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Wang C, Gao Y, Smerin D, Xiong X, Chen Z, Gu L. Genetically predicted type 2 diabetes mellitus mediates the causal association between plasma uric acid and ischemic stroke. Int Immunopharmacol 2024; 134:112267. [PMID: 38761781 DOI: 10.1016/j.intimp.2024.112267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 05/07/2024] [Accepted: 05/13/2024] [Indexed: 05/20/2024]
Abstract
OBJECTIVE This study conducts a systematic investigation into the causal relationships between plasma uric acid levels and subtypes of ischemic stroke (IS), as well as the extent to which Type 2 diabetes mellitus (T2DM) mediates this relationship. BACKGROUND There is a known association between Uric acid and IS but whether they have a causal relationship remains unclear. This study aims to determine whether a genetic predisposition to uric acid is causally linked to IS, including three subtypes, and to determine the mediating role of T2DM. METHODS Bidirectional Mendelian randomization (MR) analyses was initially used to explore the causal relationship between uric acid and three subtypes of IS. Two-step MR methods were then used to investigate the role of T2DM in mediating the effect of uric acid and IS with its subtypes. RESULTS A primary analysis showed uric acid had a markedly causal association with IS (IVW, OR 1.23; 95 % CI, 1.13 - 1.34; p = 6.39 × 10-9), and two subtypes of IS, Large-vessel atherosclerotic stroke LAS (IVW, OR 1.25; 95 % CI, 1.03 - 1.53; p = 0.026) and small vessel stroke (SVS) (IVW, OR 1.20; 95 % CI, 1.00 - 1.43; p = 0.049), but not with cardioembolic stroke (CES)(IVW, OR 1.00; 95 % CI, 0.87 - 1.15; p = 0.993). Two-step MR results showed that T2DM mediated the association between uric acid and LAS and SVS, accounting for 13.85 % (p = 0.025) and 13.57 % (p = 0.028), respectively. CONCLUSIONS The study suggests that genetic predisposition to uric acid is linked to a greater risk of IS, especially LAS and SVS. T2DM might mediate a significant proportion of the associations between uric acid and LAS as well as SVS.
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Affiliation(s)
- Chaoqun Wang
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, China; Central Laboratory, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yikun Gao
- Central Laboratory, Renmin Hospital of Wuhan University, Wuhan, China; Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Daniel Smerin
- Department of Neurosurgery, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Xiaoxing Xiong
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, China; Central Laboratory, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zhibiao Chen
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, China.
| | - Lijuan Gu
- Central Laboratory, Renmin Hospital of Wuhan University, Wuhan, China; Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, China.
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Fujiyoshi A, Kohsaka S, Hata J, Hara M, Kai H, Masuda D, Miyamatsu N, Nishio Y, Ogura M, Sata M, Sekiguchi K, Takeya Y, Tamura K, Wakatsuki A, Yoshida H, Fujioka Y, Fukazawa R, Hamada O, Higashiyama A, Kabayama M, Kanaoka K, Kawaguchi K, Kosaka S, Kunimura A, Miyazaki A, Nii M, Sawano M, Terauchi M, Yagi S, Akasaka T, Minamino T, Miura K, Node K. JCS 2023 Guideline on the Primary Prevention of Coronary Artery Disease. Circ J 2024; 88:763-842. [PMID: 38479862 DOI: 10.1253/circj.cj-23-0285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Affiliation(s)
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine
| | - Jun Hata
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University
| | - Mitsuhiko Hara
- Department of Health and Nutrition, Wayo Women's University
| | - Hisashi Kai
- Department of Cardiology, Kurume Univeristy Medical Center
| | | | - Naomi Miyamatsu
- Department of Clinical Nursing, Shiga University of Medical Science
| | - Yoshihiko Nishio
- Department of Diabetes and Endocrine Medicine, Kagoshima University Graduate School of Medical and Dental Sciences
| | - Masatsune Ogura
- Department of General Medical Science, Chiba University School of Medicine
- Department of Metabolism and Endocrinology, Eastern Chiba Medical Center
| | - Masataka Sata
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences
| | | | - Yasushi Takeya
- Division of Helath Science, Osaka University Gradiate School of Medicine
| | - Kouichi Tamura
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine
| | | | - Hiroshi Yoshida
- Department of Laboratory Medicine, The Jikei University Kashiwa Hospital
| | - Yoshio Fujioka
- Division of Clinical Nutrition, Faculty of Nutrition, Kobe Gakuin University
| | | | - Osamu Hamada
- Department of General Internal Medicine, Takatsuki General Hospital
| | | | - Mai Kabayama
- Division of Health Sciences, Osaka University Graduate School of Medicine
| | - Koshiro Kanaoka
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center
| | - Kenjiro Kawaguchi
- Division of Social Preventive Medical Sciences, Center for Preventive Medical Sciences, Chiba University
| | | | | | | | - Masaki Nii
- Department of Cardiology, Shizuoka Children's Hospital
| | - Mitsuaki Sawano
- Department of Cardiology, Keio University School of Medicine
- Yale New Haven Hospital Center for Outcomes Research and Evaluation
| | | | - Shusuke Yagi
- Department of Cardiovascular Medicine, Tokushima University Hospital
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Nishinomiya Watanabe Cardiovascular Cerebral Center
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Meidicine
| | - Katsuyuki Miura
- Department of Preventive Medicine, NCD Epidemiology Research Center, Shiga University of Medical Science
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University
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Ganbaatar G, Okami Y, Kadota A, Ganbaatar N, Yano Y, Kondo K, Harada A, Okuda N, Yoshita K, Okamura T, Okayama A, Ueshima H, Miura K. Association of Pro-Inflammatory Diet with Long-Term Risk of All-Cause and Cardiovascular Disease Mortality: NIPPON DATA80. J Atheroscler Thromb 2024; 31:326-343. [PMID: 37813643 PMCID: PMC10918047 DOI: 10.5551/jat.64330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 08/02/2023] [Indexed: 10/11/2023] Open
Abstract
AIM A pro-inflammatory diet may increase the risk of cardiovascular disease (CVD) and all-cause mortality. However, this remains inconclusive as there is yet no study using a dietary record method that has been conducted in a large general population. Furthermore, an underestimation of the pro-inflammatory diet may exist due to the unmeasured effect of salt intake. Thus, in this study, we aimed to examine how pro-inflammatory diet is associated with the long-term risk of all-cause and CVD mortality in a representative Japanese population. METHODS A national nutrition survey was conducted throughout Japan in 1980. After considering the exclusion criteria, 9284 individuals (56% women aged 30-92 years) were included in this study. In total, 20 dietary parameters derived from 3-day weighed dietary records were used to calculate the dietary inflammatory index (DII). The causes of death were monitored until 2009. The Cox proportional hazards model was used to determine multivariable-adjusted hazard ratios (HRs). Stratified analysis according to salt intake level was also performed. RESULTS Compared with the lowest quartile of DII, multivariable-adjusted HRs (95% confidence intervals) in the highest quartile were 1.28 (1.15, 1.41), 1.35 (1.14, 1.60), 1.48 (1.15, 1.92), 1.62 (1.11, 2.38), and 1.34 (1.03, 1.75) for all-cause mortality, CVD mortality, atherosclerotic CVD mortality, coronary heart disease mortality, and stroke mortality, respectively. Stratified analysis revealed stronger associations among individuals with higher salt intake. CONCLUSIONS As per our findings, a pro-inflammatory diet was determined to be positively associated with the long-term risk of all-cause and CVD mortality in a representative Japanese population. Thus, considering both salt intake and pro-inflammatory diet is deemed crucial for a comprehensive assessment of CVD risk.
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Affiliation(s)
- Gantsetseg Ganbaatar
- Department of Public Health, Shiga University of Medical Science, Shiga, Japan
- NCD Epidemiology Research Center (NERC), Shiga University of Medical Science, Shiga, Japan
| | - Yukiko Okami
- NCD Epidemiology Research Center (NERC), Shiga University of Medical Science, Shiga, Japan
| | - Aya Kadota
- Department of Public Health, Shiga University of Medical Science, Shiga, Japan
- NCD Epidemiology Research Center (NERC), Shiga University of Medical Science, Shiga, Japan
| | - Namuun Ganbaatar
- Department of Physical and Occupational therapy, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Yuichiro Yano
- NCD Epidemiology Research Center (NERC), Shiga University of Medical Science, Shiga, Japan
| | - Keiko Kondo
- Department of Public Health, Shiga University of Medical Science, Shiga, Japan
- NCD Epidemiology Research Center (NERC), Shiga University of Medical Science, Shiga, Japan
| | - Akiko Harada
- NCD Epidemiology Research Center (NERC), Shiga University of Medical Science, Shiga, Japan
| | - Nagako Okuda
- Department of Health Science, Kyoto Prefectural University, Kyoto, Japan
| | - Katsushi Yoshita
- Department of Nutrition, Osaka Metropolitan University Graduate School of Human Life and Ecology, Osaka, Japan>
| | - Tomonori Okamura
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan
| | - Akira Okayama
- Research Institute of Strategy for Prevention, Tokyo, Japan
| | - Hirotsugu Ueshima
- NCD Epidemiology Research Center (NERC), Shiga University of Medical Science, Shiga, Japan
| | - Katsuyuki Miura
- Department of Public Health, Shiga University of Medical Science, Shiga, Japan
- NCD Epidemiology Research Center (NERC), Shiga University of Medical Science, Shiga, Japan
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Cimmino G, Gallinoro E, di Serafino L, De Rosa G, Sugraliyev A, Golino P, Cirillo P. Uric acid plasma levels are associated with C-reactive protein concentrations and the extent of coronary artery lesions in patients with acute coronary syndromes. Intern Emerg Med 2023; 18:1751-1757. [PMID: 37466806 DOI: 10.1007/s11739-023-03360-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/26/2023] [Indexed: 07/20/2023]
Abstract
Many studies have pointed out that inflammation plays a pivotal role in pathophysiology of acute coronary syndromes (ACS) because several inflammatory molecules impair the endothelial functions in the coronary circulation and promote atherothrombotic events. Recently, many clinical/experimental evidences indicate that elevated plasma levels of uric acid (UA) might be considered a risk factor for developing ACS. It has been reported that elevated UA doses impair physiologic functions of endothelial cells, shifting them toward a pro atherothrombotic phenotype. In the present manuscript, we investigated the relationship between UA plasma levels, inflammatory burden, and extension of coronary atherosclerotic disease in patients with ACS. Patients with a clinical presentation of ACS (ST-elevated and non-ST-elevated myocardial infarction) admitted to the Vanvitelli Catheterization Laboratory at Monaldi Hospital in 2019, before the COVID-19 pandemia, were retrospectively analyzed. Biochemical profile, type of ACS presentation, as well as extension of coronary atherosclerosis were assessed. A total of 132 ACS patients were included in the analysis, and grouped into 3 tertiles according to the UA values (UA < 4.72 mg/dl, UA between 4.72 and 6.15 mg/dl, and UA > 6.15 mg/dl). Patients with UA plasma levels ≥ 6.15 mg/dL showed higher levels of C-reactive protein (mean of 5.1 mg/dL) as compared to patients with lower UA plasma levels. Moreover, the former group of patients showed higher levels of cardiac troponin and CPK, and presented more often with multivessel disease and complex coronary stenosis (type C of Ellis classification). Even though monocentric and with limited sample size, the present study shows that plasma levels of UA and hs-CRP are elevated in ACS patients and are associated with a more severe coronary disease, suggesting a potential role of UA in the pathophysiology of acute coronary events.
