Serum uric acid and cardiovascular mortality the NHANES I epidemiologic follow-up study, 1971-1992. National Health and Nutrition Examination Survey

Prevalence and impact of metabolic associated fatty liver disease in non-metastatic breast cancer women at initial diagnosis: a cross-sectional study in China

PURPOSE

The epidemiologic data of metabolic associated fatty liver disease (MAFLD) in breast cancer (BC) patients remains limited. We aimed to investigate the prevalence and clinicopathological characteristics of hepatic steatosis (HS) and MAFLD in Chinese BC women at initial diagnosis.

METHODS

3217 non-metastatic primary BC women with MAFLD evaluation indexes at initial diagnosis and 32,170 age-matched (in a 1:10 ratio) contemporaneous health check-up women were enrolled.

RESULTS

The prevalence of HS (21.5% vs. 19.7%, p = 0.013) and MAFLD (20.8% vs. 18.6%, p = 0.002) were significantly higher in BC women than in health check-ups, respectively. Meanwhile, the prevalence of HS/MAFLD among elderly BC women (≥ 60 years) was significantly higher than the health check-ups (38.7%/37.6% vs 31.9%/30.8%), respectively. In BC women with HS/MAFLD, the prevalence of overweight/obesity was up to 85.7%/88.6%, dyslipidemia and elevated blood pressure were 63.2%/63.7% and 59.7%/61.7%, respectively. No statistical significance of the expressions of estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor 2 (HER-2) and Ki67 were found between BC women with HS/MAFLD and BC women without HS/MAFLD. After adjustment, BC women with HS showed significantly higher risk of lymph node metastasis than BC women without HS. Subjects with HS/MAFLD had higher risks of overweight/obesity, dyslipidemia, elevated blood pressure, hyperuricemia, and elevated enzymes than those without HS/MAFLD.

CONCLUSIONS

Compared with health check-ups, BC patients have higher prevalence of HS/MAFLD. HS/MAFLD coexist with high prevalence of metabolic complications, and the risk of lymph node metastasis was significantly higher in BC women with HS than in BC women without HS.

A Droplet Microfluidic Sensor for Point-of-Care Measurement of Plasma/Serum Total Free Thiol Concentrations

Total free thiols are an important marker of the whole-body redox state, which has been shown to be associated with clinical outcome in health and disease. Recent investigations have suggested that increased insight may be gained by monitoring alterations of redox state in response to exercise and hypoxia and to monitor redox trajectories in disease settings. However, conducting such studies is challenging due to the requirement for repeated venous blood sampling and intensive lab work. Droplet microfluidic sensors offer an alternative platform for developing a point-of-care testing approach using small sample volumes and automated systems to complement or ultimately replace laboratory testing. Here we developed a small, portable droplet microfluidic sensor that can measure total free thiol concentrations in 20 μL human plasma (or serum) samples, providing a reading in less than 10 min. This system features a novel method to enhance the mixing of reagent and analyte in droplets containing viscous biological fluids. The results in a range of real-world human plasma samples showed equivalence with current standard laboratory assays while reducing sample volume requirements 9-fold and fully automating the process. Micro hematocrit capillaries allowed testing of capillary blood samples collected by fingerprick lancing. The system was used to monitor total free thiols using fingerprick samples in healthy volunteers and revealed significant changes in total free thiols in response to food intake and exercise. This device has the potential to improve our ability to conduct physiological studies of total free thiol level changes and improve our understanding of redox physiology, which may ultimately be applied in redox medicine to improve patient care.

Serum uric acid trajectories and the risk of cardiovascular disease: a longitudinal association and pathway analysis

BACKGROUND

Age-specifically longitudinal associations and potential pathways between serum uric acid (SUA) and cardiovascular disease (CVD) remained unclear. This study aimed to explore SUA trajectories in different age populations and to determine their associations and potential pathways with incident CVD.

METHODS

This prospective cohort included 41,367 participants from the Kailuan study, including 30,938 participants aged <55 years and 10,419 participants aged ≥55. The SUA trajectories during year 2006-2012 were identified by latent class growth models.

RESULTS

Three SUA trajectories were identified in the overall, aged <55 and aged ≥55 years participants, as "low-stable" (51.9%, 54.4%, and 43.3%), "moderate-stable" (39.0%, 36.9%, and 45.6%), and "high-stable" (9.1%, 9.7%, and 11.1%), respectively. During a median follow-up of 6.75 years, incident CVD occurred in 2302 participants (5.56%). Overall, a high-stable trajectory was independently associated with a higher risk of CVD (hazard ratio [HR], 1.23; 95% [confidence interval], 1.06-1.42). Notably, the associations differed by age, a significant association was only observed in participants aged ≥55 years (HR, 1.29; 95% CI, 1.05-1.58), rather than those aged <55 years (HR, 1.08; 95% CI, 0.89-1.33). The addition of SUA trajectories to a baseline risk model for CVD improved the integrated discrimination improvement value (P < 0.05) and category-free net reclassification improvement value (P < 0.05). Bayesian network showed the conditional probability of high CVD risk associated with aging, elevated SUA trajectories, blood pressure, glucose, and inflammation was 15.5%.

CONCLUSIONS

High-stable SUA trajectories were independently associated with an elevated risk of CVD, which is mainly induced by hypertension, diabetes, and inflammation, especially in participants aged ≥55 years.

Inverse relationship of oxidative balance score with hyperuricemia among Chinese adults: a population-based cross-sectional study

BACKGROUND

The oxidative balance score (OBS) is a composite metric highlights pro-oxidants and antioxidants balance, representing the overall burden of oxidative stress. This study aims to examine the association between OBS and hyperuricemia in a Chinese population.

METHODS

This study was based on population-based cross-sectional survey data of Fujian province from August 2020 to April 2021. OBS was determined based on 10 food and lifestyle OBS components. The association between OBS and hyperuricemia was investigated using logistic regression analysis. Subgroup analyses identified sensitive populations. Restricted cubic spline (RCS) was performed to examine the potential dose-response relationship.

RESULTS

A total of 9464 participants were included in the final analysis. An inverse association between OBS and hyperuricemia was observed and remained after adjusting for potential confounders. Each additional unit of OBS was associated with a 4% and 7% reduction in the risk of hyperuricemia in men [OR: 0.96(0.94,0.99)] and women [OR: 0.93(0.90,0.96)], respectively. Participants in the highest quartile had a 22% and 37% lower risk of hypertension compared with the lowest quartile of OBS in men [0.78(0.62,0.97)] and women [OR: 0.63(0.49,0.79)], respectively. There were significant interactions between OBS and gender, hypertension, and dyslipidemia on hyperuricemia (Pinteraction < 0.05), except for age, education, and diabetes (Pinteraction > 0.05). A linear dose-response relationship between OBS and the risk of hyperuricemia (Pnonlinear = 0.7854) was observed.

CONCLUSIONS

An inverse association as well as dose-response relationship between OBS and hyperuricemia were observed. Increasing antioxidant levels through lifestyle modification may be an effective way to prevent hyperuricemia, especially in women. Large prospective cohort studies and randomized controlled trials are required to verify the effect of OBS on hyperuricemia and elucidate its causal mechanism.

Serum uric acid is independently associated with impaired nitroglycerine-induced vasodilation of the brachial artery in women

Experimental and clinical studies have suggested atherosclerotic effects of uric acid (UA) on vascular smooth muscle cells (VSMCs). Nitroglycerine-induced vasodilation (NID), a control test for flow-mediated vasodilation, can be used as a possible marker of VSMC dysfunction. However, there is little information on the association between UA and NID. Therefore, we investigated the association between serum UA levels and NID according to sex. We measured NID of the brachial artery in 598 women (mean age: 66.2 ± 12.0 years) and 1008 men (mean age: 59.0 ± 18.0 years). In women, the mean serum UA level was 5.06 ± 1.24 mg/dL. Serum UA levels were negatively correlated with NID (p < 0.001), and NID significantly decreased with increasing serum UA levels (≤4.0 mg/dL, 13.4 ± 6.4%; 4.0 to ≤5.0 mg/dL, 11.4 ± 5.3%; 5.0 to ≤6.0 mg/dL, 10.8 ± 5.7%; >6.0 mg/dL, 9.7 ± 5.7%; p < 0.001). The prevalence of VSMC dysfunction, defined as NID < 8.4%, the division points for the lowest and middle tertiles of NID in women, increased with increasing serum UA levels ( ≤ 4.0 mg/dL, 23.3%; 4.0 to ≤5.0 mg/dL, 30.9%; 5.0 to ≤6.0 mg/dL, 36.4%; >6.0 mg/dL, 44.6%; p < 0.001). Multiple logistic regression analysis showed a significant association between serum UA levels and VSMC dysfunction (odds ratio, 1.21; 95% confidence interval, 1.02─1.43; p = 0.03). There was no interaction between age (<50 or ≥50 years) and the effect of serum UA levels on VSMC dysfunction (p interaction = 0.88). In contrast, no association was observed between serum UA levels and NID in men. Serum UA levels were significantly associated with VSMC dysfunction as assessed by NID in women.

Metabolomics in Atrial Fibrillation: Unlocking Novel Biomarkers and Pathways for Diagnosis, Prognosis, and Personalized Treatment

BACKGROUND/OBJECTIVES

Atrial fibrillation (AF) is the most frequent arrhythmia in the adult population associated with a high rate of severe consequences leading to significant morbidity and mortality worldwide. Therefore, its prompt recognition is of high clinical importance. AF detection often remains challenging due to unspecific symptoms and a lack of reliable biomarkers for its prediction. Herein, novel bioanalytical methodologies, such as metabolomics, offer new opportunities for a better understanding of the underlying pathological mechanisms of cardiovascular diseases, including AF. The metabolome, considered a complete set of small molecules present in the organism, directly reflects the current phenotype of the studied system and is highly sensitive to any changes, including arrhythmia's onset. A growing body of evidence suggests that metabolite profiling has prognostic value in AF prediction, highlighting its potential role not only in early diagnosis but also in guiding therapeutic interventions. By identifying specific metabolites as a disease biomarker or recognising particular metabolomic pathways involved in the AF pathomechanisms, metabolomics could be of great clinical value for further clinical decision-making, risk stratification, and an individual personalised approach. The presented narrative review aims to summarise the current state of knowledge on metabolomics in AF with a special emphasis on its implications for clinical practice and personalised medicine.

