Higher serum levels of uric acid are associated with a reduced insulin clearance in non-diabetic individuals

Sex-related differences for uric acid in the prediction of cardiovascular events in essential hypertension. A population prospective study

BACKGROUND

Uric acid (UA) is an independent prognostic factor for cardiovascular events, but there are no data demonstrating a different risk profile between women and men. Thus, we tested whether UA is associated with a possible sex-related difference in fatal and non-fatal cardiovascular events.

METHODS

In this prospective population-based study we enrolled 1,650 never-treated Caucasian hypertensive outpatients referred to Catanzaro University Hospital (Italy). Inclusion criteria were newly diagnosed hypertensive patients, aged 20 years or more. Exclusion criteria were secondary form of hypertension, previous cardiovascular events, rheumatic and non-rheumatic valvular heart disease, prosthetic valves, cardiomyopathies, type-2 diabetes, chronic kidney disease, malignant diseases, gout arthritis and secondary forms of hyperuricemia, liver diseases, peripheral vascular diseases, and heart failure. Anthropometric, clinical, and biochemical parameters were measured. UA prognostic role was investigated by Cox regression analyses. Receiver-operating characteristic curve analyses and area under the curve were used to determine the predictive validity and the optimal cut-off point of UA. We investigated following endpoints: coronary events (fatal and nonfatal myocardial infarction, unstable angina, coronary revascularization procedures, coronary death); fatal and nonfatal stroke; all-cause mortality and major adverse cardiovascular events (MACE).

RESULTS

We enrolled 830 males and 820 females aged 52.2 ± 11.3 years. During 9.5 ± 3.1 years follow-up, there were 424 new clinical events (2.71%): 250 coronary (1.59%), 118 (0.75%) cerebrovascular, and 56 (0.40%) deaths. Comparison between groups demonstrated a higher and significant difference in incidence rate in females for MACE (3.08 vs 2.33%, P = 0.001), coronary (1.82 vs 1.36%, P = 0.014) and cerebrovascular events (0.93 vs 0.57%, P = 0.006). UA at multiple Cox regression analysis resulted a strong and significant predictor of coronary events (HR = 1.493;95% CI 1.375-1.621), cerebrovascular events (HR = 1.256;95% CI 1.109-1.423), MACE (HR = 1.415;95% CI 1.328- 53 1.508), and all-cause mortality (HR = 1.469;95% CI 1.237-1.745) in the whole population and in both groups with a HR higher in females. The best estimated cut-off values of uric acid for males and females predicted these endpoints equally well, but it was always lower in females than males.

CONCLUSIONS

We demonstrate, that UA operates with a sex-related impact and best cut-off value in predicting cardiovascular outcomes and all-cause mortality, reflecting a possible sex difference in disease pathophysiology.

Effects of salvianolic acid A on intestinal microbiota and lipid metabolism disorders in Zucker diabetic fatty rats

Salvianolic acid A (SalA) is the main water-soluble component isolated from Salvia miltiorrhiza. This study explored the influences of SalA on intestinal microbiota composition and lipid metabolism in Zucker diabetic fatty (ZDF) rats. The 6-week-old male ZDF rats were treated with distilled water (N = 10) and low dose (SalA 0.5 mg/kg/d, N = 10), medium dose (SalA 1 mg/kg/d, N = 10), and high dose (SalA 2 mg/kg/d, N = 10) of SalA, with the male Zucker lean normoglycemic rats of the same week age as controls (given distilled water, N = 10). The blood glucose, body weight, and food intake of rats were examined. After 7 and 8 weeks of continuous administration, oral glucose tolerance test (OGTT) and insulin tolerance test (ITT) were performed, respectively. Serum fasting insulin (FINS), total cholesterol (TC), triglyceride (TG), and free fatty acid (FFA) were determined. Liver tissues were stained using hematoxylin-eosin (HE) and oil red O staining. Fecal samples were analyzed by 16S rRNA gene sequencing. Small intestinal tissues were stained using HE and immunohistochemistry. The tight junction proteins (ZO-1/Occludin/Claudin-1) and serum levels of LPS/TNF-α/IL-6 were evaluated. SalA reduced insulin resistance, liver injury, serum FFA, liver TC and TG levels in ZDF rats, and improved lipid metabolism. After SalA treatment, intestinal microbiota richness and diversity of ZDF rats were promoted. SalA retained the homeostasis of intestinal core microbiota. SalA reduced intestinal epithelial barrier damage, LPS, and inflammatory cytokines in ZDF rats. Overall, SalA can sustain intestinal microbiota balance and improve the lipid metabolism of ZDF rats.