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Affiliation(s)
- Giovanni Cimmino
- Department of Translational Medical Sciences, Section of Cardiology, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Emanuele Gallinoro
- Cardiology Department, IRCCS Galeazzi-Sant'Ambrogio Hospital, University of Milan, Milan, Italy
| | - Luigi di Serafino
- Department of Advanced Biomedical Sciences, Section of Cardiology, University of Naples "Federico II", Via Pansini, 5, 80131, Naples, Italy
| | - Gennaro De Rosa
- Department of Advanced Biomedical Sciences, Section of Cardiology, University of Naples "Federico II", Via Pansini, 5, 80131, Naples, Italy
| | - Akhmetzhan Sugraliyev
- Department of Internal Disease, Kazakh National Medical University, Almaty, Kazakhstan
| | - Paolo Golino
- Department of Translational Medical Sciences, Section of Cardiology, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Plinio Cirillo
- Department of Advanced Biomedical Sciences, Section of Cardiology, University of Naples "Federico II", Via Pansini, 5, 80131, Naples, Italy.
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Optimal uric acid reduction to improve vascular endothelial function in patients with chronic heart failure complicated by hyperuricemia. Hypertens Res 2023; 46:688-696. [PMID: 36539463 DOI: 10.1038/s41440-022-01116-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 10/16/2022] [Indexed: 12/24/2022]
Abstract
Although an association of serum uric acid levels with endothelial function has been shown in various clinical settings, the optimal treatment target that would benefit vascular endothelial function has not been established. We, therefore, conducted a post hoc analysis of the Excited-UA study to identify an optimal target. Patients (N = 133) with chronic heart failure and comorbid hyperuricemia who enrolled in the Excited-UA study were divided into three tertiles based on their serum uric acid level 24 weeks after initiating xanthine oxidase inhibitor treatment with topiroxostat or allopurinol (i.e., groups with low, moderate, and high uric acid levels). Flow-mediated dilation (FMD) and reactive hyperemia index (RHI) values measured by reactive hyperemia peripheral arterial tonometry (RH-PAT) were compared among groups. The change from baseline in the FMD value 24 weeks after treatment was comparable among the three groups. In contrast, the change from baseline in the RHI was significantly different among the three groups (-0.153 ± 0.073, 0.141 ± 0.081 and -0.103 ± 0.104 in the low, moderate, and high uric acid level groups, respectively, P = 0.032). After adjustment for age, body mass index, and concomitant use of diuretics, which differed among the three groups, the change in the RHI in the moderate uric acid level group tended to be higher than that in the high uric acid level group (P = 0.057) and was significantly higher than that in the low uric acid level group (P = 0.020). These results indicate that targeting excessively low uric acid levels by treatment with xanthine oxidase inhibitors might be less beneficial for improving microvascular endothelial function in patients with chronic heart failure. Comparisons of the changes from baseline in vascular endothelial function parameters at 24 weeks among the 3 groups of low, moderae and high uric acid levels achieved with xanthine oxidase inhibitors. After adjustment for confounding factors, such as age, body mass index and concomitant diuretic use, which showed differences among the 3 groups, the change in RHI in the moderate uric acid level group tended to be higher than that in the high uric acid level group and was significantly higher than that in the low uric acid level group.
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Talpur AS, Fattah A, Hewadmal H, Hafizyar F, Farooq J, Shaik TA, Qadar LT, Zaidi SMH, Pirzada S, Bahar AR. Asymptomatic Hyperuricemia as an Independent Risk Factor for Myocardial Infarction in Adult Population: A Four-Year Follow-Up Study. Cureus 2023; 15:e34614. [PMID: 36891011 PMCID: PMC9986685 DOI: 10.7759/cureus.34614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2023] [Indexed: 02/07/2023] Open
Abstract
Introduction A condition in which uric acid levels are elevated but there are no accompanying symptoms is known as asymptomatic hyperuricemia. As a result of the disparity in opinions and findings between the studies, the guidelines regarding whether or not asymptomatic hyperuricemia should be treated are unclear. Material and methods Between the months of January 2017 and June 2022, this research was carried out in the community in collaboration with the internal medicine unit and the public health unit of Liaquat University of Medical and Health Sciences. After obtaining informed consent from each participant, the researchers enrolled 1,500 patients in the study who had uric acid levels that were greater than 7.0 mg/dL. These patients ranged in age from 40 to 70 years old and were of either gender. As a control group, 1,500 patients were recruited who did not have abnormally high levels of uric acid. Patients were monitored for a total of 48 months or until the occurrence of a major cardiovascular event (MACCE) or death from all causes, whichever occurred first. Death, cardiovascular mortality, non-fatal myocardial infarction, and non-fatal stroke were the four categories that made up the primary outcome, also known as MACCEs. Results In the hyperuricemic group, the incidence of myocardial infarction that did not result in death was significantly higher than in the non-hyperuricemic group (1.6% vs. 0.7%; p-value, 0.04). However, the result was not significant for deaths from all causes, deaths from cardiovascular disease, or strokes that did not result in death. Conclusion Asymptomatic hyperuricemia is a potential threat to one's health that can lead to cardiovascular diseases and may go undiagnosed in some cases. It is important to remember that hyperuricemia can lead to delirious complications, so efforts should be made to perform routine monitoring and management of the condition.
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Affiliation(s)
| | - Abdul Fattah
- Internal Medicine, Indus Medical College, Tando Muhammad Khan, PAK
| | - Hewad Hewadmal
- Cardiology, Sheikh Zayed Medical College/Hospital, Rahim Yar Khan, PAK
| | | | - Jawad Farooq
- Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, PAK
| | - Tanveer Ahamad Shaik
- Cardiovascular Medicine, University of Louisville School of Medicine, Louisville, USA.,Cardiovascular Medicine, Liaquatian Research Council, Hyderabad, PAK
| | - Laila Tul Qadar
- Internal Medicine, Dow University of Health Sciences, Civil Hospital Karachi, Karachi, PAK
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7
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Yang S, Ye Z, Liu M, Zhang Y, Wu Q, Zhou C, Zhang Z, He P, Zhang Y, Li H, Liu C, Qin X. Association of serum uric acid with all-cause and cardiovascular mortality among adults with nonalcoholic fatty liver disease. Clin Endocrinol (Oxf) 2023; 98:49-58. [PMID: 35968564 DOI: 10.1111/cen.14810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 08/05/2022] [Accepted: 08/09/2022] [Indexed: 12/13/2022]
Abstract
AIM The association between serum uric acid (SUA) and mortality from cardiovascular diseases (CVDs) in nonalcoholic fatty liver disease (NAFLD) participants remains uncertain. We aim to investigate the relations of SUA with the risk of CVD mortality among adults with and without NAFLD. METHODS Using data from National Health and Nutrition Examination Survey (NHANES) 1999-2014, a total of 17,858 participants were recruited. Of these, 5767 had a US Fatty Liver Index (USFLI) ≥30 and were classified as having NAFLD. Death information was obtained from the National Death Index until 2015. RESULTS During a mean follow-up of 8.3 years, 427 participants died from CVD. Overall, there was a positive association between SUA and CVD mortality among participants with NAFLD (per SD μmol/L increment, adjusted hazard ratio [HR], 1.40; 95% confidence interval [CI], 1.16-1.68). Accordingly, among those with NAFLD, when SUA was assessed as quartiles, compared with those in the first quartile, a significantly higher risk of CVD mortality was found in participants in the fourth quartile (adjusted HR, 2.69; 95% CI, 1.51-4.80). However, there was no significant association between SUA and CVD mortality among participants without NAFLD (per SD μmol/L increment, adjusted HR, 1.01; 95% CI, 0.83-1.22). Similar trends were found for all-cause mortality. Similar results were also found when using FLI ≥ 60 to define NAFLD. CONCLUSIONS In a large and nationally representative sample of US adults, a higher SUA was significantly associated with a higher risk of CVD mortality among participants with NAFLD, but not in those without NAFLD.
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Affiliation(s)
- Sisi Yang
- Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou, China
| | - Ziliang Ye
- Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou, China
| | - Mengyi Liu
- Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou, China
| | - Yanjun Zhang
- Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou, China
| | - Qimeng Wu
- Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou, China
| | - Chun Zhou
- Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou, China
| | - Zhuxian Zhang
- Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou, China
| | - Panpan He
- Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou, China
| | - Yuanyuan Zhang
- Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou, China
| | - Huan Li
- Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou, China
| | - Chengzhang Liu
- Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou, China
- Institute of Biomedicine, Anhui Medical University, Hefei, China
| | - Xianhui Qin
- Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou, China
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Kubo K, Okamura T, Sugiyama D, Hisamatsu T, Hirata A, Kadota A, Kondo K, Hirata T, Higashiyama A, Hayakawa T, Miyamoto Y, Okayama A, Miura K, Ueshima H. Effect of Chronic Kidney Disease or Anemia or Both on Cardiovascular Mortality in a 25-Year Follow-Up Study of Japanese General Population (From NIPPON DATA90). Am J Cardiol 2022; 184:1-6. [PMID: 36127178 DOI: 10.1016/j.amjcard.2022.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 08/17/2022] [Accepted: 08/18/2022] [Indexed: 11/30/2022]
Abstract
The relation between chronic kidney disease (CKD) and cardiovascular disease (CVD) in the general population is well elucidated. In patients with CKD, anemia is associated with adverse outcomes. However, the effects of CKD and anemia on CVD in the general population remains poorly explored, especially in Asian populations. This study aimed to investigate the effect of CKD and/or anemia on CVD mortality in a long-term cohort study involving Japanese community dwellers. We assessed 7,339 participants (aged ≥30 years) with no CVD history. These participants were divided into 4 categories according to their CKD (estimated glomerular filtration rate <60 or urine protein >1+ by dipstick qualitative test) and/or anemia (hemoglobin: <13 g/100 ml [men], <12 g/100 ml [women]) statuses. For each category, we calculated the hazard ratios (HRs) of CVD mortality by using the Cox proportional hazards model after adjusting for age, body mass index, hypertension, diabetes, dyslipidemia, smoking, and alcohol drinking. Within 25 years of follow-up, 637 participants died because of CVD. The HRs of CVD in patients with CKD only, anemia only, and both were 1.27, 1.59, and 2.60 (95% confidence intervals [CI] 1.06 to 1.53, 1.34 to 1.90, and 1.80 to 3.76) in men and 1.42, 1.08, and 2.00 (95% CI 1.19 to 1.69, 0.99 to 1.18, and 1.54 to 2.60) in women, respectively. In conclusion, CKD with anemia is associated with an increased risk for CVD mortality in a general population in Japan.