Impact of Uric Acid Levels on Mortality and Cardiovascular Outcomes in Relation to Kidney Function

Background: Uric acid levels are linked to cardiovascular outcomes and mortality, especially in chronic kidney disease (CKD). However, their impact across varying kidney function remains unclear. Methods: We conducted a retrospective cohort study using the Observational Medical Outcomes Partnership Common Data Model (OMOP-CDM) database from a single center. Adult patients with at least one serum uric acid measurement between 2002 and 2021 were included and categorized by estimated glomerular filtration rate (eGFR): normal kidney function (≥90 mL/min/1.73 m2), mild dysfunction (60-89 mL/min/1.73 m2), moderate dysfunction (30-59 mL/min/1.73 m2), and advanced dysfunction (<30 mL/min/1.73 m2). The primary outcome was all-cause mortality with secondary outcomes being myocardial infarction (MI) and heart failure (HF). Results: A total of 242,793 participants were analyzed. Uric acid levels showed a U-shaped association with all-cause mortality in advanced kidney dysfunction, where both low (<3 mg/dL) and high (>10 mg/dL) levels increased mortality risk. In mild kidney dysfunction, lower uric acid levels were linked to better survival. HF risk increased linearly with higher uric acid, particularly in normal kidney function, while no significant association was found between uric acid and MI in any group. Conclusions: Uric acid levels are associated with mortality in a U-shaped pattern for advanced kidney dysfunction, while lower levels appear protective in mild dysfunction. These findings suggest the need for personalized uric acid management in CKD patients based on their kidney function.

Gout and Hyperuricemia: A Narrative Review of Their Comorbidities and Clinical Implications

Gout is the most common form of inflammatory arthritis, caused by the deposition of monosodium urate crystals in the joints due to elevated serum uric acid levels. Its prevalence and associated healthcare burden have been rising in recent decades, a trend expected to continue. It is crucial to recognize that gout and hyperuricemia are not merely causes of painful joint flares, but systemic metabolic disorders linked to a broad spectrum of comorbidities such as cardiovascular diseases, chronic kidney disease, diabetes, insulin resistance, steatotic liver disease, osteoarthritis, and respiratory and eye diseases. Numerous risk factors for gout and hyperuricemia have been identified, with recent research uncovering further associations with other conditions. To optimize patient outcomes, gout and hyperuricemia must be addressed through a holistic approach that accounts for these risk factors while providing comprehensive management of related comorbidities affecting various organ systems. This review summarizes the current knowledge on the risk factors, comorbidities, and clinical implications of gout and hyperuricemia. Future research should focus on improving patient outcomes by tailoring treatments individually and addressing the underlying metabolic comorbidities of gout with multimodal treatment.

Associations of uric acid with the risk of cardiovascular disease and all-cause mortality among individuals with chronic kidney disease: the Kailuan Study

AIMS

The relationship between uric acid (UA) concentrations and the risk of cardiovascular disease (CVD), especially for subtypes of CVD among individuals with chronic kidney disease (CKD), is not well understood. This study aimed to investigate whether UA concentration was associated with subtypes of CVD and all-cause mortality among individuals with CKD.

METHODS AND RESULTS

A total of 27 707 individuals with CKD, free of CVD at recruitment from the Kailuan Study, were included. Cox proportional hazards regression models were used to compute hazard ratios (HRs) and 95% confidence intervals (CIs). Over a median follow-up of 11-12 years, we documented 674 myocardial infarctions, 1197 heart failures, 2406 strokes, and 5676 total deaths. Among participants with CKD, compared with those in the lowest tertile of UA, the HRs (95% CIs) of participants in the highest UA tertile were 1.38 (1.13-1.67) for myocardial infarction, 1.60 (1.38-1.85) for heart failure, 1.01 (0.91-1.12) for stroke, and 1.29 (1.21-1.38) for all-cause mortality. Subgroup analyses showed that the associations between UA and heart failure and all-cause mortality were stronger in individuals with estimated glomerular filtration rate <45 mL/min/1.73 m2 compared to their counterparts (Pinteraction < 0.05). Additionally, the association between UA and all-cause mortality was stronger among individuals without diabetes than those with diabetes (Pinteraction < 0.05).

CONCLUSION

In individuals with CKD, a higher concentration of UA was associated with a higher risk of myocardial infarction, heart failure, and all-cause mortality, following a dose-response relationship. Our data underscore the importance of UA screening among individuals with CKD for CVD and premature death prevention.

Association between serum uric acid and all-cause and cardiovascular-related mortality in hemodialysis patients

Background

The association between serum uric acid (UA) and all-cause and cardiovascular-related mortality in hemodialysis (HD) patients is conflicting. We investigated this association and explored the effect modification of underlying nutritional status, as reflected in the lean tissue index (LTI) and the Geriatric Nutritional Risk Index (GNRI), which serve as markers of muscle mass and nutritional risk in HD patients.

Methods

A retrospective cohort study was conducted from January 2019 to December 2023. We investigated the association between serum UA and the outcomes using the Cox proportional hazards regression and restricted cubic splines. Subgroup analyses based on the LTI and GNRI were conducted to explore possible effect modification.

Results

During a mean follow-up of 32.9 months, 876 patients who underwent HD were included in the analysis. The association between serum UA and all-cause mortality showed a non-linear U-shaped pattern (p = 0.007), with a survival benefit observed for the patients with serum UA levels between 3.4 and 6.8 mg/dL. In the multivariable-adjusted model, the low and high UA groups were associated with a greater risk of all-cause mortality compared to the reference UA group (hazard ratio (HR) =1.24, confidence interval (CI) 1.03-2.12, p = 0.027; HR = 1.09; CI 1.05-2.08. p = 0.012). In the low UA group, a greater risk of mortality was observed in patients with low LTI (<12.3; HR 1.56, 95% CI 1.22-1.82) and GNRI values (<102.1; HR 1.43, 95% CI 1.12-1.76), but not in those with high LTI and GNRI values. There was no significant association between serum UA and cardiovascular disease-related mortality.

Conclusion

Our study showed that lower and higher serum UA levels increase the risk of all-cause mortality in HD patients. Among the patients with lower UA levels, low LTI and GNRI values showed a greater risk of mortality. This finding suggested that better nutritional status, rather than elevated UA levels, is likely to improve long-term survival in HD patients.

Serum uric acid and mortality in metabolic dysfunction-associated steatotic liver disease: Subgroup differences

BACKGROUND AND AIMS

This study aims to investigate the association between serum uric acid (SUA) and both the risk and long-term mortality of dysfunction-associated steatotic liver disease (MASLD), and to explore differences between the pure MASLD and metabolic and alcohol related/associated liver disease (MetALD) subgroups.

METHODS AND RESULTS

We included 11,675 participants from the Third National Health and Nutrition Examination Survey, with matched mortality data up to 2019. Logistic regression and Cox proportional hazards regression evaluated the relationship between SUA and both the risk and mortality of MASLD. Non-linear correlations and threshold effects were explored using restricted cubic splines and a two-piecewise Cox proportional hazards model. We found that SUA was positively associated with the risk of MASLD [odds ratio (OR): 1.19, 95 % confidence interval (CI) 1.12-1.27]. For pure MASLD, SUA showed a positive association with all-cause mortality [<4.7 mg/dL: hazard ratio (HR): 1.34, 95 % CI 1.04-1.73; ≥4.7 mg/dL: HR: 1.08, 95 % CI 1.02-1.15] and cardiovascular mortality (HR: 1.12, 95 % CI 1.02-1.22). For MetALD, there was an inverse J-shaped relationship (threshold: 6.6 mg/dL) between SUA and all-cause mortality. Below the threshold, SUA was negatively correlated with all-cause mortality (HR: 0.42, 95 % CI 0.19-0.93), but no association was found above it (HR: 0.81, 95 % CI 0.54-1.21). Additionally, no association was observed between SUA and cardiovascular mortality.

CONCLUSIONS

SUA serves as an independent predictor of the risk and all-cause mortality of MASLD. The relationship between SUA and both all-cause and cardiovascular mortality differs between the pure MASLD and MetALD subgroups.

Cardiovascular Outcomes of Uric Acid Lowering Medications: A Meta-Analysis

BACKGROUND

Although hyperuricemia is a recognized risk factor for cardiovascular diseases, mixed results have been reported regarding the associations between uric acid-lowering medications and cardiovascular events. This meta-analysis compared the cardiovascular outcomes of different uric acid-lowering medications and placebo.

METHODS

Following PRISMA guidelines, we searched OVID Medline, Embase, Web of Science, and Cochrane databases to identify potentially relevant articles until December 2023. Studies must be randomized or observational, report cardiovascular and mortality outcomes, and compare uric acid-lowering medications to placebo or each other. Data was analyzed using Revman (version 5.4) software.

RESULTS

A total of 3,393 studies were searched, after which 47 studies were included, totaling 3,803,509 patients (28 studies comparing xanthine oxidase inhibitors (XOI) versus placebo, 17 studies comparing allopurinol and febuxostat, and 2 studies comparing XOI and uricosuric agents). Overall mean age was 57.3 years, and females comprised 20.8% of all studies. There were no significant differences between XOI and placebo for cardiovascular outcomes (mortality, myocardial infarction, major adverse cardiovascular events, heart failure, or arrhythmia). There was significant heterogeneity in all these pooled analyses. Comparing Allopurinol to Febuxostat, there was a lower risk of heart failure in febuxostat than allopurinol in 3 RCTs (OR 0.66, 95% CI 0.50-0.89, p = 0.006). Other cardiovascular outcomes were not different. Lastly, when comparing XOI and uricosuric agents, no significant differences in MI rates were evident.

CONCLUSION

XOI was not associated with reduced cardiovascular events compared to placebo. When comparing XOI agents, Febuxostat might reduce the risk of HF, but future studies are required to confirm the findings from the current study.