Hyperuricemia Is Associated With the Risk of Atrial Fibrillation Independent of Sex: A Dose-Response Meta-Analysis

Background:

Conflicting findings of the association between serum uric acid (SUA) and atrial fibrillation (AF) have been reported in both men and women. The sex-specific associations between SUA and the risk of AF are unclear, although hyperuricemia is independently associated with the risk of AF. We performed this meta-analysis to assess the sex-specific effect of SUA on the risk of AF.

Methods

The PubMed, EMBASE, and Cochrane Library databases were searched up to October 3, 2021, for studies that reported sex-specific associations of SUA levels with AF. Linear relationships were assessed by the generalized least squares trend estimation. This study was registered with PROSPERO (42020193013).

Results

Ten eligible studies with 814,804 participants (415,779 men and 399,025 women) were identified. In the category analysis, high SUA was associated with an increased risk of AF in both men (OR: 1.42; 95% CI, 1.18–1.71, I² = 34%) and women (OR: 2.02; 95% CI, 1.29–3.16, I² = 70%). In the dose-response analysis, for each 60 μmol/L (1 mg/dL) increase in the SUA level, the risk of AF increased by 15% (OR: 1.15; 95% CI, 1.07–1.25, I² = 74%) in men and 35% (OR: 1.35; 95% CI, 1.18–1.53, I² = 73%) in women. There was a borderline difference in the impact of SUA on the risk of AF between men and women (P for interaction = 0.05). A significant linear relationship between SUA and the risk of AF was observed in men (P for non-linearity = 0.91) and women (P for non-linearity = 0.92).

Conclusions

This study suggested that there was a significant linear relationship between SUA and the risk of AF among men and women, with a higher risk estimate for women. Additional trials are required to assess the effect of reduced SUA therapy on AF incidence.

Systematic Review Registration

https:www.crd.york.ac.uk/PROSPERO/, identifier: CRD 42020193013.

Evaluation of the prognostic ability of serum uric acid for elderly acute coronary syndrome patients with diabetes mellitus: a prospective cohort study

OBJECTIVES

This study evaluated the prognostic power of serum uric acid (UA) in predicting adverse events in elderly acute coronary syndrome (ACS) patients with diabetes mellitus (DM).

METHODS

The analysis involved 718 ACS patients ‍>80 years old whose general clinical data and baseline blood biochemical indicators were collected prospectively from January 2006 to December 2012. These patients were classified into two groups based on DM status, and then followed up after discharge. The Kaplan-Meier method was used for major adverse cardiac event (MACE) rates and all-cause mortality. Multivariate Cox regression was performed to analyze the relationship between UA level and long-term clinical prognosis. Receiver operating characteristic (ROC) curves were analyzed to predict the cutoff value of UA in elderly ACS patients with DM. There were 242 and 476 patients in the DM and non-DM (NDM) groups, respectively, and the follow-up time after discharge was 40‒120 months (median, 63 months; interquartile range, 51‒74 months).

RESULTS

The all-cause mortality, cardiac mortality, and MACE rates in both DM and NDM patients were higher than those in the control group (P=0.001). All-cause mortalities, cardiac mortalities, and MACE rates in DM patients with moderate and high UA levels were significantly higher than those in the NDM group (P=0.001). Long-term survival rates decreased significantly with increased UA levels in the ACS groups (P=0.001). UA (odds ratio (OR)=2.106, 95% confidence interval (CI)=1.244‒3.568, P=0.006) was found to be an independent risk factor for all-cause mortality and MACE in elderly ACS patients with DM. The cutoff value of UA was 353.6 μmol/L (sensitivity, 67.4%; specificity, 65.7%).

CONCLUSIONS

Serum UA level is a strong independent predictor of long-term all-cause death and MACE in elderly ACS patients with DM.

Lower insulin clearance is associated with increased risk of type 2 diabetes in Native Americans

AIMS/HYPOTHESIS

Impaired insulin clearance is implicated in the pathogenesis of type 2 diabetes, but prospective evidence remains limited. Therefore, we sought to identify factors associated with the metabolic clearance rate of insulin (MCRI) and to investigate whether lower MCRI is associated with increased risk of incident type 2 diabetes.

