity analyses, the treatment effect became non-significant with the removal of one of the studies. Conclusion Based on the limited evidence available, allopurinol appears to reduce the incidence of perioperative MI following CABG. Further research is required to confirm these findings. Electronic supplementary material The online version of this article (10.1186/s12872-018-0881-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tejas P Singh
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, QLD, 4811, Australia.,The Department of Vascular and Endovascular Surgery, The Townsville Hospital, Townsville, QLD, Australia
| | - Tristan Skalina
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, QLD, 4811, Australia
| | - Daniel Nour
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, QLD, 4811, Australia
| | - Aarya Murali
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, QLD, 4811, Australia
| | - Sean Morrison
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, QLD, 4811, Australia
| | - Joseph V Moxon
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, QLD, 4811, Australia
| | - Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, QLD, 4811, Australia. .,The Department of Vascular and Endovascular Surgery, The Townsville Hospital, Townsville, QLD, Australia.
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162
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Furuhashi M, Matsumoto M, Tanaka M, Moniwa N, Murase T, Nakamura T, Ohnishi H, Saitoh S, Shimamoto K, Miura T. Plasma Xanthine Oxidoreductase Activity as a Novel Biomarker of Metabolic Disorders in a General Population. Circ J 2018; 82:1892-1899. [DOI: 10.1253/circj.cj-18-0082] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Masato Furuhashi
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine
| | - Megumi Matsumoto
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine
| | - Marenao Tanaka
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine
| | - Norihito Moniwa
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine
| | | | | | - Hirofumi Ohnishi
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine
- Department of Public Health, Sapporo Medical University School of Medicine
| | - Shigeyuki Saitoh
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine
- Department of Nursing, Division of Medical and Behavioral Subjects, Sapporo Medical University School of Health Sciences
| | | | - Tetsuji Miura
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine
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163
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The effects of xanthine oxidase inhibitor in patients with chronic heart failure complicated with hyperuricemia: a prospective randomized controlled clinical trial of topiroxostat vs allopurinol—study protocol. Clin Exp Nephrol 2018; 22:1379-1386. [DOI: 10.1007/s10157-018-1599-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 06/01/2018] [Indexed: 02/06/2023]
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164
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Borghi C, Omboni S, Reggiardo G, Bacchelli S, Esposti DD, Ambrosioni E. Effects of the concomitant administration of xanthine oxidase inhibitors with zofenopril or other ACE-inhibitors in post-myocardial infarction patients: a meta-analysis of individual data of four randomized, double-blind, prospective studies. BMC Cardiovasc Disord 2018; 18:112. [PMID: 29866077 PMCID: PMC5987407 DOI: 10.1186/s12872-018-0800-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 04/04/2018] [Indexed: 12/14/2022] Open
Abstract
Background Oxidative stress is increased in hyperuricemic patients with acute myocardial infarction (AMI). Use of sulfhydryl ACE-inhibitors (ACEIs), such as zofenopril or captopril, plus xanthine oxidase inhibitors (XOIs), may potentially result in enhanced antioxidant effects and improved survival. Objective We verified the benefit of such combination in a randomly stratified sample of 525 of the 3630 post-AMI patients of the four randomized prospective SMILE (Survival of Myocardial Infarction Long-term Evaluation) studies. Methods One hundred sixty-five (31.4%) patients were treated with XOIs (79 under zofenopril, 86 placebo, lisinopril or ramipril), whereas 360 were not (192 zofenopril, 168 placebo or other ACEIs). In these four groups, we separately estimated the 1-year combined risk of major cardiovascular events (MACE, death or hospitalization for cardiovascular causes). Results MACE occurred in 10.1% of patients receiving zofenopril + XOIs, in 18.6% receiving placebo or other ACEIs + XOIs, in 13.5% receiving zofenopril without XOIs and in 22.0% receiving placebo or other ACEIs, but no XOIs (p = 0.034 across groups). Rate of survival free from MACE was significantly larger under treatment with zofenopril + XOIs than with other ACEIs with no XOIs [hazard ratio: 2.29 (1.06–4.91), p = 0.034]. A non-significant trend for superiority of zofenopril + XOIs combination was observed vs. zofenopril alone [1.19 (0.54–2.64), p = 0.669] or vs. placebo or other ACEIs + XOIs [1.82 (0.78–4.26), p = 0.169]. Conclusions Our retrospective analysis suggests an improved survival free from MACE in post-AMI patients treated with a combination of an urate lowering drug with antioxidant activity and an ACEI, with best effects observed with zofenopril.
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Affiliation(s)
- Claudio Borghi
- Unit of Internal Medicine, Policlinico S. Orsola, University of Bologna, Bologna, Italy. .,Divisione di Medicina Interna, Policlinico S.Orsola, Via Massarenti 9, 40138, Bologna, Italy.
| | - Stefano Omboni
- Clinical Research Unit, Italian Institute of Telemedicine, Varese, Italy
| | | | - Stefano Bacchelli
- Unit of Internal Medicine, Policlinico S. Orsola, University of Bologna, Bologna, Italy
| | - Daniela Degli Esposti
- Unit of Internal Medicine, Policlinico S. Orsola, University of Bologna, Bologna, Italy
| | - Ettore Ambrosioni
- Unit of Internal Medicine, Policlinico S. Orsola, University of Bologna, Bologna, Italy
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165
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Alem MM, Alshehri AM, Cahusac PMB, Walters MR. Effect of Xanthine Oxidase Inhibition on Arterial Stiffness in Patients With Chronic Heart Failure. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2018; 12:1179546818779584. [PMID: 29899669 PMCID: PMC5992797 DOI: 10.1177/1179546818779584] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 04/30/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND The xanthine oxidase inhibitor allopurinol improves endothelial function in different populations, including patients with chronic heart failure (CHF). Its effect on arterial stiffness parameters is less clear. We investigated the effect of short-term low-dose allopurinol therapy on arterial stiffness in Saudi patients with stable mild-moderate CHF. METHODS A prospective, randomized, double-blind, placebo-controlled study was performed on 73 patients with mild-moderate CHF. In all, 36 patients were randomized to allopurinol 300 mg daily for 3 months, while 37 patients were randomized to placebo. Arterial stiffness parameters, aortic pulse wave velocity (Ao-PWV) and heart rate corrected augmentation index (c-AIx), were assessed before and after treatment along with serum uric acid. RESULTS A total of 66 patients completed the study. Both groups were matched for age, sex, severity of heart failure, and arterial stiffness. Compared with placebo, allopurinol recipients had a significant fall in uric acid concentration from 6.31 ± 1.4 (SD) mg/dL to 3.81 ± 1.2 (P < .001). Despite that, there was no significant change in arterial stiffness parameters between allopurinol and placebo groups. Post-treatment Ao-PWV was 9.79 ± 2.6 m/s in the allopurinol group and 10.07 ± 3.4 m/s in the placebo group, P = .723. Post-treatment c-AIx was 24.0% ± 9.1% and 22.0% ± 9.9%, respectively, P = .403. CONCLUSIONS We have shown that allopurinol significantly reduced uric acid concentration in Saudi patients with CHF but was not associated with a change in arterial stiffness. Our cohort of patients had worse arterial stiffness values at baseline, which might make them more resistant to change using our study regimen.The study has been registered with the International Standard Randomized Controlled Trial Number registry with an identifier number of ISRCTN58980230.
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Affiliation(s)
- Manal M Alem
- Department of Pharmacology, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Abdullah M Alshehri
- Internal Medicine Department, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Peter MB Cahusac
- Department of Pharmacology, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
- Department of Comparative Medicine, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Matthew R Walters
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK
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166
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Kahnert K, Alter P, Welte T, Huber RM, Behr J, Biertz F, Watz H, Bals R, Vogelmeier CF, Jörres RA. Uric acid, lung function, physical capacity and exacerbation frequency in patients with COPD: a multi-dimensional approach. Respir Res 2018; 19:110. [PMID: 29866121 PMCID: PMC5987642 DOI: 10.1186/s12931-018-0815-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 05/20/2018] [Indexed: 01/19/2023] Open
Abstract
Background Recent investigations showed single associations between uric acid levels, functional parameters, exacerbations and mortality in COPD patients. The aim of this study was to describe the role of uric acid within the network of multiple relationships between function, exacerbation and comorbidities. Methods We used baseline data from the German COPD cohort COSYCONET which were evaluated by standard multiple regression analyses as well as path analysis to quantify the network of relations between parameters, particularly uric acid. Results Data from 1966 patients were analyzed. Uric acid was significantly associated with reduced FEV1, reduced 6-MWD, higher burden of exacerbations (GOLD criteria) and cardiovascular comorbidities, in addition to risk factors such as BMI and packyears. These associations remained significant after taking into account their multiple interdependences. Compared to uric acid levels the diagnosis of hyperuricemia and its medication played a minor role. Conclusion Within the limits of a cross-sectional approach, our results strongly suggest that uric acid is a biomarker of high impact in COPD and plays a genuine role for relevant outcomes such as physical capacity and exacerbations. These findings suggest that more attention should be paid to uric acid in the evaluation of COPD disease status.