Association between preoperative uric acid concentration and the occurrence of atrial fibrillation following cardiac surgery: an observational prospective study

OBJECTIVES

Uric acid (UA) concentration is associated with increased risk of atrial fibrillation, but few studies have investigated this association after cardiac surgery. This study investigated the statistical association between postoperative atrial fibrillation (POAF) and preoperative UA concentration according to the type of cardiac surgery.

METHODS

Consecutive patients undergoing cardiac surgery at a tertiary center from January to May 2019 were eligible. Patients were separated into two groups according to POAF occurrence. Subgroup analyses were performed in patients undergoing coronary artery bypass grafting (CABG) or valve surgery. Binary logistic regression models were used to assess independent factors of POAF. Principal component analyses (PCA) were performed to investigate whether CABG or valve surgeries were associated with different biological profiles for POAF.

RESULTS

The study included 221 patients, of whom 76 experienced at least one POAF episode. The UA concentration was higher in the POAF group compared with the POAF-free group (352 μmol/l [295-420] vs. 321 μmol/l [249-380], p = 0.004). This association persisted in multivariable analysis (for 10 μmol, odds ratio = 1.04 [1.34-8,7], p = 0.014) and in patients undergoing isolated CABG. In patients undergoing valve surgery, despite a high incidence of POAF, no association was found. PCA identified different blood biological profiles associated with POAF after CABG vs. valve surgery.

CONCLUSION

The preoperative UA concentration was independently associated with the occurrence of POAF after CABG but not after valve surgery. PCA results indicate that different biological profiles contribute to POAF occurrence according to the type of cardiac surgery, thus suggesting different strategies for prevention/intervention.

One-Year Risk Prediction of Elevated Serum Uric Acid Levels in Older Adults: A Longitudinal Cohort Study

Objective

To develop and externally validate a nomogram to predict elevated serum uric acid (SUA) levels in older adults.

Study Design

This is a longitudinal Chinese cohort study.

Methods

A cohort of 2788 older adults was established at Huadong Hospital, followed-up for at least one year, and screened for risk factors for elevated SUA levels. A logistic regression model was built to predict elevated SUA, and its performance was validated.

Results

The risk prediction model showed good discrimination ability in both the development cohort (area under the curve (AUC) = 0.82; 95% confidence interval (CI) =0.79~0.86) and the external validation cohort (AUC=0.76; 95% CI=0.70~0.82). The model was adequately calibrated, and the predictions correlated with the observed outcome (χ 2 = 6.36, P = 0.607). Men were more prone to elevated SUA levels than women were, and a baseline SUA level ≥360 μmol/L was a common risk factor for both males and females. Proteinuria status was an additional risk factor for males, whereas a baseline estimated glomerular filtration rate (eGFR)<60 mL/min·1.73 m2 and diabetes status were additional risk factors for females.

Conclusion

The externally validated nomogram, which is predictive of elevated SUA in older adults, might aid in the detection of individual diseases, the development of preventive interventions and clinical decision-making.

Relationships between different trends of the Mediterranean diet and cardiovascular disease-related risk factors in China: results from the CHNS study, 1997-2009

Objectives

The present study aimed to explore the associations between Mediterranean diet trajectories (MDTs) and cardiovascular disease-related risk factors in Chinese adults.

Methods

A total of 4,332 participants from the China Health and Nutrition Survey (CHNS) were included in this study. A group-based trajectory model (GBTM) was used to explore Mediterranean diet trajectories (MDTs). Linear regression analyses were conducted to assess the association between Mediterranean diet trajectories and cardiovascular disease-related risk factors. Stratified analyses by gender were also performed.

Results

The following four groups were identified in the total population: Group 1 (Persistently low MDT, n = 292, 6.74%), Group 2 (Descent MDT, n = 537, 12.40%), Group 3 (Ascent MDT, n = 454, 10.48%), and Group 4 (Persistently high MDT, n = 3,049, 70.38%). Compared to the persistently low MDT (Group 1), both Group 2 and Group 4 were negatively related to low-density lipoprotein cholesterol (LDL-C) (Group 2: β = -0.23, 95% CI: -0.36 to -0.09, p = 0.001; Group 4: β = -0.25, 95% CI: -0.37 to -0.14, p < 0.001), total cholesterol (TC) (Group 2: β = -0.18, 95% CI: -0.32 to -0.04, p = 0.010; Group 4: β = -0.31, 95% CI: -0.43 to -0.19, p < 0.001), and uric acid (UA) (Group 2: β = -15.16, 95% CI: -28.66 to -2.56, p = 0.019; Group 4: β = -27.51, 95% CI: -38.77 to -16.25, p < 0.001) after adjusting for potential risk factors. Only Group 4 exhibited a negative relationship with triglycerides (TG) (β = -0.18, 95% CI: -0.34 to -0.02, p = 0.028) and blood glucose (β = -0.19, 95% CI: -0.37 to -0.02, p = 0.032).

Conclusion

Four MDTs were identified among the total participants, including men and women. These trajectories were summarized as persistently low MDT, ascent MDT, descent MDT, and persistently high MDT. Adherence to high MDTs could reduce the level of some CVD-related risk factors. The impact of the remote MD on CVD-related risk factors may be greater than that of the proximal MD.

Cardiovascular risk according to genetic predisposition to gout, lifestyle and metabolic health across prospective European and Korean cohorts

OBJECTIVE

Recent studies have reported that gout is associated with a risk of cardiovascular disease (CVD) later in life. However, the predictive value of genetic predisposition to gout combined with lifestyle habits for CVD risk remains unclear. This study aimed to examine the association between genetic predisposition to gout and lifestyle habits and the risk of developing CVD in two diverse prospective cohorts from different ancestries.

METHODS

A total of 224 689 participants of European descent from the UK Biobank and 50 364 participants of East Asian descent from the Korean Genome and Epidemiology Study were included. The genetic risk for gout was assessed using a polygenic risk score (PRS) derived from a meta-genome-wide association study (n=444 533). The incident CVD risk was evaluated according to genetic risk, lifestyle and metabolic syndrome (MetS).

RESULTS

Individuals at high genetic risk for gout had a higher risk of incident CVD than those with low genetic risk across ancestry. Notably, a reduction in CVD risk by up to 62% (HR 0.38; 95% CI 0.31 to 0.46; p <0.001) was observed in individuals at both low and high genetic risk for gout when they maintained ideal MetS and favourable lifestyle habits.

CONCLUSIONS

Our findings indicate that a higher genetic risk of gout is significantly associated with an increased risk of CVD. Moreover, adherence to a favourable lifestyle can significantly reduce CVD risk, particularly in individuals with high genetic risk. These results underscore the potential of PRS-based risk assessment to improve clinical outcomes through tailored preventative strategies.

Association of the ABCG2 rs2231142 variant with the Framingham Cardiovascular Disease Risk score in the Taiwanese population

Background

Serum uric acid (SUA) is an important predictor of cardiovascular events and mortality. The ABCG2 rs2231142 variant (TT genotype) is associated with hyperuricemia (HUA), but the relationship between ABCG2 gene polymorphisms and coronary artery disease (CAD) risk is poorly elucidated. We investigated the association between ABCG2 rs2231142 genetic variants and the Framingham Risk Score for Cardiovascular Disease (FRS-CVD) in a Taiwanese population.

Methods

This cross-sectional study enrolled 139,508 Taiwanese participants aged 30-70 years based on data from the Taiwan Biobank (TWB) database that was obtained from questionnaires, laboratory investigations, anthropometry, and Affymetrix TWB genome-wide single-nucleotide polymorphism (SNP) chip data analysis. The association between ABCG2 rs2231142 and FRS-CVD risk was evaluated using logistic regression analysis.

Results

Compared to those with the GG genotype, participants with the ABCG2 rs2231142 TT genotype had a significantly lower systolic blood pressure, smoking rate, body mass index, triglyceride level, waist circumference, waist-hip ratio, and body fat percentage, but had higher high-density lipoprotein cholesterol level. Despite the same FRS-CVD score, participants with TT genotypes had higher SUA. Even with the same SUA, TT carriers had a lower FRS-CVD than GT and GG carriers. Participants with the TT genotype had significantly lower CVD risk, particularly female participants with HUA and BMI <27 (OR: 0.760, 95 % CI: 0.587-0.985; p = 0.0381) group.

Conclusion

The ABCG2 rs2231142 TT genotype is associated with a lower FRS-CVD, particularly in non-obese hyperuricemic female individuals. The complicated interplay among genetic variations, metabolic profile, and CVD risk provides insights for precision health.

Evaluation of the relationship between xanthine oxidase activity and metabolic syndrome in a population group in Bangladesh

Xanthine oxidase (XO) is an enzyme that converts hypoxanthine into xanthine and xanthine into uric acid, which is then eliminated by the kidneys. Serum XO has been linked to diabetes, hypertension, liver dysfunction, and cardiovascular diseases. However, limited information exists on the relationship between serum XO activity and MetS. This study aimed to analyze the relationship between XO activity and metabolic syndrome (MetS) and its components in an adult population group in Bangladesh A total of 601 participants aged ≥18 years were included in the study. MetS was defined based on the criteria set by the National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III). Serum XO activity was measured using the enzyme-linked immunosorbent assay (ELISA), while other biochemical parameters were measured using colorimetric methods. The relationship between serum XO and MetS levels was determined through multivariate logistic regression analysis. Serum XO activity was found to be significantly higher in females (6.17 ± 3.77 U/L) as compared to males (4.00 ± 2.77 U/L) (p < 0.001). Furthermore, participants with MetS had significantly higher mean levels of serum XO (5.34 ± 3.39 U/L) than those without MetS (3.86 ± 2.90 U/L) (p < 0.001). The prevalence of MetS and its components, such as blood pressure and blood glucose increased across the XO quartiles (p < 0.001). Regression analysis indicated that XO activity was significantly and independently associated with the prevalence of MetS (at least p < 0.05 for all cases) and its components, including elevated blood pressure, high blood glucose, and low HDL-C (at least p < 0.05 for all cases). In conclusion, individuals with MetS had significantly higher XO levels than those without MetS. Serum XO activity showed an independent association with MetS and some of its components. Therefore, XO might serve as a useful marker of MetS. Prospective studies are needed to determine the underlying mechanisms linking XO and MetS.