METHODS

From a longitudinal cohort, 570 adult Native Americans without diabetes living in the Southwestern United States were characterised at baseline and 448 participants were monitored over a median follow-up period of 7.9 years with 146 (32%) incident cases of diabetes identified (fasting plasma glucose ≥7.0 mmol/l, 2 h plasma glucose [2-h PG] ≥11.1 mmol/l, or clinical diagnosis). At baseline, participants underwent dual-energy x-ray absorptiometry or hydrodensitometry to assess body composition, a 75 g OGTT, an IVGTT to assess acute insulin response (AIR), and a hyperinsulinaemic-euglycaemic clamp to assess MCRI and insulin action (M).

RESULTS

In adjusted linear models, MCRI was inversely associated with body fat percentage (r = -0.35), fasting plasma insulin (r = -0.55) and AIR (r = -0.22), and positively associated with M (r = 0.17; all p < 0.0001). In multivariable Cox proportional hazard models, lower MCRI was associated with an increased risk of diabetes after adjustment for age, sex, heritage, body fat percentage, AIR, M, fasting plasma glucose, 2-h PG, and fasting plasma insulin (HR per one-SD difference in MCRI: 0.77; 95% CI 0.61, 0.98; p = 0.03).

CONCLUSIONS/INTERPRETATION

Lower MCRI is associated with an unfavourable metabolic phenotype and is associated with incident type 2 diabetes independent of established risk factors.

CLINICAL TRIAL REGISTRATION NUMBERS

ClinicalTrials.gov NCT00339482; NCT00340132.

High heart rate amplifies the risk of cardiovascular mortality associated with elevated uric acid

AIMS

Whether the association between uric acid (UA) and cardiovascular disease is influenced by some facilitating factors is unclear. The aim of this study was to investigate whether the risk of cardiovascular mortality (CVM) associated with elevated UA was modulated by the level of resting heart rate (HR).

METHODS AND RESULTS

Multivariable Cox analyses were made in 19 128 participants from the multicentre Uric acid Right for heArt Health study. During a median follow-up of 11.2 years, there were 1381 cases of CVM. In multivariable Cox models both UA and HR, either considered as continuous or categorical variables were independent predictors of CVM both improving risk discrimination (P ≤ 0.003) and reclassification (P < 0.0001) over a multivariable model. However, the risk of CVM related to high UA (≥5.5 mg/dL, top tertile) was much lower in the subjects with HR

CONCLUSION

This data suggest that the contribution of UA to determining CVM is modulated by the level of HR supporting the hypothesis that activation of the sympathetic nervous system facilitates the action of UA as a cardiovascular risk factor.

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Key Words

• Cardiovascular
• Heart rate
• Longitudinal study
• Mortality
• Sympathetic activity
• Uric acid

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Affiliation(s)