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Affiliation(s)
- Kathrin Kahnert
- Department of Internal Medicine V, University of Munich (LMU), Comprehensive Pneumology Center,Member of the German Center for Lung Research (DZL), Munich, Germany.
| | - Peter Alter
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University Marburg, Germany, Member of the German Center for Lung Research (DZL), Baldingerstrasse, 35043, Marburg, Germany
| | - Tobias Welte
- Department of Pneumology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Rudolf M Huber
- Department of Internal Medicine V, University of Munich (LMU), Comprehensive Pneumology Center,Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Jürgen Behr
- Department of Internal Medicine V, University of Munich (LMU), Comprehensive Pneumology Center,Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Frank Biertz
- Institute for Biostatistics, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Henrik Watz
- Pulmonary Research Institute at LungenClinic Grosshansdorf, Airway Research Center North, Member of the German Center for Lung Research, Woehrendamm 80, 22927, Grosshansdorf, Germany
| | - Robert Bals
- Department of Internal Medicine V - Pulmonology, Allergology, Respiratory Intensive Care Medicine, Saarland University Hospital, Kirrberger Straße 1, 66424, Homburg, Germany
| | - Claus F Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University Marburg, Germany, Member of the German Center for Lung Research (DZL), Baldingerstrasse, 35043, Marburg, Germany
| | - Rudolf A Jörres
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Center Munich (CPC-M), Ludwig-Maximilians-Universität München, Ziemssenstr. 1, 80336, Munich, Germany
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167
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Mantovani A, Targher G, Temporelli PL, Lucci D, Gonzini L, Nicolosi GL, Marchioli R, Tognoni G, Latini R, Cosmi F, Tavazzi L, Maggioni AP. Prognostic impact of elevated serum uric acid levels on long-term outcomes in patients with chronic heart failure: A post-hoc analysis of the GISSI-HF (Gruppo Italiano per lo Studio della Sopravvivenza nella Insufficienza Cardiaca-Heart Failure) trial. Metabolism 2018; 83:205-215. [PMID: 29477817 DOI: 10.1016/j.metabol.2018.02.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 02/07/2018] [Accepted: 02/19/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND The prognostic impact of hyperuricemia on long-term clinical outcomes in patients with chronic heart failure (HF) has been investigated in observational registries and clinical trials, but the results have been often inconclusive. We examined the prognostic impact of elevated serum uric acid levels on long-term clinical outcomes in the GISSI-HF (Gruppo Italiano per lo Studio della Sopravvivenza nella Insufficienza Cardiaca-Heart Failure) trial. CLINICAL TRIAL REGISTRATION CLINICALTRIALS. GOV IDENTIFIER NCT00336336. METHODS We assessed the rates of all-cause death, cardiovascular death, cardiovascular hospitalization and the composite of all-cause death or cardiovascular hospitalization over a median follow-up of 3.9 years among 6683 ambulatory patients with chronic HF. RESULTS Patients in the 3rd serum uric acid tertile (>7.2 mg/dl) had a nearly 1.8-fold increased risk of both all-cause death and cardiovascular death, and a nearly 1.5-fold increased risk of cardiovascular hospitalization and of the composite endpoint compared to those in the 1st uric acid tertile (<5.7 mg/dl). Beyond serum uric acid ≥ 7 mg/dl the risk of outcomes increased sharply and linearly. The significant association between elevated serum uric acid levels and adverse outcomes persisted after adjustment for multiple established cardiovascular risk factors, HF etiology, left ventricular ejection fraction, medication use and other potential confounders, with an adjusted hazard ratio of 1.37 (95% CI 1.22-1.55) for all-cause death, 1.48 (1.29-1.69) for cardiovascular death, 1.19 (1.09-1.30) for cardiovascular hospitalization and 1.21 (1.11-1.31) for the composite endpoint, respectively. CONCLUSIONS Elevated serum uric acid levels are independently associated with poor long-term survival and increased risk of cardiovascular hospitalization in patients with chronic HF.
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Affiliation(s)
- Alessandro Mantovani
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Giovanni Targher
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | | | | | | | - Gian Luigi Nicolosi
- Department of Cardiology, Santa Maria degli Angeli Hospital, Pordenone, Italy
| | | | - Gianni Tognoni
- Department of Cardiovascular Research, IRCCS-Istituto di Ricerche Famacologiche Mario Negri, Milan, Italy
| | - Roberto Latini
- Department of Cardiovascular Research, IRCCS-Istituto di Ricerche Famacologiche Mario Negri, Milan, Italy
| | - Franco Cosmi
- Division of Cardiology, Ospedale Valdichiana Santa Margherita, Cortona, Italy
| | - Luigi Tavazzi
- Maria Cecilia Hospital, GVM Care & Research, Ettore Sansavini Health Science Foundation, Cotignola, Italy
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168
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Ndrepepa G. Uric acid and cardiovascular disease. Clin Chim Acta 2018; 484:150-163. [PMID: 29803897 DOI: 10.1016/j.cca.2018.05.046] [Citation(s) in RCA: 260] [Impact Index Per Article: 43.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 05/23/2018] [Indexed: 12/22/2022]
Abstract
Uric acid (UA) is an end product of purine metabolism in humans and great apes. UA acts as an antioxidant and it accounts for 50% of the total antioxidant capacity of biological fluids in humans. When present in cytoplasm of the cells or in acidic/hydrophobic milieu in atherosclerotic plaques, UA converts into a pro-oxidant agent and promotes oxidative stress and through this mechanism participates in the pathophysiology of human disease including cardiovascular disease (CVD). Most epidemiological studies but not all of them suggested the existence of an association between elevated serum UA level and CVD, including coronary heart disease (CHD), stroke, congestive heart failure, arterial hypertension and atrial fibrillation as well as an increased risk for mortality due to CVD in general population and subjects with confirmed CHD. Evidence available also suggests an association between elevated UA and traditional cardiovascular risk factors, metabolic syndrome, insulin resistance, obesity, non-alcoholic fatty liver disease and chronic kidney disease. Experimental and clinical studies have evidenced several mechanisms through which elevated UA level exerts deleterious effects on cardiovascular health including increased oxidative stress, reduced availability of nitric oxide and endothelial dysfunction, promotion of local and systemic inflammation, vasoconstriction and proliferation of vascular smooth muscle cells, insulin resistance and metabolic dysregulation. Although the causality in the relationship between UA and CVD remains unproven, UA may be pathogenic and participate in the pathophysiology of CVD by serving as a bridging mechanism mediating (enabling) or potentiating the deleterious effects of cardiovascular risk factors on vascular tissue and myocardium.
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Affiliation(s)
- Gjin Ndrepepa
- Department of Adult Cardiology, Deutsches Herzzentrum München, Technische Universität, Munich, Germany.