Elevated blood pressure and hyperuricemia risk: a retrospective cohort study from Wuhu, China

Although the relationship between hypertension and hyperuricemia is widely recognized, there is still a relative lack of research on prehypertensive individuals and the individual associations of systolic and diastolic blood pressure with the risk of hyperuricemia. From 2011 to 2016, we conducted a study on 53,323 individuals at Wuhu City Hospital in China. Based on initial blood pressure readings, participants were categorized into normal, prehypertension, or hypertension groups. We used Cox regression to analyze the associations with baseline factors. In subgroup analyses, systolic and diastolic pressures were treated as continuous variables, and their relationship with the risk of hyperuricemia was examined using restricted cubic spline analysis. The risk increased in the prehypertension and hypertension groups compared to the normal blood pressure group, with hazard ratios of 1.192 and 1.350, respectively. For each unit increase in blood pressure, the risk of hyperuricemia rose by 0.8% (systolic) and 0.9% (diastolic), especially when blood pressure levels exceeded 115/78 mmHg. Additionally, we observed that factors such as gender, alcohol consumption habits, obesity, and dyslipidemia might further influence this association. These findings emphasize the importance of early risk assessment and intervention in these patient populations in clinical practice.

Long-term ambient air pollution exposure and renal function and biomarkers of renal disease

BACKGROUND

Despite accumulating evidence of an association between air pollution and renal disease, studies on the association between long-term exposure to air pollution and renal function are still contradictory. This study aimed to investigate this association in a large population with relatively low exposure and with improved estimation of renal function as well as renal injury biomarkers.

METHODS

We performed a cross-sectional analysis in the middle-aged general population participating in the Swedish CardioPulmonary bioImaging Study (SCAPIS; n = 30 154). Individual 10-year exposure to total and locally emitted fine particulate matter (PM2.5), inhalable particulate matter (PM10), and nitrogen oxides (NOx) were modelled using high-resolution dispersion models. Linear regression models were used to estimate associations between exposures and estimated glomerular filtration rate (eGFR, combined creatinine and cystatin C) and serum levels of renal injury biomarkers (KIM-1, MCP-1, IL-6, IL-18, MMP-2, MMP-7, MMP-9, FGF-23, and uric acid), with consideration of potential confounders.

RESULTS

Median long-term PM2.5 exposure was 6.2 µg/m3. Almost all participants had a normal renal function and median eGFR was 99.2 mL/min/1.73 m2. PM2.5 exposure was associated with 1.3% (95% CI 0.6, 2.0) higher eGFR per 2.03 µg/m3 (interquartile range, IQR). PM2.5 exposure was also associated with elevated serum matrix metalloproteinase 2 (MMP-2) concentration, with 7.2% (95% CI 1.9, 12.8) higher MMP-2 per 2.03 µg/m3. There was a tendency towards an association between PM10 and higher levels of uric acid, but no associations were found with the other biomarkers. Associations with other air pollutants were null or inconsistent.

CONCLUSION

In this large general population sample at low exposure levels, we found a surprising association between PM2.5 exposure and a higher renal filtration. It seems unlikely that particle function would improve renal function. However, increased filtration is an early sign of renal injury and may be related to the relatively healthy population at comparatively low exposure levels. Furthermore, PM2.5 exposure was associated with higher serum concentrations of MMP-2, an early indicator of renal and cardiovascular pathology.

Uric acid and cardiovascular diseases: a reappraisal

Serum uric acid (SUA) has garnered an increased interest in recent years as an important determinant of cardiovascular disease. Uric acid, a degradation product of purine metabolism, is affected by several inheritable and acquired factors, such as genetic mutation, metabolic syndrome, chronic kidney disease, and medication interactions. Even though elevated SUA have been commonly associated with the development of gout, it has significant impact in the development of hypertension, metabolic syndrome, and cardiovascular disease. Uric acid, in both crystalline and soluble forms, plays a key role in the induction of inflammatory cascade and development of atherosclerotic diseases. This concise reappraisal emphasizes key features about the complex and challenging role of uric acid in the development and progression of atherosclerosis and cardiovascular disease. It explores the pathogenesis and historical significance of uric acid, highlights the complex interplay between uric acid and components of metabolic syndrome, focuses on the pro-inflammatory and pro-atherogenic effects of uric acid, as well as discusses the role of urate lowering therapies in mitigating the risk of cardiovascular disease while providing the latest evidence to the healthcare professionals focusing on the clinical importance of SUA levels with regards to cardiovascular disease.

The Double-Edged Sword of Total Antioxidant Capacity: Clinical Significance and Personal Experience

Oxidative stress (OS) could be a condition underlying several human diseases, despite the physiological role of reactive oxygen species (oxidative eustress). Therefore, antioxidant compounds could represent a modulatory mechanism for maintaining a proper redox balance and redox signaling. When antioxidants are insufficient or overwhelmed, OS ensues, causing multiple damages at molecular, tissue, and cellular levels. This study focuses on the role of total antioxidant capacity (TAC) as a biomarker to be interpreted according to several clinical scenarios. After a brief description of various assay methods to elucidate terminology and physiopathological roles, we focus on the hormonal influence on TAC in blood plasma and other biological fluids, as different endocrine systems can modulate the antioxidant response. Furthermore, OS characterizes several endocrinopathies through different mechanisms: an inadequate antioxidant response to an increase in reducing equivalents (reductive distress) or a marked consumption of antioxidants (oxidative distress), which leads to low TAC values. An increased TAC could instead represent an adaptive mechanism, suggesting a situation of OS. Hence, the clinical context is fundamental for a correct interpretation of TAC. This review aims to provide the reader with a general overview of oxidative stress in several clinical examples of endocrine relevance, such as metabolic syndrome, non-thyroid illness syndrome, hypopituitarism, and infertility. Finally, the impact of dietary and surgical interventions on TAC in the model of metabolic syndrome is highlighted, along with personal experience.

The effect of metabolic factors on the association between hyperuricemia and chronic kidney disease: a retrospective cohort mediation analysis

BACKGROUND

Hyperuricemia, hyperglycemia, hypertension, hyperlipidemia, and hyperhomocysteinemia are all established risk factors for chronic kidney disease (CKD), and their interplay could exacerbate CKD progression. This study aims to evaluate the potential mediation effects of hyperglycemia, hypertension, hyperlipidemia, and hyperhomocysteinemia on the association between hyperuricemia (HUA) and chronic kidney disease (CKD).

METHODS

We collected electronic medical record data from 2055 participants who underwent physical examinations at the Affiliated Hospital of Qingdao University. The data were utilized to investigate the mediating effect of various factors including systolic blood pressure (SBP), diastolic blood pressure (DBP), homocysteine (HCY), triglyceride (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), blood glucose (Glu), and hemoglobin A1c (HbA1c) on the relationship between HUA and CKD.

RESULTS

Upon adjusting for confounding variables, mediation analysis indicated that only HCY acted as a mediator in the HUA-CKD relationship (p value < 0.05), exhibiting a statistically significant mediation effect of 7.04%. However, after adjustment for multiple testing, none of these variables were statistically significant.

CONCLUSIONS

Considering the observed associations between hyperuricemia, hyperglycemia, hypertension, hyperlipidemia, and CKD, none of the factors of interest remained statistically significant after adjusting for multiple testing as potential mediators of hyperuricemia on CKD.

Effect of dapagliflozin on uric acid in patients with chronic heart failure and hyperuricemia

BACKGROUND

Patients with chronic heart failure (CHF) frequently develop hyperuricemia, an elevated serum uric acid level, associated with adverse outcomes. Dapagliflozin, a sodium-glucose cotransporter-2 inhibitor, demonstrates reduction in cardiovascular mortality and hospitalization in patients with CHF and ejection fraction (HFrEF), irrespective of diabetes. However, dapagliflozin's effect on the uric acid levels in patients with CHF and hyperuricemia remain unclear.

AIM

To investigate the effects of dapagliflozin on uric acid levels in CHF patients with hyperuricemia.

METHODS

We conducted a randomized, double-blind, placebo-controlled trial in 200 patients with CHF and hyperuricemia, with HFrEF and serum uric acid levels ≥ 7 mg/dL (≥ 416 μmol/L). The participants were randomly assigned to receive a daily dose of 10 mg dapagliflozin or placebo for 24 months. The primary endpoint was the change in serum uric acid level from baseline to 24 months. Secondary endpoints included changes in left ventricular ejection fraction (LVEF), N-terminal pro-B-type natriuretic peptide (NT-proBNP), and quality of life (QoL) scores, as well as the incidence of cardiovascular death and hospitalization for heart failure.

RESULTS

At 24 months, dapagliflozin significantly reduced serum uric acid levels by 1.2 mg/dL (71 μmol/L) compared with placebo (95%CI: -1.5 to -0.9; P < 0.001). Dapagliflozin also significantly improved LVEF by 3.5% (95%CI: 2.1-4.9; P < 0.001), NT-proBNP by 25% (95%CI: 18-32; P < 0.001), and QoL scores by 10 points (95%CI: 7-13; P < 0.001) and reduced the risk of cardiovascular death and hospitalization for heart failure by 35% (95%CI: 15-50; P = 0.002) compared with the placebo. Adverse events were similar between the two groups, except for a higher rate of genital infections in the dapagliflozin group (10% vs 2%, P = 0.01).

CONCLUSION

Dapagliflozin significantly lowered serum uric acid levels and improved the clinical outcomes in patients with CHF and hyperuricemia. Therefore, dapagliflozin may be a useful therapeutic option for this high-risk population.