Paolo Palatini Department of Medicine, Studium Patavinum, University of Padova, Via S. Fris 121, 31029 Vittorio Veneto, Italy
Gianfranco Parati S. Luca Hospital, Istituto Auxologico Italiano & University of Milan-Bicocca, Milan, Italy
Agostino Virdis Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
Gianpaolo Reboldi Department of Medical and Surgical Science, University of Perugia, Perugia, Italy
Stefano Masi Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
Alessandro Mengozzi Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
Edoardo Casiglia Department of Medicine, University of Padua, Padua, Italy
Valerie Tikhonoff Department of Medicine, University of Padua, Padua, Italy
Arrigo F G Cicero Alma Mater Studiorum University of Bologna, Bologna, Italy
Andrea Ungar Department of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Florence, Italy
Giulia Rivasi Department of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Florence, Italy
Massimo Salvetti Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
Carlo M Barbagallo Biomedical Department of Internal Medicine and Specialistics, University of Palermo, Palermo, Italy
Michele Bombelli Department of Cardiovascular, Neural and Metabolic Sciences, Clinica Medica, Monza, Italy Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
Raffaella Dell'Oro Department of Cardiovascular, Neural and Metabolic Sciences, Clinica Medica, Monza, Italy Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
Berardino Bruno Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
Luciano Lippa Italian Society of General, Medicine (SIMG), Avezzano, L'Aquila, Italy
Lanfranco D'Elia Department of Clinical Medicine and Surgery, "Federico II" University of Naples Medical School, Naples, Italy
Paolo Verdecchia Hospital S. Maria della Misericordia, Perugia, Italy
Fabio Angeli Department of Medicine and Surgery, University of Insubria, Varese, Italy Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institutes, IRCCS Tradate, Varese, Italy
Francesca Mallamaci CNR-IFC, Clinical Epidemiology of Renal Diseases and Hypertension, Reggio Cal Unit, Reggio Calabria, Italy
Massimo Cirillo Department of Public Health, "Federico II" University of Naples, Napoli, Italy
Marcello Rattazzi Department of Medicine-DIMED, University of Padova, Medicina, Interna 1°, Ca' Foncello University Hospital, Treviso, Italy
Pietro Cirillo Department of Emergency and Organ Transplantation-Nephrology, Dialysis and Transplantation Unit, Aldo Moro University of Bari, Bari, Italy
Loreto Gesualdo Department of Emergency and Organ Transplantation-Nephrology, Dialysis and Transplantation Unit, Aldo Moro University of Bari, Bari, Italy
Alberto Mazza Department of Internal Medicine, Hypertension Unit, General Hospital, Rovigo, Italy
Cristina Giannattasio Cardiology IV, 'A. De Gasperis' Department, Niguarda Ca' Granda Hospital, Milano, Italy Health Science Department, Milano-Bicocca University, Milano, Italy
Alessandro Maloberti Cardiology IV, 'A. De Gasperis' Department, Niguarda Ca' Granda Hospital, Milano, Italy Health Science Department, Milano-Bicocca University, Milano, Italy
Massimo Volpe Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome Sapienza, Sant'Andrea Hospital, Rome, Italy IRCCS Neuromed, Pozzilli (IS), Italy
Giuliano Tocci Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome Sapienza, Sant'Andrea Hospital, Rome, Italy IRCCS Neuromed, Pozzilli (IS), Italy
Georgios Georgiopoulos First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, Athens, Greece
Guido Iaccarino Department of Advanced Biomedical Sciences, "Federico II" University of Naples, Napoli, Italy
Pietro Nazzaro Department of Medical Basic Sciences, Neurosciences and Sense Organs, University of Bari Medical School, Bari, Italy
Ferruccio Galletti Department of Clinical Medicine and Surgery, "Federico II" University of Naples Medical School, Naples, Italy
Claudio Ferri Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
Giovambattista Desideri Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
Francesca Viazzi Department of Internal Medicine, University of Genoa and Policlinico San Martino, Genova, Italy
Roberto Pontremoli Department of Internal Medicine, University of Genoa and Policlinico San Martino, Genova, Italy
Maria Lorenza Muiesan Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
Guido Grassi Department of Cardiovascular, Neural and Metabolic Sciences, Clinica Medica, Monza, Italy Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
Claudio Borghi Alma Mater Studiorum University of Bologna, Bologna, Italy

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Uric acid, impaired fasting glucose and impaired glucose tolerance in youth with overweight and obesity

BACKGROUND AND AIM

The relationships between uric acid (UA) and prediabetes is poorly explored in youth. We investigated the association between UA, impaired fasting glucose (IFG), impaired glucose tolerance (IGT), insulin resistance (IR) and low insulin sensitivity (IS) in youth with overweight/obesity (OW/OB).

METHODS AND RESULTS

A cross-sectional study was performed in 2248 youths with OW/OB (age 5-17 years). The sample was stratified in sex-specific quintiles (Q1 to Q5) of UA and the associations with fasting (FG), 2-h post-load glucose (2H-PG), IR and low IS were investigated. IR and low IS were estimated by assessment model of insulin resistance (HOMA-IR) and whole-body IS index (WBISI), respectively. IFG was defined as FG ≥ 100 < 126 mg/dL, IGT as 2H-PG ≥140 < 200 mg/dL, IR as HOMA-IR ≥75th percentile and low IS as WBISI ≤25th percentile by sex. Age, body mass index z-score, 2H-PG, HOMA-IR and WBISI, increased across sex-quintiles of UA while FG did not. The prevalence of IFG and IR were significantly increased in Q5 vs Q1 (reference quartile, P < 0.025). The prevalence of IGT increased from Q3 to Q5 vs Q1 (P < 0.025-0.0001) and that of low IS from Q2 to Q5 vs Q1 (P < 0.005-0.0001).