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169
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Pascart T, Richette P. Investigational drugs for hyperuricemia, an update on recent developments. Expert Opin Investig Drugs 2018; 27:437-444. [DOI: 10.1080/13543784.2018.1471133] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Tristan Pascart
- Department of Rheumatology, Lille Catholic Hospitals, University of Lille, Lomme, France
- EA 4490, PMOI, Physiopathologie des Maladies Osseuses Inflammatoires, University of Lille, Lille, France
| | - Pascal Richette
- Department of Rheumatology, Assistance Publique-Hôpitaux de Paris, Hôpital Lariboisiere, Paris, France
- Department of Rheumatology, INSERM U1132 and University Paris-Diderot, Paris, France
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170
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Asleh R, Prasad M, Briasoulis A, Nardi V, Adigun R, Edwards BS, Pereira NL, Daly RC, Lerman A, Kushwaha SS. Uric acid is an independent predictor of cardiac allograft vasculopathy after heart transplantation. J Heart Lung Transplant 2018; 37:1083-1092. [PMID: 29802086 DOI: 10.1016/j.healun.2018.04.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 04/18/2018] [Accepted: 04/25/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Cardiac allograft vasculopathy (CAV) is a major complication after heart transplantation (HT). Uric acid (UA) may play a role in CAV due to its role in stimulating T-cell-mediated immunity. Sirolimus is associated with CAV attenuation through a number of mechanisms, including immune-mediated effects. We aimed to determine whether UA is an independent predictor of CAV and whether conversion to sirolimus as primary immunosuppression modulates UA levels. METHODS We retrospectively analyzed a cohort of 224 patients who underwent HT between 2004 and 2015 and had serial coronary intravascular ultrasound (IVUS) studies. Serum UA levels were measured at baseline and last follow-up IVUS in all participants. CAV progression was assessed by measuring the change in plaque volume (ΔPV) and plaque index (ratio of plaque volume to vessel volume [ΔPI]) between last follow-up and baseline IVUS after correction for time of follow-up. RESULTS Patients with high (≥7 mg/dl) compared with low (<7 mg/dl) UA had increased median ΔPV (0.33 [interquartile range 0.08 to 0.93] vs 0.07 [-0.17 to 0.38] mm3/mm/year; p < 0.001) and ΔPI (2.0% [0.31% to 3.9%] vs 0.33% [-1.2% to 2.0%]; p < 0.001). Elevated UA levels were associated with a significantly increased risk of developing significant CAV progression (ΔPV >0.50 mm3/mm) (hazard ratio 2.2, 95% confidence interval 1.1 to 4.6; p = 0.037). Sirolimus resulted in decreased UA levels (5.8 ± 1.4 vs 5.2 ± 1.5; p = 0.002) and patients converted to sirolimus and had low UA levels had the least CAV progression (p < 0.001). After adjustment for potential confounders, change in UA level was also an independent predictor of CAV progression. CONCLUSIONS UA is an independent predictor of CAV after HT. Sirolimus is associated with decreased UA levels and may explain one of the mechanisms by which sirolimus attenuates CAV progression.
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Affiliation(s)
- Rabea Asleh
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Megha Prasad
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Valentina Nardi
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Rosalyn Adigun
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Brooks S Edwards
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Naveen L Pereira
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Richard C Daly
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Amir Lerman
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Sudhir S Kushwaha
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA.
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171
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Tasić I, Kostić S, Stojanović NM, Skakić V, Cvetković J, Djordjević A, Karadzić M, Djordjević D, Andonov S, Stoičkov V, Tasić D, Vanka M, Lović D. Significance of asymptomatic hyperuricemia in patients after coronary events. Scandinavian Journal of Clinical and Laboratory Investigation 2018; 78:312-317. [DOI: 10.1080/00365513.2018.1467035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Ivan Tasić
- Department of Internal Medicine, Faculty of Medicine, University of Niš, Niš, Serbia
- Institute for Therapy and Rehabilitation ‘Niška Banja’, Niška Banja, Serbia
| | - Svetlana Kostić
- Institute for Therapy and Rehabilitation ‘Niška Banja’, Niška Banja, Serbia
| | | | - Vlado Skakić
- Institute for Therapy and Rehabilitation ‘Niška Banja’, Niška Banja, Serbia
| | - Jovana Cvetković
- Institute for Therapy and Rehabilitation ‘Niška Banja’, Niška Banja, Serbia
| | | | - Mirjana Karadzić
- Institute for Therapy and Rehabilitation ‘Niška Banja’, Niška Banja, Serbia
| | - Dragan Djordjević
- Department of Internal Medicine, Faculty of Medicine, University of Niš, Niš, Serbia
- Institute for Therapy and Rehabilitation ‘Niška Banja’, Niška Banja, Serbia
| | - Stanoje Andonov
- Institute for Therapy and Rehabilitation ‘Niška Banja’, Niška Banja, Serbia
| | - Viktor Stoičkov
- Department of Internal Medicine, Faculty of Medicine, University of Niš, Niš, Serbia
- Institute for Therapy and Rehabilitation ‘Niška Banja’, Niška Banja, Serbia
| | | | | | - Dragan Lović
- Veterans Affairs Medical Center Washington USA, Washington, DC, USA
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172
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Haines A, Bolt J, Dumont Z, Semchuk W. Pharmacists’ assessment and management of acute and chronic gout. Can Pharm J (Ott) 2018. [DOI: 10.1177/1715163518754916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Aleina Haines
- Regina Qu’Appelle Health Region, Department of Pharmacy Services (Haines, Dumont, Semchuk), Regina, Saskatchewan, and the Senior’s Health & Wellness Centre (Bolt), Interior Health Authority, Kelowna, British Columbia
| | - Jennifer Bolt
- Regina Qu’Appelle Health Region, Department of Pharmacy Services (Haines, Dumont, Semchuk), Regina, Saskatchewan, and the Senior’s Health & Wellness Centre (Bolt), Interior Health Authority, Kelowna, British Columbia
| | - Zack Dumont
- Regina Qu’Appelle Health Region, Department of Pharmacy Services (Haines, Dumont, Semchuk), Regina, Saskatchewan, and the Senior’s Health & Wellness Centre (Bolt), Interior Health Authority, Kelowna, British Columbia
| | - William Semchuk
- Regina Qu’Appelle Health Region, Department of Pharmacy Services (Haines, Dumont, Semchuk), Regina, Saskatchewan, and the Senior’s Health & Wellness Centre (Bolt), Interior Health Authority, Kelowna, British Columbia
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173
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Costanzo MR. Uric acid is important, but there is something that matters even more: to deliver sacubitril/valsartan to eligible heart failure patients. Eur J Heart Fail 2018; 20:523-524. [DOI: 10.1002/ejhf.1087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 10/29/2017] [Indexed: 11/12/2022] Open
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Bredemeier M, Lopes LM, Eisenreich MA, Hickmann S, Bongiorno GK, d’Avila R, Morsch ALB, da Silva Stein F, Campos GGD. Xanthine oxidase inhibitors for prevention of cardiovascular events: a systematic review and meta-analysis of randomized controlled trials. BMC Cardiovasc Disord 2018; 18:24. [PMID: 29415653 PMCID: PMC5804046 DOI: 10.1186/s12872-018-0757-9] [Citation(s) in RCA: 112] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 01/23/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Xanthine oxidase inhibitors (XOI), classified as purine-like (allopurinol and oxypurinol) and non-purine (febuxostat and topiroxostat) XOI, present antioxidant properties by reducing the production of reactive oxygen species derived from purine metabolism. Oxidative stress is an important factor related to endothelial dysfunction and ischemia-reperfusion injury, and may be implicated in the pathogenesis of heart failure, hypertension, and ischemic heart disease. However, there is contradictory evidence regarding the possible cardiovascular (CV) protective effect exerted by XOI. Our objective is to compare the incidence of major adverse cardiovascular events (MACE), mortality, total (TCE) and specific CV events in randomized controlled trials (RCTs) testing XOI against placebo or no treatment. METHODS PubMed, EMBASE, Web of Science, Cochrane Central, Lilacs databases were searched from inception to Dec 30 2016, along with hand searching. RCTs including exclusively adult individuals, lasting ≥ 4 weeks, with no language restriction, were eligible. Independent paired researchers selected studies and extracted data. Considering the expected rarity of events, Peto and DerSimonian/Laird odds ratios (OR), the latter in case of heterogeneity, were used for analysis. Random-effects meta-regression was used to explore heterogeneity. RESULTS The analysis of MACE included 81 articles (10,684 patients, 6434 patient-years). XOI did not significantly reduce risk of MACE (ORP = 0.71, 95% CI 0.46-1.09) and death (0.89, 0.59-1.33), but reduced risk of TCE (0.60, 0.44-0.82; serious TCE: 0.64, 0.46 to 0.89), and hypertension (0.54, 0.37 to 0.80). There was protection for MACE in patients with previous ischemic events (0.42, 0.23-0.76). Allopurinol protected for myocardial infarction (0.38, 0.17-0.83), hypertension (0.32, 0.18-0.58), TCE (0.48, 0.31 to 0.75, I2 = 55%) and serious TCE (0.56, 0.36 to 0.86, I2 = 44%). Meta-regression associated increasing dose of allopurinol with higher risk of TCE and serious TCE (P < 0.05). Accordingly, lower doses (≤ 300 mg/day) of allopurinol reduced the risk of TCE, unlike higher doses. Non-purine-like XOI did not significantly reduce or increase the risk of adverse CV events, but confidence intervals were wide. Quality of evidence was generally low to moderate. CONCLUSIONS Purine-like XOI may reduce the incidence of adverse CV outcomes. However, higher doses of allopurinol (> 300 mg/day) may be associated with loss of CV protection.