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Affiliation(s)
- Kota Kubo
- Department of Preventive Medicine and Public Health, School of Medicine, Keio University, Tokyo, Japan
| | - Tomonori Okamura
- Department of Preventive Medicine and Public Health, School of Medicine, Keio University, Tokyo, Japan.
| | - Daisuke Sugiyama
- Faculty of Nursing and Medical Care, Keio University, Tokyo, Japan
| | - Takashi Hisamatsu
- Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Aya Hirata
- Department of Preventive Medicine and Public Health, School of Medicine, Keio University, Tokyo, Japan
| | - Aya Kadota
- NCD Epidemiology Research Center, Shiga University of Medical Science, Otsu, Japan
| | - Keiko Kondo
- NCD Epidemiology Research Center, Shiga University of Medical Science, Otsu, Japan
| | - Takumi Hirata
- Institute for Clinical and Translational Science, Nara Medical University, Kashihara, Japan
| | - Aya Higashiyama
- Department of Hygiene, Wakayama Medical University, Wakayama, Japan
| | | | - Yoshihiro Miyamoto
- Open Innovation Center, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Akira Okayama
- Research Center for Prevention of Lifestyle-Related Diseases, Tokyo, Japan
| | - Katsuyuki Miura
- NCD Epidemiology Research Center, Shiga University of Medical Science, Otsu, Japan
| | - Hirotsugu Ueshima
- NCD Epidemiology Research Center, Shiga University of Medical Science, Otsu, Japan
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9
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Wang A, Tian X, Zuo Y, Chen S, Mo D, Zhang L, Wu S, Luo Y, Wang Y. Effect of changes in serum uric acid on the risk of stroke and its subtypes. Nutr Metab Cardiovasc Dis 2022; 32:167-175. [PMID: 34857424 DOI: 10.1016/j.numecd.2021.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/31/2021] [Accepted: 09/13/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND AIMS The role of serum uric acid (SUA) in stroke remains controversial and analyses of changes in SUA and stroke are limited. The objective of the study was to investigate the associations of changes in SUA with stroke and its subtypes (ischemic and hemorrhagic stroke). METHODS AND RESULTS A total of 51 441 participants (mean age 52.69 ± 11.71 years) without history of myocardial infarction or stroke were enrolled. Participants were divided into four groups based on SUA level changes during 2006 and 2010: stable low, increasing, decreasing, and stable high. SUA score was quantified on a 3-point scale with 1 point awarded for hyperuricemia at either year 2006, 2008 or 2010. Multivariate Cox proportion models were used to calculated hazard ratios (HRs) and their 95% confidence intervals (CIs). During 7.03-year follow up, 1611 stroke (1410 ischemic stroke, 199 hemorrhagic stroke, and 47 subarachnoid hemorrhage) were identified. Participants with stable high SUA had higher risk of hemorrhagic stroke, the HR was 1.93 (95% CI: 1.06-3.51), compared to those with stable low SUA. Furthermore, cumulative high SUA exposure also increased the risk of hemorrhagic stroke, the HR (95%CI) was 2.99 (1.55-5.74), compared with cumulative low SUA exposure. However, no significant evidence indicated changes in SUA was associated with the risk of total and ischemic stroke, the HRs (95% CIs) were 0.98 (0.74-1.29) and 0.88 (0.65-1.19), respectively. CONCLUSIONS Stable high SUA was positively associated with the risk of hemorrhagic stroke, but not with total and ischemic stroke risk.
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Affiliation(s)
- Anxin Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xue Tian
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Yingting Zuo
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Shuohua Chen
- Department of Cardiology, Kailuan Hospital, North China University of Science and Technology, China
| | - Dapeng Mo
- Department of Neurological Intervention, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Licheng Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Shouling Wu
- Department of Cardiology, Kailuan Hospital, North China University of Science and Technology, China.
| | - Yanxia Luo
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China.
| | - Yongjun Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
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10
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Increased QT Dispersion and High Risk of Ventricular Arrhythmias is Associated with Hyperuricemia in Individuals with Normal Renal Function. JOURNAL OF CARDIOVASCULAR EMERGENCIES 2021. [DOI: 10.2478/jce-2021-0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Background and aim: Uric acid elevation has been shown to be an important risk factor for cardiovascular and cerebrobascular disease. QT dispersion (QTd) is a parameter that shows the heterogeneity of ventricular repolarization and can be calculated noninvasively from surface electrocardiography. Increased QTd has been associated with severe arrhythmia and risk of sudden death in many patients and disease groups. In this context, we aimed to investigate the effect of uric acid levels on QTd and the effects of decrease in uric acid levels on QTd.
Methods: A total of 225 patients with normal renal function were included in the study; 133 of these patients were hyperuricemic (>7 mg/dL), and the remaining 72 patients were normouricemic (Group 1). The hyperuricemic patients were randomly divided into 2 groups, one group (n = 67) was given placebo (Group 2) for 4 months, and the remaining 66 patients were given allopurinol 300 mg/day (Group 3).
Results: Hyperuricemic patients had higher hsCRP and QTd and lower eGFR values compared to the normouricemic control group. After 4 months of treatment, 66 patients treated with allopurinol showed a significant decrease in serum uric acid, systolic and diastolic blood pressure, and hsCRP levels, and a significant increase in eGFR. Although the QTd values in the treatment group did not decrease to the same levels as in the normouricemic control group, a statistically significant decrease was found compared to their baseline values. In hyperuricemic control and normouricemic control patients, there were no differences in the levels of uric acid, hsCRP, eGFR, systolic and diastolic blood pressure, and QTd values compared to baseline values.
Conclusions: There was a significant association between elevated serum uric acid and QTd, as well as with inflammatory biomarkers. Also, patients who had received hypouricemic therapy during the follow-up period presented a significant decrease in inflammatory markers as well as QTd. This indicates the beneficial effects of decreasing uric acid levels in decreasing the risk for future major adverse events related to ventricular arrhythmias.
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11
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Serum Uric Acid Is a Weak Independent Predictor of Overall Survival in Older Adults. J Clin Med 2021; 10:jcm10194505. [PMID: 34640521 PMCID: PMC8509603 DOI: 10.3390/jcm10194505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 09/25/2021] [Accepted: 09/28/2021] [Indexed: 12/11/2022] Open
Abstract
Hyperuricemia accompanies many pathologies that contribute to overall death rate. The population-based multifaceted study of older adults in Poland made it possible to assess the effect of serum uric acid (SUA) on overall mortality. The PolSenior study performed between 2007–2011 included 3926 participants aged 65 years or above (mean age 79 ± 9 years) not treated with xanthin oxidase inhibitors (XOI) who were stratified by sex and SUA concentration into six subgroups increasing by 1 mg/dL. In 2019, survival data were retrieved from the population register. The crude risk of death was significantly higher in men and women with SUA ≥ 7 mg/dL. After adjustment to statistically significant factors, SUA remained a risk factor of death in men with SUA ≥ 8 mg/dL only, potentially due to the limited number of women with high SUA levels. Furthermore, age, heart failure, diabetes, and activities of daily living ≤ 4 pts were identified as factors increasing mortality risk regardless of sex. The risk of death increased also with smoking, past stroke, COPD/asthma, and hs-CRP > 3 mg/dL for men; and eGFR < 45 mL/min/1.73 m2, mini nutritional assessment ≤ 7 pts, and loop diuretics use for women. Mild hyperuricemia is a significant health status marker and an independent risk factor for overall mortality in older Caucasians not receiving XOI. Increased mortality is mostly limited to subjects with SUA levels ≥ 8 mg/dL.
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12
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Qiao T, Wu H, Peng W. The Relationship Between Elevated Serum Uric Acid and Risk of Stroke in Adult: An Updated and Dose-Response Meta-Analysis. Front Neurol 2021; 12:674398. [PMID: 34526951 PMCID: PMC8435906 DOI: 10.3389/fneur.2021.674398] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 06/03/2021] [Indexed: 12/26/2022] Open
Abstract
Background: Uric acid (UA) is proposed as a potential risk factor for stroke in adult, yet the results from published studies are not generally accordant. Method: We included prospective studies that explored the relationship between serum UA (SUA) and strokes. In this study, strokes include ischemic stroke and hemorrhagic stroke, which consists of intracerebral hemorrhage and subarachnoid hemorrhage. The effect-size estimates were expressed as hazard ratio (HR) and 95% confidence interval (CI). Sensitivity and subgroup analyses were performed to assess the robustness of the pooled estimation and potential sources of heterogeneity between studies. Results: We meta-analyzed 19 prospective cohort articles, which involve 37,386 males and 31,163 females. Overall analyses results showed a significant association between a 1 mg/dl increase in high levels of SUA and the risk of total stroke (HR = 1.13; 95% CI: 1.09–1.18; P < 0.001), ischemic stroke (HR = 1.15; 95% CI: 1.10–1.21; P < 0.001), and hemorrhagic stroke (HR = 1.07; 95% CI: 1.00 to 1.15; P = 0.046). No significant difference was found between ischemic stroke and hemorrhagic stroke. In the subgroup analyses, the association of high SUA levels and the risk of total stroke was statistically significant in females (HR = 1.19; 95% CI: 1.12–1.26; P < 0.001) and males (HR = 1.11; 95% CI: 1.05–1.17; P < 0.001). Coincidentally, the association was also statistically significant for ischemic stroke, both in females (HR = 1.26; 95% CI: 1.17–1.36; P < 0.001) and in males (HR = 1.12; 95% CI: 1.06–1.19; P < 0.001). However, for hemorrhagic stroke, it was only statistically significant in females (HR = 1.19; 95% CI: 1.04–1.35; P = 0.01). Our dose–response research indicated the J-shaped trend between the ascending SUA levels and the higher risk of suffering from a stroke. Conclusions: Our findings indicate that elevated SUA is a significant risk factor for adult stroke, both for ischemic stroke and hemorrhagic stroke, and especially in females.
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Affiliation(s)
- Tianci Qiao
- Graduate School, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Hongyun Wu
- No.3 Neurology Department, Shandong University of Traditional Chinese Medicine Affiliated Hospital, Jinan, China
| | - Wei Peng
- No.3 Neurology Department, Shandong University of Traditional Chinese Medicine Affiliated Hospital, Jinan, China
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13
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Mannarino MR, Pirro M, Gigante B, Savonen K, Kurl S, Giral P, Smit A, Veglia F, Tremoli E, Baldassarre D. Association Between Uric Acid, Carotid Intima-Media Thickness, and Cardiovascular Events: Prospective Results From the IMPROVE Study. J Am Heart Assoc 2021; 10:e020419. [PMID: 33998285 PMCID: PMC8483552 DOI: 10.1161/jaha.120.020419] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background The association between elevated serum uric acid (SUA), cardiovascular disease (CVD) risk, and carotid atherosclerosis has long been explored, and contrasting results have been reported. Therefore, the role of SUA as an independent risk factor for vascular events (VEs) and carotid atherosclerosis deserves further attention. We investigated the relationship between SUA, incident VEs, carotid intima-media thickness (cIMT), and cIMT progression in subjects at moderate-to-high CVD risk. Methods and Results In the IMPROVE (IMT-Progression as Predictors of VEs) study, 3686 participants (median age 64 years; 48% men) with ≥ 3 vascular risk factors, free from VEs at baseline, were grouped according to SUA quartiles (division points: 244-284-328 µmol/L in women, 295-336-385 µmol/L in men). Carotid-IMT and its 15-month progression, along with incident VEs, were recorded. A U-shaped association between SUA and VEs was observed in men, with 2.4-fold (P = 0.004) and 2.5-fold (P = 0.002) increased CVD risk in the first and fourth SUA quartiles as compared with the second. Adjusted hazard ratios (HRs) for cerebro-VEs in men were the highest (first and fourth quartile versus second: HR, 5.3, P = 0.010 and HR, 4.4, P = 0.023, respectively). SUA level was independently associated with cIMT progression in men (β = 0.068, P = 0.014). No significant association between SUA levels, CVD end points, and cIMT progression were found in women. Conclusions Both low and high SUA levels are associated with an increased risk of VEs in men at moderate-to-high CVD risk but not in women. Only elevated SUA levels predict cIMT progression and at a lesser but not significant extent in women.