CONCLUSIONS

In youth with OW/OB, rates of IGT and low IS increased progressively across quintiles of UA. On the contrary, IFG and IR were associated only with the highest quintile of UA. Our data suggest that UA is a biomarker of impaired glucose metabolism prevalently in post-challenge condition rather than in fasting state.

Association between Coronary Artery Spasm and the risk of incident Diabetes: A Nationwide population-based Cohort Study

Background: Non-diabetic coronary artery spasm (CAS) without obstructive coronary artery disease increases insulin resistance. We investigated the risk of incident type 2 diabetes (diabetes) associated with CAS. Methods: Patient records were retrospectively collected from the Taiwan National Health Insurance Research Database during the period 2000-2012. The matched cohorts consisted of 12,413 patients with CAS and 94,721 patients in the control group. Results: During the entire follow-up, the incidence of newly-diagnosed diabetes was 22.2 events per 1000 person-years in the CAS group and 13.9 events per 1000 person-years in the control group. The increased risk of CAS-related incident diabetes was observed regardless of sex and length of follow-up. The median time to incident diabetes was 2.9 and 3.5 years in the CAS and the control group (P <0.001), respectively, regardless of sex. Although age did not affect the risk of CAS-related incident diabetes, the risk was less apparent in the subgroups of male, dyslipidemia, chronic obstructive pulmonary disease, stroke, gout and medicated hypertension. However, CAS patients aged <50 years compared with patients ≥50 years had a greater risk of incident diabetes in females but not in males. Older CAS patients developed diabetes in a shorter length of time than younger patients. Conclusion: CAS is a risk factor for incident diabetes regardless of sex. However, females aged <50 years have a more apparent risk for CAS-related diabetes than old females, which is not observed in males. The median time of 2.9 years to incident diabetes warrants close follow-up.

Uric Acid and Vascular Damage in Essential Hypertension: Role of Insulin Resistance

Increased levels of uric acid (UA) have been shown to be correlated with many clinical conditions. Uric acid may adversely affect the insulin signalling pathway inducing insulin resistance (IR). Several studies report the association between arterial stiffness (AS), an early indicator of atherosclerosis, and UA. The purpose of the present study was to evaluate the association between UA and AS, considering the potential role of IR. We enrolled 1114 newly diagnosed, never-treated hypertensive patients. Insulin resistance was assessed by the homeostatic model assessment (HOMA) index. Arterial stiffness was evaluated as the measurement of the carotid–femoral pulse wave velocity (PWV). The study cohort was divided into subgroups, according to increasing tertiles of UA. The mean values of UA were 5.2 ± 1.6 mg/dL in the overall population. Pulse wave velocity was linearly correlated with UA (p < 0.0001), HOMA (p < 0.0001), high sensitivity C-reactive protein (p < 0.0001), systolic blood pressure (p < 0.0001) and LDL cholesterol (p = 0.005). Uric acid was the strongest predictor of PWV and was associated with the highest risk for increased AS. The interaction analysis showed that the joint effect of increased UA and HOMA was significantly higher than that expected in the absence of interaction under the additive model, indicating that the two biomarkers synergically interacted for promoting vascular damage. Our data showed that UA interacted with IR to increase AS in a large cohort of newly diagnosed, never-treated hypertensive patients.

Integrated omics analysis reveals the alteration of gut microbe-metabolites in obese adults

Obesity, a risk to health, is a global problem in modern society. The prevalence of obesity was approximately 13% among world's adult population. Recently, several reports suggested that the interference of gut microbiota composition and function is associated with metabolic disorders, including obesity. Gut microbiota produce a board range of metabolites involved in energy and glucose homeostasis, leading to the alteration in host metabolism. However, systematic evaluation of the relationship between gut microbiota, gut metabolite and host metabolite profiles in obese adults is still lacking. In this study, we used comparative metagenomics and metabolomics analysis to determine the gut microbiota and gut-host metabolite profiles in six normal and obese adults of Chinese origin, respectively. Following the functional and pathway analysis, we aimed to understand the possible impact of gut microbiota on the host metabolites via the change in gut metabolites. The result showed that the change in gut microbiota may result in the modulation of gut metabolites contributing to glycolysis, tricarboxylic acid cycle and homolactic fermentation. Furthermore, integrated metabolomic analysis demonstrated a possible positive correlation of dysregulated metabolites in the gut and host, including l-phenylalanine, l-tyrosine, uric acid, kynurenic acid, cholesterol sulfate and glucosamine, which were reported to contribute to metabolic disorders such as obesity and diabetes. The findings of this study provide the possible association between gut microbiota-metabolites and host metabolism in obese adults. The identified metabolite changes could serve as biomarkers for the evaluation of obesity and metabolic disorders.