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Affiliation(s)
- Markus Bredemeier
- Rheumatology Service at Hospital Nossa Senhora da Conceição, Grupo Hospitalar Conceição, Porto Alegre, RS Brazil
- Serviço de Reumatologia do Hospital Nossa Senhora da Conceição, Avenida Francisco Trein, 596, sala 2048, Porto Alegre, RS 91350-200 Brazil
| | - Lediane Moreira Lopes
- Rheumatology Service at Hospital Nossa Senhora da Conceição, Grupo Hospitalar Conceição, Porto Alegre, RS Brazil
| | - Matheus Augusto Eisenreich
- Rheumatology Service at Hospital Nossa Senhora da Conceição, Grupo Hospitalar Conceição, Porto Alegre, RS Brazil
| | - Sheila Hickmann
- Rheumatology Service at Hospital Nossa Senhora da Conceição, Grupo Hospitalar Conceição, Porto Alegre, RS Brazil
| | - Guilherme Kopik Bongiorno
- Rheumatology Service at Hospital Nossa Senhora da Conceição, Grupo Hospitalar Conceição, Porto Alegre, RS Brazil
| | - Rui d’Avila
- Rheumatology Service at Hospital Nossa Senhora da Conceição, Grupo Hospitalar Conceição, Porto Alegre, RS Brazil
| | | | - Fernando da Silva Stein
- Rheumatology Service at Hospital Nossa Senhora da Conceição, Grupo Hospitalar Conceição, Porto Alegre, RS Brazil
| | - Guilherme Gomes Dias Campos
- Rheumatology Service at Hospital Nossa Senhora da Conceição, Grupo Hospitalar Conceição, Porto Alegre, RS Brazil
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Carluccio E, Coiro S, Ambrosio G. Unraveling the relationship between serum uric acid levels and cardiovascular risk. Int J Cardiol 2018; 253:174-175. [DOI: 10.1016/j.ijcard.2017.11.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 11/10/2017] [Indexed: 11/30/2022]
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176
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Kim SK. Interrelationship of Uric Acid, Gout, and Metabolic Syndrome: Focus on Hypertension, Cardiovascular Disease, and Insulin Resistance. JOURNAL OF RHEUMATIC DISEASES 2018. [DOI: 10.4078/jrd.2018.25.1.19] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Seong-Kyu Kim
- Division of Rheumatology, Department of Internal Medicine, Arthritis and Autoimmunity Research Center, Catholic University of Daegu School of Medicine, Daegu, Korea
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177
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Abstract
Over the past two decades, therapeutics for diabetes have evolved from drugs with known heart failure risk to classes with potential benefit for patients with heart failure. As many as 25 to 35 % of patients with heart failure carry a diagnosis of type 2 diabetes mellitus. Therefore, newer drug classes including dipeptidyl peptidase 4 (DPP-4) inhibitors, glucagon-like peptide 1 (GIP-1) agonists, and sodium-glucose cotransporter 2 (SGLT-2) inhibitors are being examined for cardiovascular safety as well as their effects on left ventricular function, quality of life, and other measures of disease progression. The purpose of this review is to summarize the existing evidence on these classes of anti-diabetic agents in patients with heart failure.
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178
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Richette P, Latourte A, Bardin T. Cardiac and renal protective effects of urate-lowering therapy. Rheumatology (Oxford) 2017; 57:i47-i50. [DOI: 10.1093/rheumatology/kex432] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Indexed: 02/07/2023] Open
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179
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Mogensen UM, Køber L, Jhund PS, Desai AS, Senni M, Kristensen SL, Dukát A, Chen CH, Ramires F, Lefkowitz MP, Prescott MF, Shi VC, Rouleau JL, Solomon SD, Swedberg K, Packer M, McMurray JJV. Sacubitril/valsartan reduces serum uric acid concentration, an independent predictor of adverse outcomes in PARADIGM-HF. Eur J Heart Fail 2017; 20:514-522. [PMID: 29193563 PMCID: PMC6607477 DOI: 10.1002/ejhf.1056] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Revised: 07/28/2017] [Accepted: 08/11/2017] [Indexed: 12/22/2022] Open
Abstract
Aims Elevated serum uric acid concentration (SUA) has been associated with an increased risk of cardiovascular disease, but this may be due to unmeasured confounders. We examined the association between SUA and outcomes as well as the effect of sacubitril/valsartan on SUA in patients with heart failure with reduced ejection fraction (HFrEF) in PARADIGM‐HF. Methods and results The association between SUA and the primary composite outcome of cardiovascular death or heart failure (HF) hospitalization, its components, and all‐cause mortality was examined using Cox regression analyses among 8213 patients using quintiles (Q1–Q5) of SUA adjusted for baseline prognostic variables including estimated glomerular filtration rate (eGFR), diuretic dose, and log N‐terminal pro‐brain natriuretic peptide. Change in SUA from baseline over 12 months was also evaluated in each treatment group. Patients in Q5 (SUA ≥8.6 mg/dL) compared with Q1 (<5.4 mg/dL) were younger (62.8 vs. 64.2 years), more often male (88.7% vs. 63.1%), had lower systolic blood pressure (119 vs. 123 mmHg), lower eGFR (57.4 vs. 76.6 mL/min/1.73 m2), and greater diuretic use. Higher SUA was associated with a higher risk of the primary outcome (adjusted hazard ratios) Q5 vs. Q1 = 1.28 [95% confidence intervals (1.09–1.50), P = 0.003], cardiovascular death [1.44 (1.11–1.77), P = 0.001], HF hospitalization [1.37 (1.11–1.70), P = 0.004], and all‐cause mortality [1.36 (1.13–1.64), P = 0.001]. Compared with enalapril, sacubitril/valsartan reduced SUA by 0.24 (0.17–0.32) mg/dL over 12 months (P < 0.0001). Sacubitril/valsartan improved outcomes, irrespective of SUA concentration. Conclusion Serum uric acid concentration was an independent predictor of worse outcomes after multivariable adjustment in patients with HFrEF. Compared with enalapril, sacubitril/valsartan reduced SUA and improved outcomes irrespective of SUA.
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Affiliation(s)
- Ulrik M Mogensen
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.,Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Lars Køber
- Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Pardeep S Jhund
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Akshay S Desai
- Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Michele Senni
- Cardiology, Heart Failure and Heart Transplant Unit, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Søren L Kristensen
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.,Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Andrej Dukát
- Second Department of Internal Medicine, Comenius University, Bratislava, Slovakia
| | - Chen-Huan Chen
- Department of Medicine, National Yang-Ming University, Republic of China, Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China
| | - Felix Ramires
- Heart Institute (InCor) - University of São Paulo, Medical School, Brazil
| | | | | | - Victor C Shi
- Novartis Pharmaceutical Corporation, East Hanover, NJ, USA
| | - Jean L Rouleau
- Institut de Cardiologie, Université de Montréal, Montréal, Canada
| | - Scott D Solomon
- Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Karl Swedberg
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden and National Heart and Lung Institute, Imperial College London, London, UK
| | - Milton Packer
- Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX, USA
| | - John J V McMurray
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
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180
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Abstract
The Heart Failure Clinical Research Network (HFN) was established in 2008 on behalf of the NIH National Heart, Lung and Blood Institute, with the primary goal of improving outcomes in heart failure (HF) by designing and conducting high-quality concurrent clinical trials testing interventions across the spectrum of HF. Completed HFN trials have answered several important and relevant clinical questions concerning the safety and efficacy of different decongestive and adjunctive vasodilator therapies in hospitalized acute HF, phosphodiesterase-5 inhibition and nitrate therapies in HF with preserved ejection fraction, and the role of xanthine oxidase inhibition in hyperuricemic HF. These successes, independent of the "positive" or "negative" result of each individual trial, have helped to shape the current clinical care of HF patients and serve as a platform to inform future research directions and trial designs.