Co4+ in porous ZIF-67-derives intercalating-bridging adsorption of 2-reaction sites for simultaneous 2-electron transfer toward sensitive detection of uric acid

Metal-organic frameworks (MOFs) have been used to detect uric acid (UA), but still very challenging to achieve a low detection limit due to the low inferior conductivity of MOFs. Herein, three different N-doped ZIF-67-derived carbons were synthesized for the first time by one-step co-pyrolysis of 2-methylimidazole with cobalt nitrate (CN), cobalt acetate (CA) or cobalt chloride (CC) toward UA sensing. Afterwards, the cobalt nitrate-derived Co particle (Co/CN) supported by N-doped ZIF-67-derived carbon displays extremely low detection limit and high sensitivity for UA, outperformed all reported MOFs-based UA sensors. More interestingly, it was discovered that the high valence Co4+ within the Co/CN sample produced in high-acidic environment can intercalate in the frame for a bridge adsorption between two reaction sites, which boosted simultaneous 2-electron transfer, while Co3+ only allows an end-adsorption structure for one-electron transfer being the rate determining step. Furthermore, the bridge adsorption mode of UA on Co4+ -based catalyst was also verified by theoretical DFT calculations and XPS experiment. This work holds great promise for a selective and sensitive UA sensor for practical bioscience and clinic diagnostic applications while shedding lights in fundamental research for innovative designs and developments of high-sensitive electrochemical sensors.

Prevalence of metabolic syndrome among patients with hepatocellular carcinoma of different etiologies: a retrospective study

AIMS

This study compared the prevalences of metabolic syndrome and of cardiac or kidney comorbidities among patients with hepatocellular carcinoma (HCC) associated with metabolic dysfunction-related fatty liver disease (MAFLD), chronic infection with hepatitis B or C virus (HBV or HCV), or the combination of MAFLD and chronic HBV infection.

METHODS

Medical records were retrospectively analyzed for patients with HCC who underwent hepatectomy between March 2013 and March 2023. Patients with HCC of different etiologies were compared in terms of their clinicodemographic characteristics and laboratory data before surgery.

RESULTS

Of the 2422 patients, 1,822 (75.2%) were chronically infected with HBV without MAFLD and HCV, 415 (17.2%) had concurrent MAFLD and chronic HBV infection but no HCV infection, 121 (5.0%) had MAFLD without hepatitis virus infection, and 64 (2.6%) were chronically infected with HCV in the presence or absence of MAFLD and HBV infection. Compared to patients chronically infected with HBV without MAFLD and HCV, those with MAFLD but no hepatitis virus infection showed significantly lower prevalence of cirrhosis, ascites, portal hypertension, alpha-fetoprotein concentration ≥ 400 ng/mL, tumor size > 5 cm, multinodular tumors and microvascular invasion. Conversely, they showed significantly higher prevalence of metabolic syndrome, hypertension, type 2 diabetes, abdominal obesity, history of cardiovascular disease, T-wave alterations, hypertriglyceridemia and hyperuricemia, as well as higher risk of arteriosclerotic cardiovascular disease. Compared to patients with MAFLD but no hepatitis virus infection, those with concurrent MAFLD and chronic infection with HBV showed significantly higher prevalence of cirrhosis, ascites and portal hypertension, but significantly lower prevalence of hypertension and history of cardiovascular disease. Compared to patients with other etiologies, those chronically infected with HCV in the presence or absence of MAFLD and HBV infection, showed significantly higher prevalence of cirrhosis, portal hypertension, ascites, and esophagogastric varices.

CONCLUSION

Patients with HCC associated with MAFLD tend to have a background of less severe liver disease than those with HCC of other etiologies, but they may be more likely to suffer metabolic syndrome or comorbidities affecting the heart or kidneys.

Impact of hyperuricemia and chronic kidney disease on the prevalence and mortality of cardiovascular disease in cancer survivors

BACKGROUND

The risks of cardiovascular disease (CVD) and CVD mortality are prevalent among cancer survivors (CS) population. The 2022 ESC Guidelines on cardio-oncology have recommended that modifying cardiovascular risk factors (CVRF) could potentially improve long-term outcomes in CS.

OBJECTIVES

To identify the independent and joint chronic kidney disease (CKD) associations of hyperuricemia with the incidence of CVD and mortality outcomes among CS.

METHODS

Utilizing data from the US National Health and Nutrition Examination Survey spanning 2005-2018, we assessed the risk of CVD through weighted multivariable logistic regression and restricted cubic spline (RCS) regression. Additionally, all-cause and CVD-related mortality were evaluated using weighted multivariable Cox regression and Kaplan-Meier analysis. Subgroup analysis was conducted to further elucidate the interplay between hyperuricemia, CKD, and mortality within the CS population.

RESULTS

A total of 3276 CS participants were enrolled in this study. Results showed that hyperuricemia was positively related to the incidence of CVD (OR [95% CI] = 1.86 [1.24, 2.81], p = 0.004). RCS analysis further demonstrated that uric acid levels ≥345 μmol/L positively correlated with CVD incidence (p value for nonlinearity = 0.0013). However, the association between hyperuricemia and CVD mortality, as well as all-cause mortality did not reach statistical significance in the fully adjusted model (HR = 1.48, 95% CI: 0.92-2.39, p = 0.11; HR = 1.11, 95% CI:0.92, 1.34, p = 0.28, respectively). Among CS participants with CKD, hyperuricemia could increase risks of all-cause (HR [95% CI] = 1.39 [1.08, 1.11], p = 0.02) and CVD mortality (HR [95% CI] =2.17 [1.29, 3.66], p = 0.004) after adjusting for sex, age, and ethnicity.

CONCLUSIONS

In the CS population, hyperuricemia was positively associated with the incidence of CVD. In addition, CKD might be an intermediate variable among the CS population that mediated the effects of hyperuricemia on mortality.

Comparison of seven anthropometric indexes to predict hypertension plus hyperuricemia among U.S. adults

Purpose

This study aims to compare the association of hypertension plus hyperuricemia (HTN-HUA) with seven anthropometric indexes. These include the atherogenic index of plasma (AIP), lipid accumulation product (LAP), visceral adiposity index (VAI), triglyceride-glucose index (TyG), body roundness index (BRI), a body shape index (ABSI), and the cardiometabolic index (CMI).

Methods

Data was procured from the National Health and Nutrition Examination Survey (NHANES), which recruited a representative population aged 18 years and above to calculate these seven indexes. Logistic regression analysis was employed to delineate their correlation and to compute the odds ratios (OR). Concurrently, receiver operating characteristic (ROC) curves were utilized to evaluate the predictive power of the seven indexes.

Results

A total of 23,478 subjects were included in the study. Among these, 6,537 (27.84%) were patients with HUA alone, 2,015 (8.58%) had HTN alone, and 2,836 (12.08%) had HTN-HUA. The multivariate logistic regression analysis showed that the AIP, LAP, VAI, TyG, BRI, ABSI, and CMI were all significantly associated with concurrent HTN-HUA. The OR for the highest quartile of the seven indexes for HTN-HUA were as follows: AIP was 4.45 (95% CI 3.82-5.18), LAP was 9.52 (95% CI 7.82-11.59), VAI was 4.53 (95% CI 38.9-5.28), TyG was 4.91 (95% CI 4.15-5.80), BRI was 9.08 (95% CI 7.45-11.07), ABSI was 1.71 (95% CI 1.45 -2.02), and CMI was 6.57 (95% CI 5.56-7.76). Notably, LAP and BRI demonstrated significant discriminatory abilities for HTN-HUA, with area under the curve (AUC) values of 0.72 (95% CI 0.71 - 0.73) and 0.73 (95% CI 0.72 - 0.74) respectively.

Conclusion

The AIP, LAP, VAI, TyG, BRI, ABSI, and CMI all show significant correlation with HTN-HUA. Notably, both LAP and BRI demonstrate the capability to differentiate cases of HTN-HUA. Among these, BRI is underscored for its effective, non-invasive nature in predicting HTN-HUA, making it a superior choice for early detection and management strategies.

Distinct uric acid trajectories are associated with incident cardiac conduction block

BACKGROUND

The association of longitudinal uric acid (UA) changes with cardiac conduction block risk is unclear. We aimed to identify the trajectories of UA and explore its association with cardiac conduction block.

METHODS

A total of 67,095 participants with a mean age of 53.12 years were included from the Kailuan cohort in Tangshan, China, who were free of cardiac conduction block and with repeated measurements of UA from 2006 to 2012. UA trajectories during 2006 to 2012 were identified by group-based trajectory modeling. Cox proportional hazard regression models were used to assess the association of UA trajectories with cardiac conduction block.

RESULTS

We categorized three observed discrete trajectories of UA during 2006-2012 period: low-stable, moderate-stable, and high-stable. Over a median follow-up of 6.19 years, we identified 1405 (2.09%) incident cardiac conduction block. Compared to those in the low-stable trajectory, the adjusted hazard ratios (HRs) (95% confidence interval [CI]) of cardiac conduction block in the moderate-stable and high-stable trajectory were 1.30 (1.16-1.47) and 1.86 (1.56-2.22), and HRs of atrioventricular block were 1.39 (1.12-1.72) and 2.90 (2.19-3.83), and HRs of bundle branch blocks were 1.27 (1.10-1.47) and 1.43 (1.13-1.79). Notably, although the average UA level in the moderate-stable UA trajectory group is within the normal range, the risk of cardiac conduction block has increased.

CONCLUSIONS

The moderate-stable and high-stable trajectories are associated with increased risk for new-onset cardiac conduction block. Monitoring UA trajectories may assist in identifying subpopulations at higher risk for cardiac conduction block.

Association between preoperative neutrophil-lymphocyte ratio, uric acid, and postoperative delirium in elderly patients undergoing degenerative spine surgery

PURPOSE

There are few reports regarding the association between the neutrophil-lymphocyte ratio (NLR), uric acid, and the development of postoperative delirium (POD) in patients who are undergoing spine surgeries. We investigated the associations between the NLR, uric acid as a natural antioxidant, and POD in elderly patients undergoing degenerative spine surgery.

PATIENTS AND METHODS

This was a single-center, observational, and retrospective study conducted in Japan. We enrolled 410 patients who underwent degenerative spine surgery. POD was diagnosed after the surgeries by psychiatrists, based on the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). We performed a multivariable logistic regression analysis to clarify whether the NLR and uric acid values were associated with the development of POD in the patients.