Blood glucose fluctuations detected by continuous glucose monitoring system in gout patients with normal glucose tolerance and the effect of urate-lowering therapy

AIM

The aim of this study was to investigate whether there are blood glucose fluctuations in gout patients with hyperuricemia and normal glucose tolerance, and the effect of urate-lowering therapy on blood glucose fluctuations.

METHODS

Thirty patients with newly diagnosed gout, hyperuricemia and normal glucose tolerance were enrolled in our study. Continuous glucose monitoring system (CGMS) was used to detect the blood glucose fluctuations of these gout patients. Changes in blood glucose fluctuations after allopurinol therapy were also evaluated.

RESULTS

Compared with the reference values of blood glucose fluctuation parameters in China, gout patients had greater glycemic fluctuations including higher mean amplitude of glucose excursions (MAGE) (4.65 vs 1.94 mmol/L, P < .001), higher largest amplitude of blood glucose excursions (LAGE) (4.99 vs 3.72 mmol/L, P < .001) and higher standard deviations of blood glucose (SDBG) (1.36 vs 0.79 mmol/L, P < .001). MAGE was significantly correlated with uric acid (β = .007, P = .024) and HOMA-insulin resistance (IR) (β = .508, P = .03). Allopurinol treatment significantly reduced MAGE (4.16 vs 4.65 mmol/L, P < .001), SDBG (0.99 vs 1.36 mmol/L, P < .001) and HOMA-IR (2.26 vs 3.01, P < .001) in gout patients.

CONCLUSION

Blood glucose fluctuation increased even in the stage of normal glucose tolerance among gout patients. Blood glucose fluctuations in gout patients were associated with the level of serum uric acid and allopurinol could decrease blood glucose fluctuation as well as IR.

Hyperuricemia is associated with sympathovagal imbalance in older adults

PURPOSE

This study aimed to compare heart rate variability (HRV) parameters obtained through symbolic analysis (SA), between older adults with and without hyperuricemia.

METHODS

This is a cross-sectional study including 202 community-dwelling old adults, which was clinically stratified as with or without hyperuricemia, according to the cutoff point of serum uric acid ≥ 6 mg/dL for women and ≥ 7 mg/dL for men. Successive RR intervals were recorded along 5 min and analyzed with SA method. 0 V%, 1 V% and 2 V% patterns were quantified and compared between groups. Comparisons were carried out through parametric or nonparametric tests, according to the data distribution characteristics, evaluated by Kolmogorov-Smirnov test. The significance level was set as p ≤ 0.05 for all statistical procedures.

RESULTS

The prevalence of hyperuricemia was 67.8 %, and the hyperuricemic older adults exhibited significant higher values for V0% and lower values for V2% parameters when compared to normouricemic older adults.

CONCLUSION

These results suggesting a sympathovagal imbalance in hyperuricemic older adults, characterized by greater sympathetic predominance (0 V%) and lower vagal modulation (2 V%) at rest conditions.

The role of physical activity in individuals with cardiovascular risk factors: an opinion paper from Italian Society of Cardiology-Emilia Romagna-Marche and SIC-Sport