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Affiliation(s)
- Emer Joyce
- Section of Heart Failure and Cardiac Transplant Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
| | - Michael M Givertz
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA
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181
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Wilson AJ, Gill EK, Abudalo RA, Edgar KS, Watson CJ, Grieve DJ. Reactive oxygen species signalling in the diabetic heart: emerging prospect for therapeutic targeting. Heart 2017; 104:293-299. [DOI: 10.1136/heartjnl-2017-311448] [Citation(s) in RCA: 121] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 08/24/2017] [Accepted: 08/24/2017] [Indexed: 01/27/2023] Open
Abstract
Despite being first described 45 years ago, the existence of a distinct diabetic cardiomyopathy remains controversial. Nonetheless, it is widely accepted that the diabetic heart undergoes characteristic structural and functional changes in the absence of ischaemia and hypertension, which are independently linked to heart failure progression and are likely to underlie enhanced susceptibility to stress. A prominent feature is marked collagen accumulation linked with inflammation and extensive extracellular matrix changes, which appears to be the main factor underlying cardiac stiffness and subclinical diastolic dysfunction, estimated to occur in as many as 75% of optimally controlled diabetics. Whether this characteristic remodelling phenotype is primarily driven by microvascular dysfunction or alterations in cardiomyocyte metabolism remains unclear. Although hyperglycaemia regulates multiple pathways in the diabetic heart, increased reactive oxygen species (ROS) generation is thought to represent a central mechanism underlying associated adverse remodelling. Indeed, experimental and clinical diabetes are linked with oxidative stress which plays a key role in cardiomyopathy, while key processes underlying diabetic cardiac remodelling, such as inflammation, angiogenesis, cardiomyocyte hypertrophy and apoptosis, fibrosis and contractile dysfunction, are redox sensitive. This review will explore the relative contributions of the major ROS sources (dysfunctional nitric oxide synthase, mitochondria, xanthine oxidase, nicotinamide adenine dinucleotide phosphate oxidases) in the diabetic heart and the potential for therapeutic targeting of ROS signalling using novel pharmacological and non-pharmacological approaches to modify specific aspects of the remodelling phenotype in order to prevent and/or delay heart failure development and progression.
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182
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Sharaf El Din UA, Salem MM, Abdulazim DO. Uric acid in the pathogenesis of metabolic, renal, and cardiovascular diseases: A review. J Adv Res 2017; 8:537-548. [PMID: 28748119 PMCID: PMC5512153 DOI: 10.1016/j.jare.2016.11.004] [Citation(s) in RCA: 201] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Revised: 11/26/2016] [Accepted: 11/27/2016] [Indexed: 02/07/2023] Open
Abstract
The association between uric acid (UA) on one side and systemic hypertension (Htn), dyslipidemia, glucose intolerance, overweight, fatty liver, renal disease and cardiovascular disease (CVD) on the other side is well recognized. However, the causal relationship between UA and these different clinical problems is still debatable. The recent years have witnessed hundreds of experimental and clinical trials that favored the opinion that UA is a probable player in the pathogenesis of these disease entities. These studies disclosed the strong association between hyperuricemia and metabolic syndrome (MS), obesity, Htn, type 2 diabetes mellitus (DM), non-alcoholic fatty liver disease, hypertriglyceridemia, acute kidney injury, chronic kidney disease (CKD), coronary heart disease (CHD), heart failure and increased mortality among cardiac and CKD patients. The association between UA and nephrolithiasis or preeclampsia is a non-debatable association. Recent experimental trials have disclosed different changes in enzyme activities induced by UA. Nitric oxide (NO) synthase, adenosine monophosphate kinase (AMPK), adenosine monophosphate dehydrogenase (AMPD), and nicotinamide adenine dinucleotide phosphate (NADPH)-oxidase are affected by UA. These changes in enzymatic activities can lead to the observed biochemical and pathological changes associated with UA. The recent experimental, clinical, interventional, and epidemiologic trials favor the concept of a causative role of UA in the pathogenesis of MS, renal, and CVDs.
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Affiliation(s)
- Usama A.A. Sharaf El Din
- Nephrology Unit, Internal Medicine Department, School of Medicine, Cairo University, Egypt
- Corresponding author. Fax: +20 222753890.
| | - Mona M. Salem
- Endocrinology Unit, Internal Medicine Department, School of Medicine, Cairo University, Egypt
| | - Dina O. Abdulazim
- Rheumatology and Rehabilitation Department, School of Medicine, Cairo University, Egypt
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183
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Postconditioning with Intralipid emulsion protects against reperfusion injury in post-infarct remodeled rat hearts by activation of ROS-Akt/Erk signaling. Transl Res 2017. [PMID: 28641075 DOI: 10.1016/j.trsl.2017.05.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The clinically used lipid emulsion Intralipid (ILE) reduces ischemia reperfusion injury in healthy rodent hearts. We tested whether ILE is cardioprotective in postinfarct remodeled hearts. Post-infarct remodeled and sham Sprague-Dawley rat hearts were perfused in working mode and subjected to ischemia (15 minutes) and reperfusion (30 minutes). Left ventricular (LV) work was measured in hearts that were untreated or that received ILE (1%) postconditioning administered at the onset of reperfusion, or the reactive oxygen species (ROS) scavenger N-(2-mercaptopropionyl)-glycine (10 μM) alone or in combination with ILE. Mitochondrial O2 consumption was measured in LV muscle fibers. Acetyl CoA production was calculated from the oxidation of [U-14C]glucose and [9,10-3H]palmitate. ROS production was assessed by loss of aconitase activity as well as by release of hydrogen peroxide. Phosphorylation of Akt, Erk1/2, and STAT3 were used to evaluate protection signaling. Remodeled hearts exhibited LV dysfunction and signs of hypertrophy consistent with significant postinfarct remodeling. ILE postconditioning enhanced the recovery of postischemic LV function in remodeled hearts, preserved energy metabolism in mitochondria, accelerated palmitate oxidation and acetyl CoA production, and activated Akt/Erk/STAT3 in a ROS-dependent manner. Protection by ILE postconditioning evolved rapidly within the first minutes of reperfusion without evidence of additional cardiotonic effects due to provision of supplementary energy substrates potentially released from ILE during reperfusion. ILE represents a novel and clinically feasible cardioprotective strategy that is highly effective in remodeled hearts. Our data provide a rationale for the clinical evaluation of ILE postconditioning where ILE is administered as a bolus at the onset of reperfusion.
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184
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de Melo LGP, Nunes SOV, Anderson G, Vargas HO, Barbosa DS, Galecki P, Carvalho AF, Maes M. Shared metabolic and immune-inflammatory, oxidative and nitrosative stress pathways in the metabolic syndrome and mood disorders. Prog Neuropsychopharmacol Biol Psychiatry 2017; 78:34-50. [PMID: 28438472 DOI: 10.1016/j.pnpbp.2017.04.027] [Citation(s) in RCA: 107] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 03/27/2017] [Accepted: 04/08/2017] [Indexed: 02/08/2023]
Abstract
This review examines the shared immune-inflammatory, oxidative and nitrosative stress (IO&NS) and metabolic pathways underpinning metabolic syndrome (MetS), bipolar disorder (BD) and major depressive disorder (MDD). Shared pathways in both MetS and mood disorders are low grade inflammation, including increased levels of pro-inflammatory cytokines and acute phase proteins, increased lipid peroxidation with formation of malondialdehyde and oxidized low density lipoprotein cholesterol (LDL-c), hypernitrosylation, lowered levels of antioxidants, most importantly zinc and paraoxonase (PON1), increased bacterial translocation (leaky gut), increased atherogenic index of plasma and Castelli risk indices; and reduced levels of high-density lipoprotein (HDL-c) cholesterol. Insulin resistance is probably not a major factor associated with mood disorders. Given the high levels of IO&NS and metabolic dysregulation in BD and MDD and the high comorbidity with the atherogenic components of the MetS, mood disorders should be viewed as systemic neuro-IO&NS-metabolic disorders. The IO&NS-metabolic biomarkers may have prognostic value and may contribute to the development of novel treatments targeting neuro-immune, neuro-oxidative and neuro-nitrosative pathways.
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Affiliation(s)
- Luiz Gustavo Piccoli de Melo
- Department of Clinical Medicine, Londrina State University (UEL), Health Sciences Centre, Londrina, Paraná, Brazil; Center of Approach and Treatment for Smokers, University Hospital, Londrina State University, University Campus, Londrina, Paraná, Brazil; Health Sciences Graduation Program, Health Sciences Center, State University of Londrina, Londrina, Paraná, Brazil
| | - Sandra Odebrecht Vargas Nunes
- Department of Clinical Medicine, Londrina State University (UEL), Health Sciences Centre, Londrina, Paraná, Brazil; Center of Approach and Treatment for Smokers, University Hospital, Londrina State University, University Campus, Londrina, Paraná, Brazil; Health Sciences Graduation Program, Health Sciences Center, State University of Londrina, Londrina, Paraná, Brazil
| | | | - Heber Odebrecht Vargas
- Department of Clinical Medicine, Londrina State University (UEL), Health Sciences Centre, Londrina, Paraná, Brazil; Center of Approach and Treatment for Smokers, University Hospital, Londrina State University, University Campus, Londrina, Paraná, Brazil; Health Sciences Graduation Program, Health Sciences Center, State University of Londrina, Londrina, Paraná, Brazil
| | - Décio Sabbattini Barbosa
- Health Sciences Graduation Program, Health Sciences Center, State University of Londrina, Londrina, Paraná, Brazil; Department of Clinical and Toxicological Analysis, State University of Londrina, Londrina, Paraná, Brazil
| | - Piotr Galecki
- Department of Adult Psychiatry, University of Lodz, Lodz, Poland
| | - André F Carvalho
- Department of Clinical Medicine and Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Michael Maes
- Health Sciences Graduation Program, Health Sciences Center, State University of Londrina, Londrina, Paraná, Brazil; Department of Psychiatry, Chulalongkorn University, Bangkok, Thailand; Department of Psychiatry, Plovdiv University, Plovdiv, Bulgaria; Revitalis, Waalre, The Netherlands; Impact Strategic Research Center, Deakin University, Geelong, Australia.