RESULTS

129 of the 410 patients were excluded from the analysis. Of the 281 patients (137 females, 144 males), 32 patients (11.4%) were diagnosed with POD. The multivariable logistic regression analysis revealed that the preoperative uric acid level (adjusted odds ratio [aOR]: 0.67, 95% confidence interval [CI]: 0.49-0.90, p = 0.008) and age (aOR: 1.09, 95% CI: 1.02-1.16, p = 0.008) were significantly associated with POD. The preoperative NLR (aOR: 0.82, 95% CI: 0.60-1.13, p = 0.227) and antihyperuricemic medication (aOR: 0.97, 95% CI: 0.24-3.82, p = 0.959) were not significantly associated with POD.

CONCLUSION

Our results demonstrated that in elderly patients undergoing degenerative spine surgery, the preoperative NLR was not significantly associated with POD, but a lower preoperative uric acid value was an independent risk factor for developing POD. Uric acid could have a neuroprotective impact on POD in patients with degenerative spine diseases.

Uric acid formation is driven by crosstalk between skeletal muscle and other cell types

Hyperuricemia is implicated in numerous pathologies, but the mechanisms underlying uric acid production are poorly understood. Using a combination of mouse studies, cell culture studies, and human serum samples, we sought to determine the cellular source of uric acid. In mice, fasting and glucocorticoid treatment increased serum uric acid and uric acid release from ex vivo-incubated skeletal muscle. In vitro, glucocorticoids and the transcription factor FoxO3 increased purine nucleotide degradation and purine release from differentiated muscle cells, which coincided with the transcriptional upregulation of AMP deaminase 3, a rate-limiting enzyme in adenine nucleotide degradation. Heavy isotope tracing during coculture experiments revealed that oxidation of muscle purines to uric acid required their transfer from muscle cells to a cell type that expresses xanthine oxidoreductase, such as endothelial cells. Last, in healthy women, matched for age and body composition, serum uric acid was greater in individuals scoring below average on standard physical function assessments. Together, these studies reveal skeletal muscle purine degradation is an underlying driver of uric acid production, with the final step of uric acid production occurring primarily in a nonmuscle cell type. This suggests that skeletal muscle fiber purine degradation may represent a therapeutic target to reduce serum uric acid and treat numerous pathologies.

Prediction of hyperuricemia in people taking low-dose aspirin using a machine learning algorithm: a cross-sectional study of the National Health and Nutrition Examination Survey

Background: Hyperuricemia is a serious health problem related to not only gout but also cardiovascular diseases (CVDs). Low-dose aspirin was reported to inhibit uric acid excretion, which leads to hyperuricemia. To decrease hyperuricemia-related CVD, this study aimed to identify the risk of hyperuricemia in people taking aspirin. Method: The original data of this cross-sectional study were obtained from the National Health and Nutrition Examination Survey between 2011 and 2018. Participants who filled in the "Preventive Aspirin Use" questionnaire with a positive answer were included in the analysis. Six machine learning algorithms were screened, and eXtreme Gradient Boosting (XGBoost) was employed to establish a model to predict the risk of hyperuricemia. Results: A total of 805 participants were enrolled in the final analysis, of which 190 participants had hyperuricemia. The participants were divided into a training set and testing set at a ratio of 8:2. The area under the curve for the training set was 0.864 and for the testing set was 0.811. The SHapley Additive exPlanations (SHAP) method was used to evaluate the performances of the modeling. Based on the SHAP results, the feature ranking interpretation showed that the estimated glomerular filtration rate, body mass index, and waist circumference were the three most important features for hyperuricemia in individuals taking aspirin. In addition, triglyceride, hypertension, total cholesterol, high-density lipoprotein, low-density lipoprotein, age, race, and smoking were also correlated with the development of hyperuricemia. Conclusion: A predictive model established by XGBoost algorithms can potentially help clinicians make an early detection of hyperuricemia risk in people taking low-dose aspirin.

Dyslipidemia and hyperuricemia: a cross-sectional study of residents in Wuhu, China

BACKGROUND

While dyslipidemia has been recognized as a potential risk factor for hyperuricemia, there is currently a dearth of large-scale data specifically focused on studying the relationship between these two conditions. To address this gap, the present study analyzed a dataset of 298,891 physical examination records to investigate in greater detail the clinical classification and compositional relationship between hyperuricemia and dyslipidemia.

METHODS

For this investigation, a cross-sectional research design was utilized to analyze physical examination data that was gathered from Yijishan Hospital in Wuhu, China between 2011 and 2016. Logistic regression was employed to examine the association between hyperuricemia and dyslipidemia. Furthermore, the association between hyperuricemia and dyslipidemia was evaluated based on the clinical classifications of dyslipidemia and its components.

RESULTS

A total of 298,891 participants from China (124,886 [41.8%] females) were included in the study, with an age range of 18 to 90 years (mean [SD]: 47.76 [13.54] years). In multivariate analysis, the odds of hyperuricemia was 1.878 times higher in patients with dyslipidemia compared to those without dyslipidemia (95% confidence interval [CI]: 1.835-1.922). In the clinical classification of dyslipidemia, individuals with hypertriglyceridemia and mixed hyperlipidemia had 1.753 times (95% CI: 1.706-1.802) and 1.925 times (95% CI: 1.870-1.982) higher odds of hyperuricemia, respectively, compared to those without dyslipidemia. Among the components of dyslipidemia, the odds ratios for hyperuricemia in individuals in the fourth quartile compared to those in the first quartile were 3.744 (95% CI: 3.636-3.918) for triglycerides, 1.518 (95% CI: 1.471-1.565) for total cholesterol, and 1.775 (95% CI: 1.718 - 1.833) for non-high-density lipoprotein cholesterol.

CONCLUSIONS

Dyslipidemia has been independently linked with hyperuricemia. Moreover, the elevation of triglycerides or total cholesterol levels, including conditions such as hypertriglyceridemia and mixed hyperlipidemia, have been observed to have a positive association with the development of hyperuricemia.

Thyroid function, renal function, and depression: an association study

Objective

To investigate the correlations between thyroid function, renal function, and depression.

Methods

Clinical data of 67 patients with Major depressive disorder (MDD) and 36 healthy control subjects between 2018 and 2021 were collected to compare thyroid and renal function. Thyroid and renal functions of depressed patients were then correlated with the Hamilton Depression Rating Scale (HAMD) and the Hamilton Anxiety Rating Scale (HAMA).Spearman correlation analysis was used to find the correlation between renal function, thyroid function, and depression. A logistic regression was performed to find significant predictors of depression.

Results

Triiodothyronine protamine (T3), thyroxine (T4), free triiodothyronine protamine (FT3), uric acid, sodium, and anion gap were lower in the MDD group than in the control group (p < 0.05). Correlation analysis of thyroid function, renal function, and factor terms of HAMD in the MDD group suggested that diurnal variation, hopelessness, and depression level were positively correlated with thyrotropin (TSH) (p < 0.05). Cognitive disturbance, retardation, and depression level were negatively correlated with creatinine (p < 0.05). Diurnal variation was negatively correlated with sodium ion (p < 0.01); hopelessness and depression level were positively correlated with chloride ion (p < 0.05); diurnal variation, retardation, and depression level were negatively correlated with anion gap (p < 0.05). Diurnal variation (p < 0.01) and retardation (p < 0.05) were negatively correlated with osmolality. Cognitive disturbance and depression level were positively correlated with estimated glomerular filtration rate (eGFR) (p < 0.05). In the MDD group, correlation analysis of thyroid function, renal function, and HAMA factor terms suggested that the total HAMA score and anxiety level were positively correlated with chloride ion (p < 0.05); psychic anxiety, total HAMA score, and anxiety level were negatively correlated with anion gap (p < 0.05). Furthermore, a low level of anion gap was an independent risk factor for depression and anxiety levels (p < 0.05).

Conclusion

Low thyroid function and reduced waste metabolized by the kidneys in patients with MDD suggest a low intake and low metabolism in depressed patients. In addition, subtle fluctuations in the anion gap in depressed patients were strongly correlated with the degree of depression and anxiety.

Association between paroxysmal or persistent atrial fibrillation and hyperuricemia in patients who underwent coronary computed tomography angiography: from the FU-CCTA-AF Registry

BACKGROUND

Hyperuricemia (HU) and hypertension (HTN) contribute to atherosclerotic cardiovascular disease, and both are also involved in the onset and development of atrial fibrillation (AF).

OBJECTIVE

In the present study, we investigated the association between risk factors for atherosclerosis [including HU, HTN, blood pressure and serum uric acid (UA) levels] and paroxysmal atrial fibrillation (Paro-AF) or persistent atrial fibrillation (Pers-AF) in patients who underwent coronary computed tomography angiography (CCTA).

METHODS

We enrolled 263 patients from the Fukuoka University-CCTA-AF (FU-CCTA-AF Registry) who underwent CCTA prior to AF ablation therapy. AF was classified as either Paro-AF (≤ 7 days) or Pers-AF (> 7 days). HU was diagnosed by a serum UA level > 7.0 mg/dl, and coronary artery disease (CAD) was diagnosed when CCTA results showed ≥ 50% significant coronary artery stenosis. The number of significantly diseased coronary artery vessels (VD), the Gensini score and the coronary artery calcification score (CACS) were measured. Left atrial morphology was also evaluated.

RESULTS

Diastolic blood pressure and HbA1c in the Pers-AF group were significantly higher than those in the Paro-AF group. The Pers-AF group showed a significantly higher prevalence of HU and higher UA levels than the Paro-AF group. In a multivariate logistic regression analysis, HU was an independent associated factor to Pers-AF (odds ratio: 2.023, 95% confidence interval: 1.055-3.881, p = 0.034), while HTN was not.

CONCLUSION

In patients with AF, HU is associated with Pers-AF.