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Affiliation(s)
- Massimo R Mannarino
- Unit of Internal Medicine, Angiology and Arteriosclerosis Diseases Department of Medicine and Surgery University of Perugia Perugia Italy
| | - Matteo Pirro
- Unit of Internal Medicine, Angiology and Arteriosclerosis Diseases Department of Medicine and Surgery University of Perugia Perugia Italy
| | - Bruna Gigante
- Unit of Cardiovascular Epidemiology Institute of Environmental Medicine Stockholm Sweden.,Division of Cardiovascular Medicine Department of Clinical Sciences Danderyd HospitalKarolinska Institutet Stockholm Sweden
| | - Kai Savonen
- Foundation for Research in Health Exercise and Nutrition Kuopio & Research Institute of Exercise Medicine Kuopio Finland.,Department of Clinical Physiology and Nuclear Medicine Kuopio University Hospital Kuopio Finland
| | - Sudhir Kurl
- Institute of Public Health and Clinical Nutrition University of Eastern Finland Kuopio Finland
| | - Philippe Giral
- Unités de Prévention Cardiovasculaire Service Endocrinologie-Metabolisme Assistance Publique - Hopitaux de ParisGroupe Hôpitalier Pitie-Salpetriere Paris France
| | - Andries Smit
- Department of Medicine University Medical Center Groningen Groningen the Netherlands.,Department of Medicine Isala Clinics Zwolle Zwolle the Netherlands
| | - Fabrizio Veglia
- Centro Cardiologico MonzinoIstituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Milan Italy
| | - Elena Tremoli
- Centro Cardiologico MonzinoIstituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Milan Italy
| | - Damiano Baldassarre
- Centro Cardiologico MonzinoIstituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Milan Italy.,Department of Medical Biotechnology and Translational Medicine Università degli Studi di Milano Milan Italy
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14
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Mozzini C, Girelli D, Setti A, Croce J, Stefanoni F, Castagna A, Pizzolo F, Friso S, Olivieri O, Martinelli N. Serum Uric Acid Levels, but Not rs7442295 Polymorphism of SCL2A9 Gene, Predict Mortality in Clinically Stable Coronary Artery Disease. Curr Probl Cardiol 2021; 46:100798. [PMID: 33540324 DOI: 10.1016/j.cpcardiol.2021.100798] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 01/14/2021] [Indexed: 10/22/2022]
Abstract
Serum uric acid (SUA) has been associated with cardiovascular disease, but up to now whether SUA is an independent cardiovascular risk factor or merely a disease-related epiphenomenon remains still controversial. within the framework of the Verona Heart Study, we prospectively followed 703 subjects with angiographically demonstrated and clinically stable coronary artery disease between May 1996 and March 2007. At baseline, SUA levels were measured in all the patients. Genotype data of SCL2A9 rs7442295 polymorphism, which has been associated with SUA by genome-wide association studies, were available for 686 subjects (97.6%). After a median follow-up of 57 months, 116 patients (16.5%) had died, 83 (11.8%) because of cardiovascular causes. Patients with hyperuricemia, defined by SUA levels above the 75th percentile (≥0.41 mmol/L), had an increased total and cardiovascular mortality rate than those with SUA below this threshold level (23.3% vs 14.1%, P = 0.048 and 19.4% vs 9.2%, P = 0.001, respectively, by Kaplan-Meier with Log-Rank test). These associations were confirmed by Cox regression after adjustment for sex, age, other predictors of mortality, coronary revascularization, and drug therapies at discharge (hazard ratio for total mortality 1.87 [1.05-3.34], P = 0.033; hazard ratio for cardiovascular mortality 2.09 [1.03-4.25], P = 0.041). Although associated with SUA levels, rs7442295 polymorphism did not predict total or cardiovascular mortality. our data support that SUA may be a prognostic cardiovascular biomarker, predicting total and cardiovascular mortality in the setting of secondary prevention of coronary artery disease. On the other hand, SCL2A9 gene polymorphism, notwithstanding a clear influence on SUA levels, was not associated with mortality.
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Affiliation(s)
- Chiara Mozzini
- Department of Medicine, Section of Internal Medicine, University of Verona, Verona, Italy.
| | - Domenico Girelli
- Department of Medicine, Section of Internal Medicine, University of Verona, Verona, Italy
| | - Angela Setti
- Department of Medicine, Section of Internal Medicine, University of Verona, Verona, Italy
| | - Jacopo Croce
- Department of Medicine, Section of Internal Medicine, University of Verona, Verona, Italy
| | - Filippo Stefanoni
- Department of Medicine, Section of Internal Medicine, University of Verona, Verona, Italy
| | - Annalisa Castagna
- Department of Medicine, Section of Internal Medicine, University of Verona, Verona, Italy
| | - Francesca Pizzolo
- Department of Medicine, Section of Internal Medicine, University of Verona, Verona, Italy
| | - Simonetta Friso
- Department of Medicine, Section of Internal Medicine, University of Verona, Verona, Italy
| | - Oliviero Olivieri
- Department of Medicine, Section of Internal Medicine, University of Verona, Verona, Italy
| | - Nicola Martinelli
- Department of Medicine, Section of Internal Medicine, University of Verona, Verona, Italy
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15
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Okami Y, Ueshima H, Nakamura Y, Kondo K, Kadota A, Okuda N, Ohkubo T, Miyamatsu N, Okamura T, Miura K, Okayama A. Risk Factors That Most Accurately Predict Coronary Artery Disease Based on the Duration of Follow-up - NIPPON DATA80. Circ J 2020; 85:908-913. [PMID: 33298627 DOI: 10.1253/circj.cj-20-0739] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND This study assessed sex-specific time-associated changes in the impact of risk factors on coronary artery disease (CAD) mortality in a general population over long-term follow-up.Methods and Results:A prospective longitudinal cohort study was conducted on representative Japanese populations followed up for 29 years. Data from 8,396 participants (3,745 men, 4,651 women) were analyzed. The sex-specific multivariable adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of 4 risk factors (smoking, diabetes, serum total cholesterol [TC], and systolic blood pressure [SBP]) for CAD mortality were calculated at baseline and at 10, 15, 20, 25, and 29 years of follow-up. In men, smoking (HR 3.23; 95% CI 1.16-9.02) and a 1-SD increase in TC (HR 1.82; 95% CI 1.29-2.57) were strongly associated with a higher risk of CAD in the first 10 years, but this association decreased over time. Diabetes (HR 2.30; 95% CI 1.37-3.85) and a 1-SD increase in SBP (HR 1.23; 95% CI 1.00-1.50) were strongly correlated with a higher risk of CAD after 29 years). In women, diabetes was correlated with CAD after 20 years (HR 2.53; 95% CI 1.19-5.36) and this correlation persisted until after 29 years (HR 2.47; 95% CI 1.40-4.35). CONCLUSIONS The duration of follow-up needed for the accurate assessment of risk factors for CAD mortality varies according to risk factor and sex.
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Affiliation(s)
- Yukiko Okami
- Department of Public Health, Shiga University of Medical Science
| | - Hirotsugu Ueshima
- Department of Public Health, Shiga University of Medical Science.,Center for Epidemiologic Research in Asia, Shiga University of Medical Science
| | - Yasuyuki Nakamura
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science.,Racto Clinic & Medical Examination Center
| | - Keiko Kondo
- Department of Public Health, Shiga University of Medical Science
| | - Aya Kadota
- Department of Public Health, Shiga University of Medical Science
| | - Nagako Okuda
- Department of Health and Nutrition, University of Human Arts and Sciences
| | - Takayoshi Ohkubo
- Department of Hygiene and Public Health, Teikyo University School of Medicine
| | - Naomi Miyamatsu
- Division of Adult Health Nursing, Shiga University of Medical Science
| | - Tomonori Okamura
- Department of Preventive Medicine and Public Health, School of Medicine, Keio University School of Medicine
| | - Katsuyuki Miura
- Department of Public Health, Shiga University of Medical Science.,Center for Epidemiologic Research in Asia, Shiga University of Medical Science
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16
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Dong Y, Shi H, Chen X, Fu K, Li J, Chen H, Teng W, Tian L. Serum uric acid and risk of stroke: a dose-response meta-analysis. J Clin Biochem Nutr 2020; 68:221-227. [PMID: 34025024 PMCID: PMC8129984 DOI: 10.3164/jcbn.20-94] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 07/19/2020] [Indexed: 01/11/2023] Open
Abstract
The relationship between serum uric acid and risk of stroke is still controversial. Therefore, we conducted a meta-analysis based on the cohort study to explore the relationship between serum uric acid and risk of stroke, and further illuminate whether there is a linear or non-linear relationship between them. We manually searched the database including Cochrane, PubMed, Embase, Web of Science, and selected cohort studies focusing on the relationship between serum uric acid and stroke risk. Random effect model was used for statistical analysis. Twenty-one cohort studies involving 818,098 participants were included. The pooled relative risk for the high-vs-low categories was 1.22 (95% CI: 1.15-1.30). In addition, there was a non-linear dose-response relationship between uric acid and stroke risk. Serum uric acid was in the range of 3-5 mg/dl, with the lowest risk of stroke. In conclusion, high serum uric acid level increases the risk of stroke, with a non-linear dose-response relationship.
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Affiliation(s)
- Yunan Dong
- Department of Geriatrics, Shengjing Hospital of China Medical University, No. 36, San Hao Street, Heping District, Shenyang 110004, China
| | - Han Shi
- The First Clinical Department, China Medical University, No. 77, Puhe Road, Shenyang North Area, Shenyang, Liaoning Province, 110122, China
| | - Xinxin Chen
- Department of Neurology, The First Hospital of China Medical University, No. 155, North Nanjing Street, Heping District, Shenyang 110001, China
| | - Kailei Fu
- Department of Neurology, The First Hospital of China Medical University, No. 155, North Nanjing Street, Heping District, Shenyang 110001, China
| | - Jinwei Li
- Department of Neurology, The First Hospital of China Medical University, No. 155, North Nanjing Street, Heping District, Shenyang 110001, China
| | - Hanze Chen
- Department of Neurology, The First Hospital of China Medical University, No. 155, North Nanjing Street, Heping District, Shenyang 110001, China
| | - Weiyu Teng
- Department of Neurology, The First Hospital of China Medical University, No. 155, North Nanjing Street, Heping District, Shenyang 110001, China
| | - Li Tian
- Department of Geriatrics, Shengjing Hospital of China Medical University, No. 36, San Hao Street, Heping District, Shenyang 110004, China
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17
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Irfan M, Jawaid W, Hashmat O, Nisa Q, Khastoori DR, Shahbaz NN. Association Between Hyperuricemia and Acute Ischemic Stroke in Patients at a Tertiary Care Hospital. Cureus 2020; 12:e10899. [PMID: 33194468 PMCID: PMC7654977 DOI: 10.7759/cureus.10899] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Introduction Stroke is the most debilitating of neurologic diseases. The rationale of the current study was to determine the association between hyperuricemia and ischemic stroke to establish a local perspective. Methods A total of 148 patients at a tertiary care hospital in Pakistan who fulfilled the inclusion criteria were enrolled in the study and then equally distributed into two study groups consisting of cases and controls (n = 74 in each group). In this study, there were 36 (48.6%) participants in the case group with hyperuricemia and ischemic stroke and 18 (24.3%) participants in the control group with hyperuricemia. The mean and standard deviations were computed for quantitative variables such as age, body mass index (BMI), and duration of stroke. Frequencies and percentages for the qualitative variables such as gender, hypertension, type 2 diabetes (T2D), dyslipidemia, smoking status, socioeconomic status, educational level, and hyperuricemia were calculated. The chi-square test was applied to compare both groups, with p ≤ 0.05 indicating significance. The odds ratio was also calculated to determine the association between case and control. Effect modifiers were controlled through stratification of age, gender, BMI, duration of stroke, hypertension, T2D, dyslipidemia, socioeconomic status, educational level, and smoking status to determine the effect of these on outcome variables. A post-stratification chi-square test was applied, with p ≤ 0.05 indicating statistical significance. Results In our study, stratification of hyperuricemia into cases and controls was performed for age, gender, T2D, hypertension, dyslipidemia, smoking status, socioeconomic status, and educational status. The maximum results were significant, with high strength of association between both groups. In the case group, the frequency of elevated uric acid was significantly higher than that of the control group. A comparison of hyperuricemia indicated p = 0.002, with an odds ratio of 2.95, which showed that elevated uric acid could be taken as a predictor of ischemic stroke. The uric acid level was significantly higher in men than in women. Additionally, hyperuricemia was associated with dyslipidemia. In patients with ischemic stroke, there was a significant association between serum uric acid level and T2D, hypertension, and smoking. Conclusions This study showed that the prevalence of hyperuricemia in patients with ischemic stroke was significantly higher as compared to the healthy population. Hyperuricemia can be considered as a risk factor for ischemic stroke because of its high prevalence in ischemic stroke patients. Our study explored the relationship between stroke and hyperuricemia and enabled increased understanding for caregivers so that effective management plans can be formulated for patients with ischemic stroke to prevent adverse outcomes.