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185
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Yamauchi Y, Fujita SI, Shibata K, Morita H, Ito T, Sohmiya K, Hoshiga M, Ishizaka N. Is Serum Uric Acid Independently Associated With Left Ventricular Mass Index, Ejection Fraction, and B-Type Natriuretic Peptide Among Female and Male Cardiac Patients? Int Heart J 2017; 58:562-569. [PMID: 28701671 DOI: 10.1536/ihj.16-359] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Mean serum uric acid (SUA) levels are higher in men than women. In addition, recent studies have suggested that the SUA threshold at which the cardiovascular risk might increase may vary between women and men. In the current retrospective study, by analyzing the data from 219 female and 519 male patients who were free from uric acid-lowering medication, we investigated whether SUA is associated with left ventricular mass index (LVMI), left ventricular ejection fraction (LVEF), and plasma levels of B-type natriuretic peptide (BNP) independent of confounding factors, such as serum calcium, inorganic phosphate, and fibroblast growth factor 23 (FGF23), in a gender-specific manner.In multivariate stepwise linear regression analysis in which age, blood pressure, eGFR, corrected calcium, inorganic phosphate, and FGF23 were entered as potential covariates, SUA was selected as a factor significantly associated with LVEF, LVMI, and plasma levels of BNP in both genders. On the other hand, however, after adding diuretic use as a potential covariate, the association between SUA and LVEF lost statistical significance in both genders, and that between SUA and BNP lost significance among female patients. These findings suggest that diuretic use is a non-negligible confounder in understanding the observed association between SUA and cardiac dysfunction and heart failure.In summary, SUA is associated with left ventricular hypertrophy independent of confounding factors including FGF23 and diuretic use in female and male patients. Whether lowering SUA can influence the progression of cardiac remodeling awaits further investigation.
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186
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Bardin T, Richette P. Impact of comorbidities on gout and hyperuricaemia: an update on prevalence and treatment options. BMC Med 2017; 15:123. [PMID: 28669352 PMCID: PMC5494879 DOI: 10.1186/s12916-017-0890-9] [Citation(s) in RCA: 179] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 06/12/2017] [Indexed: 02/07/2023] Open
Abstract
Gout, the most prevalent inflammatory arthritis worldwide, is associated with cardiovascular and renal diseases, and is an independent predictor of premature death. The frequencies of obesity, chronic kidney disease (CKD), hypertension, type 2 diabetes, dyslipidaemias, cardiac diseases (including coronary heart disease, heart failure and atrial fibrillation), stroke and peripheral arterial disease have been repeatedly shown to be increased in gout. Therefore, the screening and care of these comorbidities as well as of cardiovascular risk factors are of outmost importance in patients with gout. Comorbidities, especially CKD, and drugs prescribed for their treatment, also impact gout management. Numerous epidemiological studies have shown the association of asymptomatic hyperuricaemia with the above-mentioned diseases and cardiovascular risk factors. Animal studies have also produced a mechanistic approach to the vascular toxicity of soluble urate. However, causality remains uncertain because confounders, reverse causality or common etiological factors might explain the epidemiological results. Additionally, these uncertainties remain unsolved despite recent studies using Mendelian randomisation or therapeutic approaches. Thus, large randomised placebo-controlled trials are still needed to assess the benefits of treating asymptomatic hyperuricaemia.
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Affiliation(s)
- Thomas Bardin
- Université Paris Diderot, UFR médicale, Paris, France. .,Assistance Publique-Hôpitaux de Paris, Hôpital Lariboisière, Service de Rhumatologie, Paris, Cedex, France. .,INSERM 1132, Université Paris-Diderot, Hôpital Lariboisière, Paris, France. .,French-Vietnamese Research Center on Gout, Ho Chi Minh City, Vietnam.
| | - Pascal Richette
- Université Paris Diderot, UFR médicale, Paris, France.,Assistance Publique-Hôpitaux de Paris, Hôpital Lariboisière, Service de Rhumatologie, Paris, Cedex, France.,INSERM 1132, Université Paris-Diderot, Hôpital Lariboisière, Paris, France
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187
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Ansari-Ramandi MM, Maleki M, Alizadehasl A, Amin A, Taghavi S, Alemzadeh-Ansari MJ, Kazem Moussavi A, Naderi N. Safety and effect of high dose allopurinol in patients with severe left ventricular systolic dysfunction. J Cardiovasc Thorac Res 2017; 9:102-107. [PMID: 28740630 PMCID: PMC5516049 DOI: 10.15171/jcvtr.2017.17] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 04/07/2017] [Indexed: 12/28/2022] Open
Abstract
Introduction: Allopurinol used in the treatment of gout has been shown to improve the vascular endothelial dysfunction and reduce the dysfunction of the failing heart. This study was done to evaluate the effect and safety of allopurinol in non-hyperuricemic patients with chronic severe left ventricular (LV) dysfunction.
Methods: In this study, 35 consecutive cases of non-hyperuricemic patients with chronic heart failure who had severe LV systolic dysfunction (ejection fraction of less than 35%) and were on optimal guideline directed medical therapies for at least 3 months were included. Allopurinol was administered with the dose of 300 mg po daily for 1 week and then it was up-titrated to a dose of 600 mg po daily for 3 months. Six minute walk test, strain imaging, laboratory testing were done for every patient at baseline and after 3 months treatment with allopurinol.
Results: In this study 30 heart failure (HF) patients with a mean age of 49.3 ± 14.4 years old were evaluated. No adverse effects were reported except for one case of skin rash after 4 days treatment which was excluded from the study. Study showed significant improvement of six minute walk test of the patients from 384.5 ± 81.5 meters to 402.8 ± 89.6 meters and the global longitudinal peak strain (P < 0.001). There was also significant decrease in the level of erythrocyte sedimentation rate and N-terminal pro-brain natriuretic peptide (NT-proBNP) after 3 months.
Conclusion: Allopurinol could be of benefit in non-hyperuricemic patients with severe LV systolic dysfunction without significant adverse effects. Randomized clinical trials are needed in future to confirm the results.
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Affiliation(s)
| | - Majid Maleki
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Azin Alizadehasl
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ahmad Amin
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Sepideh Taghavi
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | - Ali Kazem Moussavi
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Nasim Naderi
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
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188
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Leitner LM, Wilson RJ, Yan Z, Gödecke A. Reactive Oxygen Species/Nitric Oxide Mediated Inter-Organ Communication in Skeletal Muscle Wasting Diseases. Antioxid Redox Signal 2017; 26:700-717. [PMID: 27835923 PMCID: PMC5421600 DOI: 10.1089/ars.2016.6942] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
SIGNIFICANCE Cachexia is defined as a complex metabolic syndrome that is associated with underlying illness and a loss of muscle with or without loss of fat mass. This disease is associated with a high incidence with chronic diseases such as heart failure, cancer, chronic obstructive pulmonary disease (COPD), and acquired immunodeficiency syndrome (AIDS), among others. Since there is currently no effective treatment available, cachectic patients have a poor prognosis. Elucidation of the underlying mechanisms is, therefore, an important medical task. Recent Advances: There is accumulating evidence that the diseased organs such as heart, lung, kidney, or cancer tissue secrete soluble factors, including Angiotensin II, myostatin (growth differentiation factor 8 [GDF8]), GDF11, tumor growth factor beta (TGFβ), which act on skeletal muscle. There, they induce a set of genes called atrogenes, which, among others, induce the ubiquitin-proteasome system, leading to protein degradation. Moreover, elevated reactive oxygen species (ROS) levels due to modulation of NADPH oxidases (Nox) and mitochondrial function contribute to disease progression, which is characterized by loss of muscle mass, exercise resistance, and frailty. CRITICAL ISSUES Although substantial progress was achieved to elucidate the pathophysiology of cachexia, effectice therapeutic strategies are urgently needed. FUTURE DIRECTIONS With the identification of key components of the aberrant inter-organ communication leading to cachexia, studies in mice and men to inhibit ROS formation, induction of anti-oxidative superoxide dismutases, and upregulation of muscular nitric oxide (NO) formation either by pharmacological tools or by exercise are promising approaches to reduce the extent of skeletal muscle wasting. Antioxid. Redox Signal. 26, 700-717.