Women with Metabolic Syndrome and Unhealthy Lifestyle Factors Are at a Higher Risk for Hyperuricemia

Hyperuricemia (HUA) has become a significant medical concern due to its complications and links to metabolic syndrome (MetS) and cardiovascular disease (CVD), which result in increased mortality. The pathogenic processes associated with unhealthy behaviors, MetS, and HUA can be cooperative and potentially synergistic in the activation of risk factors. Recent research has shown sex-based differences in the relationship between HUA and its associated risk factors. This study aimed to investigate these differences, particularly in the context of MetS and CVD risk factors and unhealthy lifestyles. We also aimed to evaluate the joint effects of these factors based on sex. We conducted a cross-sectional study using nationally representative survey data from the Korean National Health and Nutritional Examination Survey 2016-2018. We performed multivariable logistic regression analysis, calculating adjusted odds ratios (ORs) with their 95% confidence intervals (CIs). We also conducted subgroup analyses based on sex and the presence of MetS with or without unhealthy lifestyle factors (tobacco use, alcohol intake). We found sex-based differences in the relationships between HUA and MetS, CVD risk factors, and lifestyle behaviors. Our major finding was a significant association between MetS and HUA in both men and women, regardless of alcohol consumption and smoking status, and this association was stronger in women. We also observed a synergistic effect of MetS and lifestyle factors on the risk of HUA, particularly in women, in whom the risk of HUA increased up to four times compared to the reference group. A sex-based clinical strategy for HUA is necessary to reduce related complications and their socio-economic burden.

Major adverse cardiovascular events and hyperuricemia during tuberculosis treatment

BACKGROUND

Hyperuricemia is common during tuberculosis (TB) treatment, especially in association with pyrazinamide (PZA). This study investigated the relationship between major adverse cardiovascular events (MACEs) and hyperuricemia during TB treatment.

METHODS

We conducted a single-center retrospective cohort study. From January 2010 through June 2017, we assessed all consecutive TB patients at Chonnam National University Hospital in South Korea. Hyperuricemia was defined as serum uric acid levels exceeding 7.0 mg/dL (men) and 6.0 mg/dL (women).

RESULTS

Of the 1,143 patients included, PZA was administered to 1,081 (94.6%), and hyperuricemia was detected in 941 (82.3%). Eight patients experienced MACEs. Multivariate analysis using logistic regression indicated that prior ischemic heart disease was associated with MACE development (OR,14.087; 95% CI,3.304-60.061; P < 0.000), while hyperuricemia was not (OR, 1.505; 95% CI, 0.184-12.299; P = 0.703). For patients without drug-resistant TB, the absence of hyperuricemia was associated with higher mortality (OR, 2.609; 95% CI, 1.066-6.389; P = 0.036), whereas hyperuricemia was associated with less worse outcomes (OR,0.316; 95% CI,0.173-0.576; P < 0.000).

CONCLUSIONS

Although most patients treated with PZA developed hyperuricemia, it was not associated with MACE development. Hyperuricemia during TB treatment was associated with better outcomes, possibly due to consistent adherence to TB treatment.

Association between urate-lowering therapy and cardiovascular events in patients with asymptomatic hyperuricemia

INTRODUCTION/OBJECTIVES

To investigate the role of urate-lowering therapy (ULT) in the prevention of cardiovascular disease (CVD) in patients with asymptomatic hyperuricemia using the Japanese healthcare record database.

METHODS

This retrospective cohort study used data from the JMDC Claims Database, which includes records of medical check-ups and Japanese health insurance claims. Subjects aged at least 18 years with a serum uric acid (sUA) level ≥ 7.0 mg/dL and at least one medical check-up from January 2007 to August 2021 were included in this study. The exposure was any ULT prescription, and the primary outcome included composite CVD outcomes, including coronary artery disease, stroke, and atrial fibrillation. Analysis was performed with a new-user design and overlap weighting to balance the baseline characteristics of the subjects. Cox proportional hazards models were used to investigate the association between ULT and the development of CVD.

RESULTS

In total, 152,166 patients were included in the main analysis before overlap weighting in this retrospective cohort study. The number of subjects in the ULT group was 5,270, and there were 146,896 subjects in the control group. Composite CVD outcomes were observed in a total of 7,703 patients. The risk of developing composite CVD outcomes was not different between the ULT group and the control group (HR: 1.01, 95% CI: 0.89 to 1.13).

CONCLUSIONS

ULT for patients with asymptomatic hyperuricemia did not prevent the development of CVD based on the Japanese claims database. Key points • Among subjects with asymptomatic hyperuricemia, ULT was not associated with a lower risk of CVD • There was no appropriate cutoff for initiating ULT in patients with asymptomatic hyperuricemia • There was no appropriate cutoff as the therapeutic goal of ULT in patients with asymptomatic hyperuricemia.

Serum uric acid to creatinine ratio as a risk factor for mortality among patients on continuous ambulatory peritoneal dialysis: a multi-center retrospective study

BACKGROUND

Serum uric acid to serum creatinine ratio (SUA/Scr) has emerged as a new biomarker, which is significantly associated with several metabolic diseases. However, no study has investigated the association between SUA/Scr and mortality among patients on continuous ambulatory peritoneal dialysis (CAPD).

METHODS

In this multicenter retrospective cohort study, we enrolled CAPD patients in eight tertiary hospitals in China from 1 January 2005 to 31 May 2021. Cox proportional hazard models were used to determine the relationship between SUA/Scr and mortality.

RESULTS

A total of 2480 patients were included; the mean age was 48.9 ± 13.9 years and 56.2% were males. During 12648.0 person-years of follow-up, 527 (21.3%) patients died, of which 267 (50.7%) deaths were caused by cardiovascular disease. After multivariable adjustment for covariates, per unit increase in SUA/Scr was associated with a 62.9% (HR, 1.629 (95% confidence interval (CI) 1.420-1.867)) and 73.0% (HR, 1.730 (95% CI 1.467-2.041)) higher risk of all-cause and cardiovascular mortality. Results were similar when categorized individuals by SUA/Scr quartiles. Compared with the lowest quartile of SUA/Scr, the highest and the second highest quartile of SUA/Scr had a 2.361-fold (95% CI 1.810-3.080) and 1.325-fold (95% CI 1.003-1.749) higher risk of all-cause mortality, as well as a 3.701-fold (95% CI 2.496-5.489) and 2.074-fold (95% CI 1.387-3.100) higher risk of cardiovascular mortality. Multivariable-adjusted spline regression models showed nonlinear association of SUA/Scr with mortality in CAPD patients.

CONCLUSIONS

Higher levels of SUA/Scr were associated with higher risk of all-cause and cardiovascular mortality in CAPD patients.

Associations of Serum Uric Acid Level With Liver Enzymes, Nonalcoholic Fatty Liver Disease, and Liver Fibrosis in Korean Men and Women: A Cross-Sectional Study Using Nationally Representative Data

BACKGROUND

This study aimed to determine whether serum uric acid (SUA) levels are associated with various indices of liver damage in the adult Korean population.

METHODS

We used the Seventh (VII) Korean National Health and Nutritional Examination Surveys. Our study population comprised 6,007 men and 8,488 women. Levels of SUA were divided into four groups (≤ 5.3, 5.3-6.0, 6.0-7.0, and > 7.0 mg/dL for men and ≤ 4.0, 4.0-4.8, 4.8-6.0, and > 6.0 mg/dL for women). Elevated liver enzyme levels were defined as > 35 (men) and > 31 (women) IU/L for aspartate aminotransferase (AST), > 45 (men) and > 34 (women) IU/L for alanine aminotransferase (ALT). Hepatic steatosis index and fibrosis (FIB)-4 index was used to determine nonalcoholic fatty liver disease (NAFLD) and liver FIB, respectively. Adjusted odds ratios (aORs) were calculated by logistic regression analysis for liver enzymes, NAFLD, and liver FIB, according to the SUA level.

RESULTS

Among women, the 4.8-6.0 and > 6.0 mg/dL SUA groups showed higher ORs of elevated AST (aOR, 1.78 and 2.03; 95% confidence interval [CI], 1.37-2.32 and 1.40-2.96, respectively; P < 0.001) and the 4.0-4.8, 4.8-6.0, and > 6.0 mg/dL SUA groups showed a higher ORs of ALT elevation (aOR, 1.35, 2.26, and 2.37; 95% CI, 1.02-1.79, 1.72-2.97, and 1.60-3.50, respectively; P < 0.001) compared to the lowest level SUA group. Among women with normal ALT, > 6.0 mg/dL SUA group showed higher OR of NAFLD status (aOR, 1.52; 95% CI, 1.06-2.19). Among men and women with NAFLD, hyperuricemia showed higher ORs of liver FIB (aOR, 2.25 and 1.89; 95% CI, 1.21-4.19 and 1.09-3.27, respectively) than the lowest level SUA group.

CONCLUSION

High SUA levels may be associated with elevated liver enzymes and NAFLD, mainly in women. Even in women with normal ALT levels, SUA levels may predict the NAFLD status. Hyperuricemia may predict advanced liver FIB in both men and women with NAFLD. Further studies investigating the causal effects of SUA on liver damage are required.

Prevalence and Risk Factors of Hyperuricemia in the Urban Health Checkup Population in Xinjiang, China: A Cross-Sectional Study

Purpose

In this study, the aim was to investigate the prevalence and risk factors of hyperuricemia (HUA) in the urban health checkup population in Urumqi, Xinjiang, and thus provide clues for the prevention of HUA.

Methods

People who attended medical examinations from May 2021 to June 2022 at a hospital in Urumqi, Xinjiang, were selected for evaluation based on their general information, physical examination results, and laboratory test results. The chi-square test was used to determine whether there was a difference in the prevalence of HUA among participants with different characteristics. Using logistic regression analyses, risk factors for HUA were identified.

Results

There were 8722 participants diagnosed with HUA, with an overall prevalence of 26.96%. The prevalence in men was 37.72%, significantly higher than in women (13.29%). Participants were characterized by a multiethnic composition, with Han (28.61%), Hui (27.88%) and Manchu (38.46%) being the three ethnicities with the highest prevalence. According to logistic regression analyses, HUA was associated with age, ethnicity, residence, marital status, body mass index (BMI), diastolic blood pressure (DBP), fasting blood glucose (FPG), triglyceride glucose (TyG) index, abdominal obesity, and dyslipidemia differently in males and females.

Conclusion

The prevalence of HUA was high in the urban health checkup population in Urumqi, Xinjiang, particularly among men and youth. The early intervention for HUA should be enhanced to reduce the risk of cardiovascular disease and other related conditions.