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Affiliation(s)
- Muhammad Irfan
- Neurology, Dow University of Health Sciences, Karachi, PAK
| | - Wajid Jawaid
- Neurology, Dow University of Health Sciences, Karachi, PAK
| | | | - Qamar Nisa
- Neurology, Dow University of Health Sciences, Karachi, PAK
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18
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Cao JY, Waldman B, O'Connell R, Sullivan DR, Scott RS, Aryal N, Gebski V, Marschner I, Taskinen MR, Simes JR, McGill N, Jenkins AJ, Keech AC. Uric acid predicts long-term cardiovascular risk in type 2 diabetes but does not mediate the benefits of fenofibrate: The FIELD study. Diabetes Obes Metab 2020; 22:1388-1396. [PMID: 32243036 DOI: 10.1111/dom.14046] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 03/28/2020] [Accepted: 03/28/2020] [Indexed: 01/17/2023]
Abstract
AIM To explore the relationship between baseline uric acid (UA) levels and long-term cardiovascular events in adults with type 2 diabetes (T2D) and to determine whether the cardioprotective effects of fenofibrate are partly mediated through its UA-lowering effects. METHODS Data from the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) trial were utilized, comprising 9795 adults with T2D randomly allocated to treatment with fenofibrate or matching placebo. Plasma UA was measured before and after a 6-week, active fenofibrate run-in phase in all participants. Cox proportional hazards models were used to explore the relationships between baseline UA, pre-to-post run-in reductions in UA and long-term cardiovascular outcomes. RESULTS Mean baseline plasma UA was 0.33 mmol/L (SD 0.08). Baseline UA was a significant predictor of long-term cardiovascular events, with every 0.1 mmol/L higher UA conferring a 21% increase in event rate (HR 1.21, 95% CI 1.13-1.29, P < .001). This remained significant after adjustment for treatment allocation, cardiovascular risk factors and renal function. The extent of UA reduction during fenofibrate run-in was also a significant predictor of long-term cardiovascular events, with every 0.1 mmol/L greater reduction conferring a 14% lower long-term risk (HR 0.86, 95% CI 0.76-0.97, P = .015). This effect was not modified by treatment allocation (Pinteraction = .77). CONCLUSIONS UA is a strong independent predictor of long-term cardiovascular risk in adults with T2D. Although greater reduction in UA on fenofibrate is predictive of lower cardiovascular risk, this does not appear to mediate the cardioprotective effects of fenofibrate.
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Affiliation(s)
- Jacob Y Cao
- National Health and Medical Research Council Clinical Trials Centre, Sydney, New South Wales, Australia
- Sydney Medical School, Sydney, New South Wales, Australia
| | - Boris Waldman
- National Health and Medical Research Council Clinical Trials Centre, Sydney, New South Wales, Australia
- Sydney Medical School, Sydney, New South Wales, Australia
| | - Rachel O'Connell
- National Health and Medical Research Council Clinical Trials Centre, Sydney, New South Wales, Australia
| | - David R Sullivan
- National Health and Medical Research Council Clinical Trials Centre, Sydney, New South Wales, Australia
- Sydney Medical School, Sydney, New South Wales, Australia
| | - Russell S Scott
- Lipid & Diabetes Research Group, Christchurch Hospital, Christchurch, New Zealand
| | - Nanda Aryal
- National Health and Medical Research Council Clinical Trials Centre, Sydney, New South Wales, Australia
| | - Val Gebski
- National Health and Medical Research Council Clinical Trials Centre, Sydney, New South Wales, Australia
| | - Ian Marschner
- National Health and Medical Research Council Clinical Trials Centre, Sydney, New South Wales, Australia
| | - Marja-Riitta Taskinen
- Heart and Lung Centre, Cardiovascular Research Unit, Helsinki University Central Hospital, Helsinki, Finland
| | - John R Simes
- National Health and Medical Research Council Clinical Trials Centre, Sydney, New South Wales, Australia
- Sydney Medical School, Sydney, New South Wales, Australia
| | - Neil McGill
- National Health and Medical Research Council Clinical Trials Centre, Sydney, New South Wales, Australia
- Sydney Medical School, Sydney, New South Wales, Australia
| | - Alicia J Jenkins
- National Health and Medical Research Council Clinical Trials Centre, Sydney, New South Wales, Australia
- Sydney Medical School, Sydney, New South Wales, Australia
| | - Anthony C Keech
- National Health and Medical Research Council Clinical Trials Centre, Sydney, New South Wales, Australia
- Sydney Medical School, Sydney, New South Wales, Australia
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19
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Association between long-term prescription of febuxostat and the progression of heart failure with preserved ejection fraction in patients with hypertension and asymptomatic hyperuricemia. Heart Vessels 2020; 35:1446-1453. [DOI: 10.1007/s00380-020-01619-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 05/01/2020] [Indexed: 12/28/2022]
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Li S, Cui L, Cheng J, Shu R, Chen S, Nguyen US, Misra D, Wu S, Gao X. Repeated measurements of serum urate and mortality: a prospective cohort study of 152,358 individuals over 8 years of follow-up. Arthritis Res Ther 2020; 22:84. [PMID: 32295651 PMCID: PMC7160947 DOI: 10.1186/s13075-020-02173-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 03/31/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Longitudinal evidence on change of serum urate level with mortality risk is limited as prior studies have a measurement of serum urate at a single time point. Further, the combined effect of serum urate and systemic inflammation on mortality is unknown. METHODS We conducted a prospective cohort study of 152,358 participants (122,045 men and 30,313 women) with repeated measurements of serum urate in 2006, 2008, 2010, and 2012 (107,751 participants had all four measurements of serum urate). We used the Cox proportional hazard model to examine the association between cumulative average and changes in serum urate with mortality. The combined effect of serum urate and systemic inflammation was determined by testing the interaction of serum urate and high-sensitive C-reactive protein (hs-CRP) in relation to mortality risk. RESULTS During a median follow-up of 8.7 (interquartile range 6.3-9.2) years, we identified 7564 all-cause deaths, 1763 CVD deaths, 1706 cancer deaths, and 1572 other deaths. We observed U-shaped relationships of cumulative average serum urate with all-cause mortality, cardiovascular mortality, and other mortalities. Compared with participants with stable serum urate, those with greater increases in serum urate had a 1.7-fold elevated mortality (hazard ratio (HR) = 1.66, 95% confidence interval (CI) = 1.49-1.84), and those with decreased serum urate had a 2-fold elevated mortality risk (HR = 2.14, 95% CI 1.93-2.37). Participants with both hyperuricemia and hs-CRP had 1.6 times higher mortality, compared with those with low serum urate and hs-CRP levels (HR = 1.56, 95% CI 1.37-1.76). CONCLUSIONS We observed a U-shaped relationship of long-term cumulative average serum urate with all-cause mortality, cardiovascular mortality, and other mortalities. Compared with participants with relatively stable serum urate levels, a greater increase or decrease in serum urate was associated with elevated mortality. Participants with both hyperuricemia and high systemic inflammation had the greatest mortality risk compared with those with low serum urate and low hs-CRP levels.
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Affiliation(s)
- Shanshan Li
- Slone Epidemiology Center, Boston University, Boston University Medical Campus, 72 East Concord Street, L-7, Boston, MA, 02118, USA.
| | - Liufu Cui
- Department of Rheumatology and Immunology, Kailuan General Hospital, Tangshan, China
| | - Jin Cheng
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, USA
| | - Rong Shu
- Health Care Center of Kailuan Group, Tangshan, China
| | - Shuohua Chen
- Health Care Center of Kailuan Group, Tangshan, China
| | - Uyen-Sa Nguyen
- Department of Biostatistics and Epidemiology, University of North Texas Health Science Center School of Public Health, Fort Worth, TX, USA
| | - Devyani Misra
- Geriatrics and Rheumatology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Shouling Wu
- Health Care Center of Kailuan Group, Tangshan, China.
- Department of Cardiology, Kailuan General Hospital, 57 Xinhua East Rd., Tangshan, 063000, China.
| | - Xiang Gao
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, USA
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The Optimal Range of Serum Uric Acid for Cardiometabolic Diseases: A 5-Year Japanese Cohort Study. J Clin Med 2020; 9:jcm9040942. [PMID: 32235468 PMCID: PMC7231289 DOI: 10.3390/jcm9040942] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 03/27/2020] [Indexed: 12/13/2022] Open
Abstract
The optimal range of serum uric acid (urate) associated with the lowest risk for developing cardiometabolic diseases is unknown in a generally healthy population. This 5-year cohort study is designed to identify the optimal range of serum urate. The data were collected from 13,070 Japanese between ages 30 and 85 at the baseline (2004) from the Center for Preventive Medicine, St. Luke’s International Hospital, Tokyo. We evaluated the number of subjects (and prevalence) of those free of the following conditions: hypertension, diabetes, dyslipidemia, and chronic kidney disease (CKD) over 5 years for each 1 mg/dL of serum urate stratified by sex. Furthermore, the odds ratios (ORs) for remaining free of these conditions were calculated with multiple adjustments. Except for truly hypouricemic subjects, having lower serum urate was an independent factor for predicting the absence of hypertension, dyslipidemia, and CKD, but not diabetes. The OR of each 1 mg/dL serum urate decrease as a protective factor for hypertension, dyslipidemia, and CKD was 1.153 (95% confidence interval, 1.068–1.245), 1.164 (1.077–1.258), and 1.226 (1.152–1.306) in men; 1.306 (1.169–1.459), 1.121 (1.022–1.230), and 1.424 (1.311–1.547) in women, respectively. Moreover, comparing serum urate of 3–5 mg/dL in men and 2–4 mg/dL in women, hypouricemia could be a higher risk for developing hypertension (OR: 4.532; 0.943–21.78) and CKD (OR: 4.052; 1.181–13.90) in women, but not in men. The optimal serum urate range associated with the lowest development of cardiometabolic diseases was less than 5 mg/dL for men and 2–4 mg/dL for women, respectively.