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Affiliation(s)
- Lucia M Leitner
- 1 Institut für Herz- und Kreislaufphysiologie, Heinrich-Heine-Universität Düsseldorf, Universitätsklinikum , Düsseldorf, Germany
| | - Rebecca J Wilson
- 2 Department of Medicine-Cardiovascular Medicine, University of Virginia , Charlottesville, Virginia
| | - Zhen Yan
- 2 Department of Medicine-Cardiovascular Medicine, University of Virginia , Charlottesville, Virginia.,3 Center for Skeletal Muscle Research at Robert Berne Cardiovascular Research Center, University of Virginia , Charlottesville, Virginia
| | - Axel Gödecke
- 1 Institut für Herz- und Kreislaufphysiologie, Heinrich-Heine-Universität Düsseldorf, Universitätsklinikum , Düsseldorf, Germany
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189
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Packer M. Development and Evolution of a Hierarchical Clinical Composite End Point for the Evaluation of Drugs and Devices for Acute and Chronic Heart Failure: A 20-Year Perspective. Circulation 2017; 134:1664-1678. [PMID: 27881506 DOI: 10.1161/circulationaha.116.023538] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Traditional approaches to the assessment of new treatments for heart failure have generally evaluated individual components of the syndrome at fixed points in time or have relied on surrogate physiological measures that are poorly correlated with the clinical status of patients. Conventional time-to-event trials that focus on morbidity and mortality represent an important methodological advance, but they generally assign undue weight to clinical events of less importance and are insensitive to difference in functional capacity among individuals who do not experience a clinical event during follow-up. Twenty years ago, a hierarchical clinical composite was developed to address these limitations; it aims to assess the clinical course of patients as a physician would in practice by combining a symptomatic assessment of the patient at each visit with an evaluation of the clinical stability of the patient between visits. The composite does not generate a numeric score by summing arbitrarily assigned weights to certain symptoms or events; instead, the composite ranks relevant measures and outcomes according to clinical priority. In doing so, the clinical composite minimizes the biases created by noncompleting patients in the assessment of symptoms or exercise tolerance while expanding the range of patients who contribute to the treatment difference in a typical morbidity and mortality trial. When applied appropriately, the hierarchical clinical composite end point has reliably distinguished effective from ineffective treatments. The composite may have particular advantages in the evaluation of new devices and transcatheter interventions in chronic heart failure and of new drugs for acute heart failure. Recent modifications enhance its discriminant characteristics and its ability to accurately assess the efficacy of novel interventions for heart failure.
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Affiliation(s)
- Milton Packer
- From Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX.
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190
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Okafor ON, Farrington K, Gorog DA. Allopurinol as a therapeutic option in cardiovascular disease. Pharmacol Ther 2017; 172:139-150. [DOI: 10.1016/j.pharmthera.2016.12.004] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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191
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Kuwabara M, Sato Y, Kanbay M, Johnson RJ. Uric Acid and Left Ventricular Hypertrophy: A Potentially New Modifiable Target? Am J Hypertens 2017; 30:229-231. [PMID: 28096149 DOI: 10.1093/ajh/hpw195] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 12/06/2016] [Indexed: 02/07/2023] Open
Affiliation(s)
- Masanari Kuwabara
- Division of Renal Diseases and Hypertension, School of Medicine, University of Colorado Denver, Denver, Colorado, USA
- Department of Cardiology, Toranomon Hospital, Tokyo, Japan
| | - Yuka Sato
- Division of Renal Diseases and Hypertension, School of Medicine, University of Colorado Denver, Denver, Colorado, USA
| | - Mehmet Kanbay
- Division of Nephrology, Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Richard J Johnson
- Division of Renal Diseases and Hypertension, School of Medicine, University of Colorado Denver, Denver, Colorado, USA
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192
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Stamp L, Dalbeth N. Urate-lowering therapy for asymptomatic hyperuricaemia: A need for caution. Semin Arthritis Rheum 2017; 46:457-464. [DOI: 10.1016/j.semarthrit.2016.07.015] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 07/21/2016] [Accepted: 07/25/2016] [Indexed: 02/07/2023]
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193
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Hsu WL, Li SY, Liu JS, Huang PH, Lin SJ, Hsu CC, Lin YP, Tarng DC. High Uric Acid Ameliorates Indoxyl Sulfate-Induced Endothelial Dysfunction and Is Associated with Lower Mortality among Hemodialysis Patients. Toxins (Basel) 2017; 9:toxins9010020. [PMID: 28067806 PMCID: PMC5308252 DOI: 10.3390/toxins9010020] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 12/22/2016] [Accepted: 01/02/2017] [Indexed: 01/08/2023] Open
Abstract
High uric acid (UA) can act as a pro-oxidant in normal physiological conditions; however, emerging evidence is still debatable with regard to the association between high UA and poor outcomes among chronic hemodialysis (HD) patients. In the present study, 27,229 stable prevalent HD patients were enrolled and divided into four groups according to the quartiles of baseline UA concentration, and 5737 died during a median follow-up of 38 months. Multivariate Cox regression analysis showed that a UA level of <6.1 mg/dL was associated with a higher risk of all-cause mortality compared with a UA level of >8.1 mg/dL [HR, 1.20, 95% CI (1.10–1.31)] adjusting for baseline demographic and biochemical parameters. Moreover, a UA level of <6.1 mg/dL was associated with greater risks of cardiovascular mortality [HR, 1.26, 95% CI (1.13–1.41)] and stroke-related mortality [HR, 1.59, 95% CI (1.12–2.25)], respectively. In vitro experiments further showed an increase in oxidative stress and an inhibition nitric oxide synthesis by indoxyl sulfate (IS) in human aortic endothelial cells, which were significantly attenuated by UA in a dose-dependent manner. We concluded that higher UA in serum was associated with lower risk of all-cause and cardiovascular mortality among HD patients probably through its antioxidant property in ameliorating the IS-related vascular toxicity.
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Affiliation(s)
- Wei-Liang Hsu
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan.
- Faculty of Medicine, National Yang-Ming University, Taipei 11217, Taiwan.
| | - Szu-Yuan Li
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan.
- Faculty of Medicine, National Yang-Ming University, Taipei 11217, Taiwan.
| | - Jia-Sin Liu
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan 35053, Taiwan.
| | - Po-Hsun Huang
- Faculty of Medicine, National Yang-Ming University, Taipei 11217, Taiwan.
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan.
- Cardiovascular Research Center, National Yang-Ming University, Taipei 11217, Taiwan.
| | - Shing-Jong Lin
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan.
- Cardiovascular Research Center, National Yang-Ming University, Taipei 11217, Taiwan.
- Department of Medical Research, Taipei Veterans General Hospital, Taipe 11217, Taiwan.
| | - Chih-Cheng Hsu
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan 35053, Taiwan.
- Department of Health Services Administration, China Medical University, Taichung 40402, Taiwan.
| | - Yao-Ping Lin
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan.
- Faculty of Medicine, National Yang-Ming University, Taipei 11217, Taiwan.
| | - Der-Cherng Tarng
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan.
- Faculty of Medicine, National Yang-Ming University, Taipei 11217, Taiwan.
- Department and Institute of Physiology, National Yang-Ming University, Taipei 11217, Taiwan.
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194
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Xie JX, Hayek SS. Is it Time to Find a Role for Uric Acid Levels in the Prevention and Management of Hypertension. Am J Hypertens 2017; 30:16-18. [PMID: 27940429 DOI: 10.1093/ajh/hpw139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 10/11/2016] [Accepted: 10/21/2016] [Indexed: 01/02/2023] Open
Affiliation(s)
- Joe X Xie
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Salim S Hayek
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA.