Relationship between serum uric acid and estimated glomerular filtration rate in adolescents aged 12-19 years with different body mass indices: a cross-sectional study

Background

Globally, chronic kidney disease (CKD) is a growing public health concern. Serum uric acid (SUA) is an easily detectable and readily available biochemical indicator that has long been recognized as an independent risk factor for CKD. In addition, studies have indicated a potential relationship between SUA and body mass index (BMI). However, studies on the effect of SUA levels on the estimated glomerular filtration rate (eGFR) in adolescents with different BMIs are very rare.

Methods

Weighted multiple regression analysis was used to estimate the independent relationship between SUA and log-transformed eGFR. Additionally, we used a weighted generalized additive model and smooth curve fitting to describe the nonlinear relationships in the subgroup analysis.

Results

First, SUA was negatively associated with log-transformed eGFR even after adjusting for all covariates (β=-0.0177, 95% CI: -0.0203-0.0151, P<0.0001). Second, the results of the stratified analysis found that after adjusting for all covariates, the decrease in log-transformed eGFR due to changes in per SUA levels (Per 1, mg/dL increase) was elevated in female adolescents (β=-0.0177, 95% CI: -0.0216, -0.0138, P<0.0001), adolescents aged 12-15 years (β=-0.0163, 95% CI: -0.0200, -0.0125, P<0.0001) and black (β=-0.0199, 95% CI: -0.0251, -0.0148, P<0.0001) adolescents. Furthermore, we found that adolescents with a higher BMI had higher SUA levels, and the effect of SUA on eGFR was significantly higher in underweight adolescents (β=-0.0386, 95% CI: (-0.0550, -0.0223), P<0.0001).

Conclusion

SUA was negatively associated with the eGFR in adolescents aged 12-19 years. Furthermore, we found for the first time that SUA affects the eGFR differently in adolescents with different BMIs. This effect was particularly significant in underweight adolescents.

Comparative Safety of Gout Treatment Strategies on Cardiovascular Outcomes Using Observational Data: Clone-censor-weight Target Trial Emulation Approach

BACKGROUND

We sought to examine the cardiovascular safety of intensive treat-to-target serum urate strategies for gout using Medicare claims data linked to electronic health record laboratory data.

METHODS

We selected patients with gout who initiated urate-lowering therapy. We emulated a hypothetical trial comparing the rate of major adverse cardiovascular events (nonfatal myocardial infarction, nonfatal stroke, and cardiovascular death) among seven different strategies over 24 months. Three aspects were considered in defining increasingly intensive strategies: (1) continuation of urate-lowering therapy, (2) serum urate monitoring, and (3) modification of urate-lowering therapy when serum urate >6 mg/dl. We applied the "clone-censor-weight" method to account for baseline and time-varying confounding.

RESULTS

We identified 4402 patients with gout who initiated urate-lowering therapy (mean age 77; male 60%). During a total of 6611 person-years (PY) of follow-up under usual care, the rate of major cardiovascular events (first and recurrent) was 4.5/100 PY (95% CI = 4.0, 5.1). The rate ratios (RRs) suggested reductions (RR point estimates 0.88-0.84) compared with usual care. All 95% CIs were imprecise, but their upper bounds excluded substantial increase in RRs. RRs were closer to 1.0 for the analysis focusing on the first major adverse cardiovascular event during follow-up and on comparison to the strategy requiring continuation of urate-lowering therapy (but not necessarily titration).

CONCLUSIONS

Our treatment strategy trial emulation did not find increased risk of major adverse cardiovascular events with intensive urate-lowering strategies. Results may provide reassurance of the cardiovascular safety of intensive treat-to-target serum urate strategies recommended by rheumatology societies.

Asymptomatic hyperuricaemia in chronic kidney disease: mechanisms and clinical implications

Asymptomatic hyperuricaemia (HU) is considered a pathogenic factor in multiple disease contexts, but a causative role is only proven for the crystalline form of uric acid in gouty arthritis and urate nephropathy. Epidemiological studies document a robust association of HU with hypertension, cardiovascular disease (CVD) and CKD progression, but CKD-related impaired uric acid (UA) clearance and the use of diuretics that further impair UA clearance likely accounts for these associations. Interpreting the available trial evidence is further complicated by referring to xanthine oxidase inhibitors as urate-lowering treatment, although these drugs inhibit other substrates, so attributing their effects only to HU is problematic. In this review we provide new mechanistic insights into the biological effects of soluble and crystalline UA and discuss clinical evidence on the role of asymptomatic HU in CKD, CVD and sterile inflammation. We identify research areas with gaps in experimental and clinical evidence, specifically on infectious complications that represent the second common cause of death in CKD patients, referred to as secondary immunodeficiency related to kidney disease. In addition, we address potential therapeutic approaches on how and when to treat asymptomatic HU in patients with kidney disease and where further interventional studies are required.

Gout and hyperuricaemia: modifiable cardiovascular risk factors?

Gout and hyperuricaemia are two clinical situations associated with an elevated risk of developing cardiovascular (heart failure, myocardial infarction, stroke) and metabolic and renal complications. One reason is probably related to the fact that the prevalence of hyperuricaemia and gout is high in clinical situations, which themselves involve a high cardiovascular risk, such as hypertension, diabetes, chronic kidney disease or obesity. However, recent studies suggest that hyperuricaemia may promote cardiovascular complications independently of other cardiovascular risk factors, by inducing chronic inflammation, oxidative stress, and endothelial dysfunction. The questions that arise today concern primarily the treatment of asymptomatic hyperuricaemia. Should it be treated to decrease the patients' cardiovascular risk and if so, starting from which level and towards which target? There are now several pieces of evidence indicating that this might be useful, but data from large studies are not unanimous. This review will discuss this issue as well as new well-tolerated treatments, such as febuxostat or SGLT2 inhibitors, which lower uric acid levels, prevent gout and lower the risk of cardio-renal events.

The synergistic effect of the triglyceride-glucose index and serum uric acid on the prediction of major adverse cardiovascular events after coronary artery bypass grafting: a multicenter retrospective cohort study

BACKGROUND

Elevated serum uric acid (SUA) is regarded as a risk factor for the development of cardiovascular diseases. Triglyceride-glucose (TyG) index, a novel surrogate for insulin resistance (IR), has been proven to be an independent predictor for adverse cardiac events. However, no study has specifically focused on the interaction between the two metabolic risk factors. Whether combining the TyG index and SUA could achieve more accurate prognostic prediction in patients undergoing coronary artery bypass grafting (CABG) remains unknown.

METHODS

This was a multicenter, retrospective cohort study. A total of 1225 patients who underwent CABG were included in the final analysis. The patients were grouped based on the cut-off value of the TyG index and the sex-specific criteria of hyperuricemia (HUA). Cox regression analysis was conducted. The interaction between the TyG index and SUA was estimated using relative excess risk due to interaction (RERI), attributable proportion (AP), and synergy index (SI). The improvement of model performance yielded by the inclusion of the TyG index and SUA was examined by C-statistics, net reclassification improvement (NRI) and integrated discrimination improvement (IDI). The goodness-of-fit of models was evaluated using the Akaike information criterion (AIC), Bayesian information criterion (BIC) and χ2 likelihood ratio test.

RESULTS

During follow-up, 263 patients developed major adverse cardiovascular events (MACE). The independent and joint associations of the TyG index and SUA with adverse events were significant. Patients with higher TyG index and HUA were at higher risk of MACE (Kaplan-Meier analysis: log-rank P < 0.001; Cox regression: HR = 4.10; 95% CI 2.80-6.00, P < 0.001). A significant synergistic interaction was found between the TyG index and SUA [RERI (95% CI): 1.83 (0.32-3.34), P = 0.017; AP (95% CI): 0.41 (0.17-0.66), P = 0.001; SI (95% CI): 2.13 (1.13-4.00), P = 0.019]. The addition of the TyG index and SUA yielded a significant improvement in prognostic prediction and model fit [change in C-statistic: 0.038, P < 0.001; continuous NRI (95% CI): 0.336 (0.201-0.471), P < 0.001; IDI (95% CI): 0.031 (0.019-0.044), P < 0.001; AIC: 3534.29; BIC: 3616.45; likelihood ratio test: P < 0.001).

CONCLUSIONS

The TyG index interacts synergistically with SUA to increase the risk of MACE in patients undergoing CABG, which emphasizes the need to use both measures concurrently when assessing cardiovascular risk.

Postoperative Hyperuricemia-A Risk Factor in Elective Cardiosurgical Patients

Hyperuricemia is a well-known cardiovascular risk factor. The aim of our study was to investigate the connection between postoperative hyperuricemia and poor outcomes after elective cardiac surgery compared to patients without postoperative hyperuricemia. In this retrospective study, a total of 227 patients after elective cardiac surgery were divided into two groups: 42 patients with postoperative hyperuricemia (mean age 65.14 ± 8.9 years) and a second group of 185 patients without it (mean age 62.67 ± 7.45 years). The time spent on mechanical ventilation (hours) and in the intensive care unit (days) were taken as the primary outcome measures while the secondary measure comprised postoperative complications. The preoperative patient characteristics were similar. Most of the patients were men. The EuroSCORE value of assessing the risk was not different between the groups nor the comorbidities. Among the most common comorbidities was hypertension, seen in 66% of all patients (69% in patients with postoperative hyperuricemia and 63.7% in those without it). A group of patients with postoperative hyperuricemia had a prolonged time of treatment in the intensive care unit (p = 0.03), as well as a prolonged duration of mechanical ventilation (p < 0.01) and a significantly higher incidence of the following postoperative complications: circulatory instability and/or low cardiac output syndrome (LCOS) (χ2 = 4486, p < 0.01), renal failure and/or continuous venovenous hemodiafiltration (CVVHDF's) (χ2 = 10,241, p < 0.001), and mortality (χ2 = 5.22, p < 0.01). Compared to patients without postoperative hyperuricemia, elective cardiac patients with postoperative hyperuricemia have prolonged postoperative treatment in intensive care units, extended durations of mechanically assisted ventilation, and a higher incidence of postoperative circulatory instability, renal failure, and death.