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Wang Z, Xu Y, Liao H, Chen X, He S. U-shaped association between serum uric acid concentration and mortality in hypertrophic cardiomyopathy patients. Ups J Med Sci 2020; 125:44-51. [PMID: 32013714 PMCID: PMC7054957 DOI: 10.1080/03009734.2020.1719245] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background. No study has examined the effect of low serum uric acid (SUA) concentrations on mortality in hypertrophic cardiomyopathy (HCM) patients. The aim of the present study was to assess the relations between both low and high SUA concentrations and the risk of mortality across the full range of SUA concentrations in a retrospective cohort of HCM patients.Methods. A total of 454 HCM patients were enrolled in the study, and SUA concentrations were measured at baseline. The primary and secondary endpoints were all-cause mortality and HCM-related mortality, respectively. The associations between SUA concentrations and endpoints were analysed.Results. During a median follow-up of 3.8 years, there were 80 (17.6%) all-cause mortality events, and 52 of them (11.5%) were ascribed to HCM-related mortality. Patients with SUA concentrations of 250-350 µmol/L had the lowest all-cause mortality rate (11.8%) and HCM-related mortality rate (5.0%). Both low and high SUA concentrations were associated with increased all-cause and HCM-related mortality. Adjusted HRs were 2.52 (95% CI 1.13-5.61, p = 0.024) and 4.86 (95% CI 1.74-13.58, p = 0.003) for all-cause mortality and HCM-related mortality in the lowest SUA group (<250 µmol/L) when compared with the reference group (250-350 µmol/L), respectively. The corresponding HRs in the highest SUA group (≥450 µmol/L) were 2.73 (95% CI 1.42-5.23, p = 0.003) and 4.14 (95% CI 1.70-10.13, p = 0.002), respectively.Conclusions. Both low and high SUA concentrations were significantly associated with increased risk of all-cause mortality and HCM-related mortality, which supported a U-shaped association between SUA concentrations and mortality in HCM patients.
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Affiliation(s)
- Ziqiong Wang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Ying Xu
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Hang Liao
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoping Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Sen He
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
- CONTACT Sen He Department of Cardiology, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041 Sichuan Province, China
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Kimura Y, Yanagida T, Onda A, Tsukui D, Hosoyamada M, Kono H. Soluble Uric Acid Promotes Atherosclerosis via AMPK (AMP-Activated Protein Kinase)-Mediated Inflammation. Arterioscler Thromb Vasc Biol 2020; 40:570-582. [PMID: 31996020 DOI: 10.1161/atvbaha.119.313224] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Uric acid is supposed but not yet determined to be associated with atherosclerosis. Uric acid is released from damaged cells to form urate crystal, which is recognized by the immune system to produce IL (interleukin)-1. Danger signals and IL-1 have been shown to play an important role in atherosclerosis. We determined whether the physiological level of soluble uric acid promotes inflammation and develops atherosclerosis. Approach and Results: The secretion of IL-1β from human peripheral blood mononuclear cells mediated by NLRP3 (NACHT, LRR, and PYD domain-containing protein 3) inflammasome was promoted by physiological levels in serum uric acid. This augmentation of inflammation was mediated by the regulation of the AMPK (AMP-activated protein kinase)-mTOR (mammalian target of rapamycin) mitochondrial reactive oxygen species and HIF-1α (hypoxia-inducible factor-1α) pathway. In both of uricase transgenic and xanthine oxidase inhibitor-treated mice, decreased levels of uric acid resulted in the activation of AMPK and attenuation of the development of atherosclerotic plaques. Further, acute uric acid reduction by the administration of benzbromarone in healthy humans for 2 weeks significantly decreased plasma IL-18-an inflammasome-dependent cytokine. CONCLUSIONS The data indicate that the development of atherosclerosis and inflammation is promoted by uric acid in vivo. Moreover, the lowering of uric acid levels attenuated inflammation via the activation of the AMPK pathway. This study provides mechanistic evidence of uric acid-lowering therapies for atherosclerosis.
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Affiliation(s)
- Yoshitaka Kimura
- From the Department of Internal Medicine, Faculty of Medicine (Y.K., T.Y., A.O., D.T., H.K.), Teikyo University, Tokyo, Japan
| | - Tamiko Yanagida
- From the Department of Internal Medicine, Faculty of Medicine (Y.K., T.Y., A.O., D.T., H.K.), Teikyo University, Tokyo, Japan
| | - Akiko Onda
- From the Department of Internal Medicine, Faculty of Medicine (Y.K., T.Y., A.O., D.T., H.K.), Teikyo University, Tokyo, Japan
| | - Daisuke Tsukui
- From the Department of Internal Medicine, Faculty of Medicine (Y.K., T.Y., A.O., D.T., H.K.), Teikyo University, Tokyo, Japan
| | - Makoto Hosoyamada
- Department of Human Physiology and Pathology, Faculty of Pharma-Sciences (M.H.), Teikyo University, Tokyo, Japan
| | - Hajime Kono
- From the Department of Internal Medicine, Faculty of Medicine (Y.K., T.Y., A.O., D.T., H.K.), Teikyo University, Tokyo, Japan
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Li J, Muraki I, Imano H, Cui R, Yamagishi K, Umesawa M, Hayama-Terada M, Ohira T, Kiyama M, Okada T, Sankai T, Tanigawa T, Kitamura A, Iso H. Serum uric acid and risk of stroke and its types: the Circulatory Risk in Communities Study (CIRCS). Hypertens Res 2020; 43:313-321. [DOI: 10.1038/s41440-019-0385-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 08/11/2019] [Accepted: 08/14/2019] [Indexed: 02/07/2023]
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The causality between the serum uric acid level and stroke. Hypertens Res 2020; 43:354-356. [DOI: 10.1038/s41440-019-0346-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 09/24/2019] [Accepted: 09/24/2019] [Indexed: 12/18/2022]
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Association between serum uric acid levels and coronary artery disease in different age and gender: a cross-sectional study. Aging Clin Exp Res 2019; 31:1783-1790. [PMID: 30694512 DOI: 10.1007/s40520-019-01137-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 01/18/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND The association between uric acid (UA) and coronary artery disease (CAD) was controversial. It was still unclear how the UA level changes with age and gender. AIMS To confirm the relationship between the change of UA with age and gender and CAD, especially in elderly people. METHODS 8285 individuals were investigated. The changes of UA and hyperuricemia in female and male with age were analyzed. The associations of UA, and hyperuricemia with CAD in different age and sex were assessed. RESULTS Individuals were stratified into four groups according to their age: ≤ 39 years; 40-59 years; 60-79 years, and ≥ 80 years. The level of UA and the proportion of hyperuricemia increased significantly with age in female (P < 0.001), but showed a downward trend in male (P < 0.001). After adjusting for confounding factors, hyperuricemia remained an independent risk factor for the incident of CAD in all women (P = 0.029). In ≥ 80 year groups of female, UA and hyperuricemia became independent risk factors for the incident of CAD in the univariate and multivariate logistic regression analyses (all P ≤ 0.001). DISCUSSION The level of UA showed significantly different changes with age in different gender. The relationship between UA and CAD showed differences in different age and sex. CONCLUSIONS There were significant correlations between UA, hyperuricemia, and CAD only in female, particularly in the ≥ 80 year elderly women, but not in men.
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Tariq MA, Shamim SA, Rana KF, Saeed A, Malik BH. Serum Uric Acid - Risk Factor for Acute Ischemic Stroke and Poor Outcomes. Cureus 2019; 11:e6007. [PMID: 31815071 PMCID: PMC6881082 DOI: 10.7759/cureus.6007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Over the last decades several studies among the adult population have attempted to establish a correlation between the risk of stroke incidence and serum uric acid (SUA) concentration, and how these levels influence the patient’s neurological outcome after a stroke. But, to date, the results are conflicting. In this review, an extensive literature search was performed through PubMed for articles published until May 2019 to review the association. The study selection was narrowed by searching PubMed database using the Medical Subject Headings (MesH) and associated keywords. Only articles conducted in English and on human subjects were included. We considered an article for this review if it had statistics on either the incidence, stroke mortality or post-stroke functional outcomes along with serum uric acid levels in adults. This review includes 21 articles with data of 33,580 cases of stroke and 1,100,888 participants. We can divide the articles reviewed into two separate cohorts of studies. One relates serum uric acid levels to stroke frequency and mortality, while the other is associated with serum uric acid and outcomes for stroke survivors. Based on our review, no significant relationship is observed with uric acid exhibiting protective effects on stroke outcome. Large clinical trials are advised to provide well-defined solutions to further assess the benefits of uric acid level lowering treatment in patients of vascular events, such as a stroke. However, we confidently report that increasing uric acid levels poses a higher risk for incidence of stroke.
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Affiliation(s)
- Muhammad Ali Tariq
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Sohaib A Shamim
- Neurology, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Kiran F Rana
- Family Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Aisha Saeed
- Family Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Bilal Haider Malik
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
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Mazidi M, Katsiki N, Mikhailidis DP, Banach M. Associations of serum uric acid with total and cause-specific mortality: Findings from individuals and pooling prospective studies. Atherosclerosis 2019; 296:49-58. [PMID: 32032905 DOI: 10.1016/j.atherosclerosis.2019.07.019] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 07/16/2019] [Accepted: 07/19/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND AIMS There is considerable controversy regarding the link between serum uric acid (SUA) and mortality. We prospectively evaluated the association between SUA and risk of total and cause specific (coronary heart disease [CHD], cerebrovascular and cancer) mortality by using the National Health and Nutrition Examination Surveys (NHANES, 1999-2010). Furthermore, a systematic review and meta-analysis of cohort studies was performed to investigate pooled associations of SUA with all-cause and cause-specific mortality. METHODS Vital status through December 31, 2011 was ascertained. PubMed-Medline, SCOPUS, Web of Science and Google Scholar databases were searched (up to April 2018). Adjusted Cox proportional hazard regression models were used to determine the association between SUA and mortality. The DerSimonian-Laird method and generic inverse variance methods were used for quantitative data synthesis. RESULTS Overall, 21,025 individuals were included (mean age = 47.6 years, 48.7% men) and 3520 deaths occurred during the 144 months of follow-up. In adjusted models, individuals in the highest quartile of SUA had 10 and 8% greater risk of CHD and stroke mortality, whereas there was no link between SUA, all-cause and cancer mortality. The associations of CHD and stroke mortality with SUA were more pronounced in women and, among women, in those aged >50 years. Furthermore, all-cause mortality was positively and significantly related to SUA concentrations only in women. In the meta-analysis, SUA was shown to predict the risk of total (21%), CHD (24%) and stroke (29%) mortality. Furthermore, participants with a higher level of central adiposity had a greater risk of mortality from CHD and stroke for the same level of SUA. CONCLUSIONS Our results highlight the adverse impact of SUA on mortality, particularity in older (>50 years) women. The clinical implications of these findings remain to be established in future trials.