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195
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Gudiño Gomezjurado Á. Hyperuricemia as a risk factor for cardiovascular disease: clinical review. Medwave 2016; 16:e6606. [PMID: 27922586 DOI: 10.5867/medwave.2016.10.6606] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 10/13/2016] [Indexed: 11/27/2022] Open
Abstract
Cardiovascular diseases are one of the most important causes of morbidity and mortality worldwide. Several risk factors have been associated with the development of these pathologies. However, there is controversy about whether hyperuricemia is an independent risk factor for developing cardiovascular disease. To answer this question, we performed a recent literature review of relevant published material to assess the association of hyperuricemia with four major cardiovascular diseases: hypertension, coronary heart disease, heart failure and atrial fibrillation.
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Affiliation(s)
- Álvaro Gudiño Gomezjurado
- Facultad de Medicina, Pontificia Universidad Católica del Ecuador, Quito, Ecuador. Address: Calle Teodoro Sampaio 10-20, Pinheiros, São Paulo, Brasil.
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196
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Xin W, Mi S, Lin Z. Allopurinol therapy improves vascular endothelial function in subjects at risk for cardiovascular diseases: a meta-analysis of randomized controlled trials. Cardiovasc Ther 2016; 34:441-449. [PMID: 27542348 DOI: 10.1111/1755-5922.12215] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Wei Xin
- Department of Cardiology; Beijing Anzhen Hospital; Capital Medical University; Beijing China
| | - Shuhua Mi
- Department of Cardiology; Beijing Anzhen Hospital; Capital Medical University; Beijing China
| | - Zhiqin Lin
- Department of Cardiovascular Medicine; Affiliated Hospital of Guiyang Medical College; Guizhou China
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197
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Rob D, Marek J, Dostálová G, Goláň L, Linhart A. Uric Acid as a Marker of Mortality and Morbidity in Fabry Disease. PLoS One 2016; 11:e0166290. [PMID: 27835692 PMCID: PMC5105940 DOI: 10.1371/journal.pone.0166290] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 10/26/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Serum uric acid (UA) elevation is common in patients with cardiovascular, renal and metabolic diseases. However, no study to date has analysed the role of UA in Fabry disease (FD). OBJECTIVES To evaluate the association between serum UA levels and mortality and morbidity in FD. MATERIALS AND METHODS We conducted a post-hoc analysis of a prospectively followed-up cohort of 124 patients with genetically proven FD. Serum UA levels were acquired at baseline; clinical events and mortality were assessed during regular visits every 6 to 12 months. The primary endpoint was a composite of multiple secondary outcomes: all-cause mortality, adverse cardiovascular events, progression of renal dysfunction and stroke or transient ischaemic attack (TIA). Predictive value was assessed using the Cox proportional hazards model and the Kaplan Meyer estimator. RESULTS During follow-up of 7.4 ± 3.7 years, 64 (52%) patients reached the primary combined endpoint. Overall, UA levels were significantly associated with combined outcome (p < 0.001) and remained independently associated after correcting for age, sex and estimated glomerular filtration rate (hazard ratio [HR] per 20 μmol/l increase 1.09, 95% confidence interval [95%CI] (1.00-1.19), p = 0.04). UA was associated with overall mortality in univariate analysis (p = 0.021); however, the association did not reach statistical significance after multivariate correction (HR per 20 μmol/l increase 1.07 95%CI 0.93-1.25, p = 0.32). Higher UA levels were also associated with cardiac adverse outcomes, progression of left ventricular hypertrophy and progression of renal dysfunction (ps < 0.001). No association was observed between UA levels and stroke or TIA (p = 0.323). CONCLUSION AND IMPLICATIONS Increased serum UA levels may represent an independent risk factor for adverse clinical outcomes in Fabry patients and are associated with all-cause mortality. UA is a widely available and cheap biomarker that may improve risk stratification of Fabry patients in clinical practice.
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Affiliation(s)
- Daniel Rob
- 2nd Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Josef Marek
- 2nd Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Gabriela Dostálová
- 2nd Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Lubor Goláň
- 2nd Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Aleš Linhart
- 2nd Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
- * E-mail:
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198
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Haque ZK, Wang DZ. How cardiomyocytes sense pathophysiological stresses for cardiac remodeling. Cell Mol Life Sci 2016; 74:983-1000. [PMID: 27714411 DOI: 10.1007/s00018-016-2373-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 09/01/2016] [Accepted: 09/19/2016] [Indexed: 12/14/2022]
Abstract
In the past decades, the cardiovascular community has laid out the fundamental signaling cascades that become awry in the cardiomyocyte during the process of pathologic cardiac remodeling. These pathways are initiated at the cell membrane and work their way to the nucleus to mediate gene expression. Complexity is multiplied as the cardiomyocyte is subjected to cross talk with other cells as well as a barrage of extracellular stimuli and mechanical stresses. In this review, we summarize the signaling cascades that play key roles in cardiac function and then we proceed to describe emerging concepts of how the cardiomyocyte senses the mechanical and environmental stimuli to transition to the deleterious genetic program that defines pathologic cardiac remodeling. As a highlighting example of these processes, we illustrate the transition from a compensated hypertrophied myocardium to a decompensated failing myocardium, which is clinically manifested as decompensated heart failure.
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Affiliation(s)
- Zaffar K Haque
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, 1260 John F. Enders Research Bldg, 320 Longwood Ave, Boston, MA, 02115, USA.
| | - Da-Zhi Wang
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, 1260 John F. Enders Research Bldg, 320 Longwood Ave, Boston, MA, 02115, USA
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199
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Therapeutic strategy for efficient reduction of serum uric acid levels with allopurinol versus benzbromarone in hyperuricemic patients with essential hypertension - A randomized crossover study (terao study). Int J Cardiol 2016; 224:437-439. [PMID: 27701062 DOI: 10.1016/j.ijcard.2016.09.073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Accepted: 09/20/2016] [Indexed: 11/21/2022]
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200
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Singh JA, Yu S. Allopurinol reduces the risk of myocardial infarction (MI) in the elderly: a study of Medicare claims. Arthritis Res Ther 2016; 18:209. [PMID: 27655429 PMCID: PMC5032238 DOI: 10.1186/s13075-016-1111-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 09/05/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Previous observational studies that have examined the association of allopurinol with myocardial infarction (MI) have provided contradictory results. One study showed that allopurinol reduced the risk, while another study showed an increased risk with allopurinol. Therefore, our objective was to assess whether allopurinol use is associated with a reduction in the risk of MI in the elderly. METHOD We used the 2006-2012 5 % random sample of Medicare beneficiaries to study the association of new allopurinol initiation and the risk of incident MI in a cohort study. Multivariable-adjusted Cox regression models adjusted for age, gender, race, and Charlson index, in addition to various cardio-protective medications (beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, diuretics, statins). We calculated hazard ratios (HRs) with 95 % confidence intervals (CIs). Sensitivity analyses adjusted for coronary artery disease (CAD) risk factors, including hypertension, hyperlipidemia, diabetes, and smoking. RESULTS Of the 29,298 episodes of incident allopurinol use, 1544 were associated with incident MI (5.3 % episodes). Allopurinol use was associated with reduced hazards of MI, with a HR of 0.85 (95 % CI, 0.77 to 0.95). Compared to no allopurinol use, longer durations of allopurinol use were associated with a lower HR of MI: 1-180 days, 0.98 (95 % CI, 0.84 to 1.14); 181 days to 2 years, 0.83 (95 % CI, 0.72 to 0.95); and >2 years, 0.70 (95 % CI, 0.56 to 0.88). Other factors associated with a higher hazard of MI were: age 75 to <85 years and ≥85 years, male gender, higher Charlson index score, and the use of an ACE inhibitor. Adjustment for CAD risk factors confirmed these findings. CONCLUSION Incident allopurinol use was associated with a reduction in the risk of incident MI in the elderly. Longer durations of allopurinol use reduced the risk of incident MI incrementally. Future studies should assess the underlying mechanisms for MI prevention and assess the risk-benefit ratio for allopurinol use.
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Affiliation(s)
- Jasvinder A Singh
- Medicine Service, Birmingham VA Medical Center, Birmingham, AL, USA. .,Department of Medicine at School of Medicine, and Division of Epidemiology at School of Public Health, University of Alabama at Birmingham (UAB), Faculty Office Tower 805B, 510 20th Street S, Birmingham, AL, 35294, USA. .,Department of Orthopedic Surgery, Mayo Clinic College of Medicine, Rochester, MN, USA.
| | - Shaohua Yu
- Department of Medicine at School of Medicine, and Division of Epidemiology at School of Public Health, University of Alabama at Birmingham (UAB), Faculty Office Tower 805B, 510 20th Street S, Birmingham, AL, 35294, USA
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