: Regular physical activity is a cornerstone in the prevention and treatment of atherosclerotic cardiovascular disease (CVD) due to its positive effects in reducing several cardiovascular risk factors. Current guidelines on CVD suggest for healthy adults to perform at least 150 min/week of moderate intensity or 75 min/week of vigorous intensity aerobic physical activity. The current review explores the effects of physical activity on some risk factors, specifically: diabetes, dyslipidemia, hypertension and hyperuricemia. Physical activity induces an improvement in insulin sensitivity and in glucose control independently of weight loss, which may further contribute to ameliorate both diabetes-associated defects. The benefits of adherence to physical activity have recently proven to extend beyond surrogate markers of metabolic syndrome and diabetes by reducing hard endpoints such as mortality. In recent years, obesity has greatly increased in all countries. Weight losses in these patients have been associated with improvements in many cardiometabolic risk factors. Strategies against obesity included caloric restriction, however greater results have been obtained with association of diet and physical activity. Similarly, the beneficial effect of training on blood pressure via its action on sympathetic activity and on other factors such as improvement of endothelial function and reduction of oxidative stress can have played a role in preventing hypertension development in active subjects. The main international guidelines on prevention of CVD suggest to encourage and to increase physical activity to improve lipid pattern, hypertension and others cardiovascular risk factor. An active action is required to the National Society of Cardiology together with the Italian Society of Sports Cardiology to improve the prescription of organized physical activity in patients with CVD and/or cardiovascular risk factors.

In-situ synthesis of 3D ultra-small gold augmented graphene hybrid for highly sensitive electrochemical binding capability

The fascinating properties of graphene can be augmented with other nanomaterials to generate hybrids to design innovative applications. Contrary to the conventional methodologies, we showed a novel yet simple, in-situ, biological approach which allowed for the effective growth of gold nanostructures on graphene surfaces (3D Au NS@GO). The morphology of the obtained hybrid consisted of sheets of graphene, anchoring uniform dispersion of ultra-small gold nanostructures of about 2-8 nm diameter. Surface plasmon resonance at 380 nm confirmed the nano-regimen of the hybrid. Fourier transform infrared spectroscopy indicated the utilization of amine spacers to host gold ions leading to nucleation and growth. The exceptional positive surface potential of 55 mV suggest that the hybrid as an ideal support for electrocatalysis. Ultimately, the hybrid was found to be an efficient receptor material for electrochemical performance towards the binding of uric acid which is an important biomolecule of human metabolism. The designed material enabled the detection of uric acid concentrations as low as 30 nM. This synthesis strategy is highly suitable to design new hybrid materials with interesting morphology and outstanding properties for the identification of clinically relevant biomolecules.

Dynamics of associations between perfluoroalkyl substances and uric acid across the various stages of glomerular function

National Health and Nutrition Examination Survey 2007-2014 data (N = 6844) for adults aged ≥ 20 years were analyzed to estimate associations of perfluoroalkyl substances (PFAS), namely, PFOA, PFOS, PFDA, PFHxS, and PFNA with uric acid across stages of declining glomerular function. The population was stratified by the estimated glomerular filtration rates (eGFR) stages accompanying kidney disease: GF-1 with eGFR > 90 mL/min/1.73 m²; GF-2 with eGFR 60-89 mL/min/1.73 m²; GF-3A with eGFR 45-59 mL/min/1.73 m²; and GF-3B/4 with eGFR 15-44 mL/min/1.73 m². Adjusted and unadjusted geometric means of uric acid increased from GF-1 to GF-3B/4 for males and females. Adjusted geometric means for uric acid were higher for males by 1.38, 1.03, and 0.62 mg/dL for GF-1, GF2, and GF-3 respectively but for GF-3B/4, females had higher adjusted geometric means than males by 0.16 mg/dL, revealing narrowing of sex differences in uric acid as glomerular function declines. The direction of association between PFAS and uric acid was positive for GF-1 and GF-2 for males and for every PFAS except PFDA for females. For males for GF-3B/4, association between every PFAS except PFHxS and uric acid was found to be negative (p < 0.01). For females, only PFHxS actually reverses its relationship with increasing stages of renal disease. Uric acid associations with PFAS reverse in males with advanced renal failure. An implication is that previously reported association of PFAS exposure with uric acid is not due to renal failure. Understanding of other biomarkers associated with both PFAS exposure and renal failure may benefit from similar evaluation.

Effects of Uric Acid on Diabetes Mellitus and Its Chronic Complications

With the deepening of the researches on uric acid, especially in the study of metabolic diseases, uric acid has been found to be closely related to obesity, metabolic syndrome, nonalcoholic fatty liver disease, diabetes, and other metabolic diseases. Uric acid causes a series of pathophysiological changes through inflammation, oxidative stress, vascular endothelial injury, and so on and thus subsequently promotes the occurrence and development of diseases. This review confirmed the positive correlation between uric acid and diabetes mellitus and its chronic complications through the pathogenesis and clinical studies aspects.