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Affiliation(s)
- Mohsen Mazidi
- Department of Twin Research and Genetic Epidemiology, Kings College London, London, UK.
| | - Niki Katsiki
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
| | - Dimitri P Mikhailidis
- Department of Clinical Biochemistry, Royal Free Campus, University College London Medical School, University College London (UCL), London, UK
| | - Maciej Banach
- Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, Poland; Polish Mother's Memorial Hospital Research Institute (PMMHRI), Lodz, Poland; Cardiovascular Research Centre, University of Zielona Gora, Zielona Gora, Poland
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Asymptomatic hyperuricemia and incident stroke in elderly Chinese patients without comorbidities. Eur J Clin Nutr 2019; 73:1392-1402. [PMID: 30787471 DOI: 10.1038/s41430-019-0405-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 11/13/2018] [Accepted: 11/14/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND/OBJECTIVES Hyperuricemia is usually associated with other comorbidities; so it is difficult to distinguish the effects of hyperuricemia from other coexisting comorbidities in patients who suffer a stroke. SUBJECT/METHODS Data for this study were collected from the patients of Kangjian Community Health Center of Shanghai. Selected participants ≥65 years of age were available at enrollment (2009-2013). Subjects were excluded if they had hypertension, diabetes mellitus, pre-existing cardiovascular disease, or hyperlipidemia. Further, patients who were overweight or obese, had gout or drug-treated hyperuricemia, or had chronic kidney disease were also excluded. Cox regression was used in order to assess the hazard ratio (HR) for the incidence of stroke events between hyperuricemic and normouricemic patients. RESULTS A total of 3243 subjects without comorbidities (70.8 ± 6.0 years) were followed for 35.5 ± 3.0 months. Hyperuricemia conferred increased cumulative incident stroke events (6.9 versus 3.1%, odds ratio [OR] = 2.27, 95% confidence index [CI] 1.52-3.37, p < 0.001). Male and female hyperuricemic subjects also showed a significantly higher incident stroke incidence than normouricemic subjects (6.1 versus 2.7%, OR = 2.34, 95% CI 1.31-4.18, p = 0.003 and 7.6 versus 3.7%, OR = 2.16, 95% CI 1.25-3.72, p = 0.005, respectively). Cox regression showed that hyperuricemia independently predicted incident stroke risk (HR = 2.32, 95%CI 1.56-3.45). CONCLUSION Asymptomatic hyperuricemia carried a significant risk of stroke events in Chinese elderly without comorbidities.
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Mazidi M, Katsiki N, Mikhailidis DP, Banach M. Association of ideal cardiovascular health metrics with serum uric acid, inflammation and atherogenic index of plasma: A population-based survey. Atherosclerosis 2018; 284:44-49. [PMID: 30875492 DOI: 10.1016/j.atherosclerosis.2018.09.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 08/18/2018] [Accepted: 09/14/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND AIMS We aimed to evaluate the link between inflammatory score [consisting of C-reactive protein (CRP) and white blood cells], serum uric acid (SUA) and atherogenic index of plasma (AIP) and the cardiovascular health (CVH) score. METHODS We used the cross-sectional National Health and Nutrition Examination Survey database. Statistical analyses accounted for the survey design and sample weights. RESULTS Overall, there were 23,004 participants (mean age = 47.2 years, 46.5% males). Participants with an ideal CVH level had the highest ratio of poverty to income (3.62%, p < 0.001), as well as lower levels of CRP, SUA and AIP (p < 0.001 for all comparisons). In adjusted linear regression, a significant negative association was observed between inflammatory score (β = -0.052, p < 0.001), SUA (β = -0.041, p < 0.001) and AIP (β = -0.039, p < 0.001) and CVH score, i.e. participants with a better (greater) CVH score had a lower inflammatory score. Results from adjusted logistic regression showed reduction in the likelihood of "high-risk atherosclerosis" (defined as AIP ≥0.21) [intermediate: odds ratio (OR) = 0.90, 95% confidence interval (CI):0.85-0.95, ideal: OR = 0.81, 95%CI: 0.74-0.88] and "high CVD risk" (defined as CRP ≥3 mg/l) [intermediate: OR = 0.86, 95%CI:0.73-0.98, ideal: OR = 0.82, 95%CI:0.69-0.95] across the categories of CVH. CONCLUSIONS Our findings highlight that CVH metrics were associated with inflammatory score, SUA and AIP. Furthermore, participants with a better CVH score had a lower CVD risk. These results reinforce the importance of implementing healthy behaviours as proposed by the American Heart Association. If confirmed in clinical trials, this knowledge may have implications for CVD prevention and management.
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Affiliation(s)
- Mohsen Mazidi
- Key State Laboratory of Molecular Developmental Biology, Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, Chaoyang, China; Institute of Genetics and Developmental Biology, International College, University of Chinese Academy of Science (IC-UCAS), Chaoyang, China.
| | - Niki Katsiki
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
| | - Dimitri P Mikhailidis
- Department of Clinical Biochemistry, Royal Free Campus, University College London Medical School, University College London (UCL), London, UK
| | - Maciej Banach
- Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, Poland; Polish Mother's Memorial Hospital Research Institute (PMMHRI), Lodz, Poland; Cardiovascular Research Centre, University of Zielona Gora, Zielona Gora, Poland
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Effects of uric acid on vascular endothelial function from bedside to bench. Hypertens Res 2018; 41:923-931. [PMID: 30185927 DOI: 10.1038/s41440-018-0095-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Revised: 04/06/2018] [Accepted: 04/10/2018] [Indexed: 12/20/2022]
Abstract
This study was designed to investigate the effects of uric acid on vascular endothelial function in measurements carried out either at the bedside or the laboratory bench. First, we performed reactive hyperemia peripheral arterial tonometry using an EndoPAT 2000 device and measured serum uric acid levels in 92 outpatients with hypertension. The reactive hyperemia index (RHI) showed no correlation with serum uric acid level (R = -0.125, P = 0.235) in either overall patients or in a high-risk group of 51 patients with complications such as cardiovascular and cerebrovascular diseases, chronic kidney disease, and/or diabetes (R = -0.025, P = 0.860). However, in the remaining 41 patients in the low-risk group, RHI correlated negatively with serum uric acid level (R = -0.335, P = 0.032). Multiple regression analysis showed that serum uric acid level predicted RHI (R = -0.321, P = 0.043) in the low-risk group independent of age, body mass index, systolic blood pressure, and low density lipoprotein-cholesterol level. We then performed an in-vitro study using the WST-8 assay in human umbilical vein endothelial cells, which showed that hypoxic conditions reduced cell viability. Treatment with uric acid caused a further reduction in cell viability, while ascorbic acid improved viability. Using Western blot analysis, we observed that uric acid reduced endothelial nitric oxide synthase phosphorylation during hypoxic conditions. Serum uric acid level is associated with peripheral vascular endothelial function in patients with low-risk hypertension and uric acid could directly impair endothelial function under hypoxic conditions. These results are relevant to the interventional studies examining the cardiovascular protective effect of hypouricemic agents.
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Mancusi C, Izzo R, Ferrara LA, Rozza F, Losi MA, Canciello G, Pepe M, de Luca N, Trimarco B, de Simone G. Is increased uric acid a risk factor or a defensive response? The Campania Salute Network. Nutr Metab Cardiovasc Dis 2018; 28:839-846. [PMID: 29898822 DOI: 10.1016/j.numecd.2018.04.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 04/15/2018] [Accepted: 04/26/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND AIMS Circulating uric acid (UA) is positively associated with body mass index (BMI), blood glucose, blood pressure (BP), markers of inflammation, and altered lipid profile. UA has also anti-oxidative properties which might be beneficial for cardiovascular (CV) system. It is still debated whether or not UA is independently associated with increased CV morbidity and/or mortality. METHODS AND RESULTS We studied prognostic impact of UA in 8833 hypertensive adults (mean age 53 ± 12 yrs, 3857 women) from the Campania Salute Network, without prevalent CV disease and more than stage 3 CKD. We calculated standardized UA Z-score, adjusted for age, sex, glomerular filtration rate, and BMI. Low and high UA and UA Z-score quartiles were compared to the 2 middle quartiles assumed to be "normal". Prevalence of obesity and diabetes was higher in low and high than in normal UA Z-score group (all p < 0.001). Systolic BP, left ventricular mass, carotid intima thickness were significantly higher and ejection fraction was reduced in the presence of high UA Z-score (all p < 0.001). Over 33-months average follow-up, incident major CV end-points (MACE) were not significantly different among low, normal and high UA or UA Z-score. In the latter analysis, however, incident MACE tended to be more frequent in the low than the high UA Z-score. Despite the results of multivariable analyses, the effect of less aggressive therapy in low UA Z-score cannot be excluded with certainty. CONCLUSION In treated hypertensive patients, high levels of UA normalized for major biological determinants do not independently predict CV outcome. CLINICALTRIALS. GOV IDENTIFIER NCT02211365.
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Affiliation(s)
- C Mancusi
- Hypertension Research Center, Italy; Department of Advanced Biomedical Sciences, Italy
| | - R Izzo
- Hypertension Research Center, Italy; Department of Translational Medical Sciences, Federico II University Hospital, Italy
| | | | - F Rozza
- Hypertension Research Center, Italy; Department of Advanced Biomedical Sciences, Italy
| | - M A Losi
- Hypertension Research Center, Italy; Department of Advanced Biomedical Sciences, Italy
| | | | - M Pepe
- Casa di Cura "San Michele", Maddaloni, Italy
| | - N de Luca
- Hypertension Research Center, Italy; Department of Translational Medical Sciences, Federico II University Hospital, Italy
| | - B Trimarco
- Hypertension Research Center, Italy; Department of Advanced Biomedical Sciences, Italy
| | - G de Simone
- Hypertension Research Center, Italy; Department of Translational Medical Sciences, Federico II University Hospital, Italy.
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Kuwata H, Okamura S, Hayashino Y, Tsujii S, Ishii H. Serum uric acid levels are associated with increased risk of newly developed diabetic retinopathy among Japanese male patients with type 2 diabetes: A prospective cohort study (diabetes distress and care registry at Tenri [DDCRT 13]). Diabetes Metab Res Rev 2017; 33. [PMID: 28444955 DOI: 10.1002/dmrr.2905] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 04/11/2017] [Accepted: 04/18/2017] [Indexed: 11/11/2022]
Abstract
OBJECTIVE We assessed the prospective association between baseline serum uric acid levels and consequent risk of developing diabetic retinopathy. RESEARCH DESIGN AND METHODS Data for 1839 type 2 diabetes patients without diabetic retinopathy were obtained from a Japanese diabetes registry. A Cox proportional hazards model with time-varying exposure information by sex was used and adjusted for potential confounders to assess the independent correlations between baseline serum uric acid levels and incidence rate of diabetic retinopathy. RESULTS Newly developed diabetic retinopathy was recognized in 188 patients (10.2%) during the observation period of 2 years. Compared to the first serum uric acid quartile level, the multivariate adjusted hazards ratio for diabetic retinopathy development in male patients was 1.97 (95% CI, 1.14-3.41; P = .015), 1.92 (95% CI, 1.18-3.13; P = .008), and 2.17 (95% CI, 1.40-3.37; P = .001) for the second, third, and fourth serum uric acid quartile levels, respectively. But this was not the case with female patients. CONCLUSION Higher serum uric acid levels were associated with increased risk of developing diabetic retinopathy in male patients with type 2 diabetes, but not in female patients. Serum uric acid may be a useful biomarker for predicting the future risk of developing diabetic retinopathy in male patients with type 2 diabetes.
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Affiliation(s)
- Hirohito Kuwata
- Department of Diabetology, Nara Medical University, Kashihara, Nara, Japan
| | | | | | - Satoru Tsujii
- Department of Endocrinology, Tenri Hospital, Tenri, Nara, Japan
| | - Hitoshi Ishii
- Department of Diabetology, Nara Medical University, Kashihara, Nara, Japan
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Wu J, Lei G, Wang X, Tang Y, Cheng H, Jian G, Wu X, Wang N. Asymptomatic hyperuricemia and coronary artery disease in elderly patients without comorbidities. Oncotarget 2017; 8:80688-80699. [PMID: 29113336 PMCID: PMC5655231 DOI: 10.18632/oncotarget.21079] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 09/03/2017] [Indexed: 02/07/2023] Open
Abstract
Because many subjects with hyperuricemia have comorbidities, it can be difficult to differentiate the role of hyperuricemia from that of other comorbidities of coronary artery disease (CAD). Subjects aged ≥ 65 years were enrolled in the study and were available at enrollment and at 5-year follow-up. Subjects were excluded if they were overweight or obese, hypertensive, diabetic, hyperlipidemic, had a pre-existing cardiovascular disease, a history of gout or hyperuricemia on medications, or chronic kidney disease as estimated by a glomerular filtration rate (eGFR) < 60 mL/min per 1.73 m2. We used Poisson regression to estimate the hazard ratio (HR) for incident CAD events between hyperuricemic (> 7 mg/dL in men and ≥ 6 mg/dL in women) and normouricemic subjects. A total of 2,142 subjects without comorbidities (mean age of 70.7 ± 5.9 years, 1,194 men) were followed for 57.4 ± 8.9 months. Hyperuricemia was associated with an increased cumulative incidence of incident CAD events (15.0% versus 8.8%, P < 0.001). After adjusting for confounding factors, hyperuricemia independently predicted the risk of incident CAD events (HR=1.71, 95% CI 1.26-2.34). In conclusion, asymptomatic hyperuricemia is a valuable biomarker for predicting the development of incident CAD events.
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Affiliation(s)
- Junnan Wu
- Department of Nephrology, Affiliated Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Guangtao Lei
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xiao Wang
- Department of Endocrinology, Affiliated Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yuezhong Tang
- Kangjian Community Health Center, Xuhui District, Shanghai, China
| | - Huan Cheng
- Kangjian Community Health Center, Xuhui District, Shanghai, China
| | - Guihua Jian
- Department of Nephrology, Affiliated Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xianfeng Wu
- Department of Nephrology, Affiliated Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Niansong Wang
- Department of Nephrology, Affiliated Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
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Caliceti C, Calabria D, Roda A, Cicero AFG. Fructose Intake, Serum Uric Acid, and Cardiometabolic Disorders: A Critical Review. Nutrients 2017; 9:nu9040395. [PMID: 28420204 PMCID: PMC5409734 DOI: 10.3390/nu9040395] [Citation(s) in RCA: 142] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 04/07/2017] [Accepted: 04/10/2017] [Indexed: 02/07/2023] Open
Abstract
There is a direct relationship between fructose intake and serum levels of uric acid (UA), which is the final product of purine metabolism. Recent preclinical and clinical evidence suggests that chronic hyperuricemia is an independent risk factor for hypertension, metabolic syndrome, and cardiovascular disease. It is probably also an independent risk factor for chronic kidney disease, Type 2 diabetes, and cognitive decline. These relationships have been observed for high serum UA levels (>5.5 mg/dL in women and >6 mg/dL in men), but also for normal to high serum UA levels (5-6 mg/dL). In this regard, blood UA levels are much higher in industrialized countries than in the rest of the world. Xanthine-oxidase inhibitors can reduce UA and seem to minimize its negative effects on vascular health. Other dietary and pathophysiological factors are also related to UA production. However, the role of fructose-derived UA in the pathogenesis of cardiometabolic disorders has not yet been fully clarified. Here, we critically review recent research on the biochemistry of UA production, the relationship between fructose intake and UA production, and how this relationship is linked to cardiometabolic disorders.
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Affiliation(s)
- Cristiana Caliceti
- Department of Chemistry "Giacomo Ciamician", Alma Mater Studiorum, University of Bologna, 40126 Bologna, Italy.
- Istituto Nazionale Biostrutture e Biosistemi (INBB), 00136 Rome, Italy.
- Centro Interdipartimentale di Ricerca Industriale Energia e Ambiente (CIRI EA), Alma Mater Studiorum, University of Bologna, 47900 Rimini, Italy.
| | - Donato Calabria
- Centro Interdipartimentale di Ricerca Industriale Energia e Ambiente (CIRI EA), Alma Mater Studiorum, University of Bologna, 47900 Rimini, Italy.
| | - Aldo Roda
- Department of Chemistry "Giacomo Ciamician", Alma Mater Studiorum, University of Bologna, 40126 Bologna, Italy.
- Istituto Nazionale Biostrutture e Biosistemi (INBB), 00136 Rome, Italy.
- Centro Interdipartimentale di Ricerca Industriale Energia e Ambiente (CIRI EA), Alma Mater Studiorum, University of Bologna, 47900 Rimini, Italy.
| | - Arrigo F G Cicero
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy.
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Zhang W, Iso H, Murakami Y, Miura K, Nagai M, Sugiyama D, Ueshima H, Okamura T. Serum Uric Acid and Mortality Form Cardiovascular Disease: EPOCH-JAPAN Study. J Atheroscler Thromb 2017; 23:1365-1366. [PMID: 27904050 PMCID: PMC5221499 DOI: 10.5551/jat.er31591] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Wen Zhang
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine
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Zhong C, Zhong X, Xu T, Xu T, Zhang Y. Sex-Specific Relationship Between Serum Uric Acid and Risk of Stroke: A Dose-Response Meta-Analysis of Prospective Studies. J Am Heart Assoc 2017; 6:JAHA.116.005042. [PMID: 28356280 PMCID: PMC5533011 DOI: 10.1161/jaha.116.005042] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Conflicting findings of the association between serum uric acid (UA) and stroke have been reported in both men and women, and it is unclear whether this association was different between men and women. We preformed this meta‐analysis to assess the sex‐specific effect of serum UA on the risk of stroke and its subtypes. Methods and Results Prospective studies that reported sex‐specific association of UA levels with stroke or reported in a certain sex were included. Dose‐response relationships were assessed by the generalized least squares trend estimation, and summary effect estimates were evaluated with random‐effect models. Subgroup and sensitivity analyses were performed to assess the potential sources of heterogeneity and the robustness of the pooled estimation. Altogether, 13 prospective studies were identified in this study. The summary of relative risks (95% CIs) of stroke for a 1‐mg/dL increase in serum UA levels were 1.10 (1.05–1.14) for men and 1.11 (1.09–1.13) for women. There is no significant difference in the effect of UA on future stroke risk between men and women (Pinteraction=0.736). Subgroup analyses showed that the significant associations persisted in most stratifications, and sensitivity analyses according to various inclusion criteria yielded similar results. A nonlinear relationship was observed in men (Pnon‐linearity<0.001), with risk increasing significantly from a UA of 6 mg/dL and more steeply at higher UA levels. Conclusions Elevated serum UA levels were significantly associated with modestly increased risk of stroke in both men and women and have similar adverse effects on development of stroke in both sexes.
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Affiliation(s)
- Chongke Zhong
- Department of Epidemiology, School of Public Health, Medical College of Soochow University, Suzhou, China.,Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China
| | - Xiaoyan Zhong
- Department of Nanomedicine & Biopharmaceuticals, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, China
| | - Tian Xu
- Department of Neurology, Affiliated Hospital of Nantong University, Nantong, China
| | - Tan Xu
- Department of Epidemiology, School of Public Health, Medical College of Soochow University, Suzhou, China.,Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China
| | - Yonghong Zhang
- Department of Epidemiology, School of Public Health, Medical College of Soochow University, Suzhou, China .,Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China
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Zuo T, Liu X, Jiang L, Mao S, Yin X, Guo L. Hyperuricemia and coronary heart disease mortality: a meta-analysis of prospective cohort studies. BMC Cardiovasc Disord 2016; 16:207. [PMID: 27793095 PMCID: PMC5084405 DOI: 10.1186/s12872-016-0379-z] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 10/22/2016] [Indexed: 02/07/2023] Open
Abstract
Background Hyperuricemia may be associated with an increased risk of coronary heart disease (CHD) mortality; however, the results from prospective studies are conflicting. The objective of this study was to assess the association between hyperuricemia and risk of CHD mortality by performing a meta-analysis. Methods Pubmed and Embase were searched for relevant prospective cohort studies published until July 2015. Studies were included only if they reported data on CHD mortality related to hyperuricemia in a general population. The pooled adjusted relative risk (RR) was calculated using a random-effects model. Results A total of 14 studies involving 341 389 adults were identified. Hyperuricemia was associated with an increased risk of CHD mortality (RR: 1.14; 95 % CI: 1.06–1.23) and all-cause mortality (RR: 1.20; 95 % CI: 1.13–1.28). For each increase of 1 mg/dl of serum uric acid (SUA), the overall risks of CHD and all-cause mortality increased by 20 and 9 %, respectively. According to the gender subgroup analyses, hyperuricemia increased the risk of CHD mortality in women (RR: 1.47; 95 % CI: 1.21–1.73) compared to men (RR: 1.10; 95 % CI: 1.00–1.19). The risk of all-cause mortality was greater in women. Conclusions Hyperuricemia may modestly increase the risk of CHD and all-cause mortality. Future research is needed to determine whether urate–lowering therapy has beneficial effects for reducing CHD mortality. Electronic supplementary material The online version of this article (doi:10.1186/s12872-016-0379-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tian Zuo
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, People's Republic of China.,Department of Critical Care Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, People's Republic of China
| | - Xuehui Liu
- Department of Cardiology, Yichang Hospital of Chinese Medicine, Clinical Medical College of Chinese Medicine, China Three Gorges University, Yichang, 443000, People's Republic of China
| | - Lu Jiang
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, People's Republic of China
| | - Shuai Mao
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, People's Republic of China.,Department of Critical Care Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, People's Republic of China
| | - Xin Yin
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, People's Republic of China.,Department of Critical Care Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, People's Republic of China
| | - Liheng Guo
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, People's Republic of China. .,Department of Critical Care Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120, People's Republic of China.
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Oyama S, Hirose C, Hori K, Sugano K, Zhang J, Tamura M, Tomita K. Effects, safety, and plasma levels of topiroxostat and its metabolites in patients receiving hemodialysis. RENAL REPLACEMENT THERAPY 2016. [DOI: 10.1186/s41100-016-0068-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Kamei K, Konta T, Hirayama A, Ichikawa K, Kubota I, Fujimoto S, Iseki K, Moriyama T, Yamagata K, Tsuruya K, Narita I, Kondo M, Shibagaki Y, Kasahara M, Asahi K, Watanabe T. Associations between serum uric acid levels and the incidence of nonfatal stroke: a nationwide community-based cohort study. Clin Exp Nephrol 2016; 21:497-503. [DOI: 10.1007/s10157-016-1311-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 07/07/2016] [Indexed: 02/07/2023]
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41
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Aloia E, Sciaccaluga C. Low acid uric in primary prophylaxis: worthy? Int J Cardiol 2016; 215:223-6. [DOI: 10.1016/j.ijcard.2016.04.065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 04/11/2016] [Indexed: 12/22/2022]
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Oyama JI, Tanaka A, Sato Y, Tomiyama H, Sata M, Ishizu T, Taguchi I, Kuroyanagi T, Teragawa H, Ishizaka N, Kanzaki Y, Ohishi M, Eguchi K, Higashi Y, Yamada H, Maemura K, Ako J, Bando YK, Ueda S, Inoue T, Murohara T, Node K. Rationale and design of a multicenter randomized study for evaluating vascular function under uric acid control using the xanthine oxidase inhibitor, febuxostat: the PRIZE study. Cardiovasc Diabetol 2016; 15:87. [PMID: 27317093 PMCID: PMC4912773 DOI: 10.1186/s12933-016-0409-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Accepted: 06/09/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Xanthine oxidase inhibitors are anti-hyperuricemic drugs that decrease serum uric acid levels by inhibiting its synthesis. Xanthine oxidase is also recognized as a pivotal enzyme in the production of oxidative stress. Excess oxidative stress induces endothelial dysfunction and inflammatory reactions in vascular systems, leading to atherosclerosis. Many experimental studies have suggested that xanthine oxidase inhibitors have anti-atherosclerotic effects by decreasing in vitro and in vivo oxidative stress. However, there is only limited evidence on the clinical implications of xanthine oxidase inhibitors on atherosclerotic cardiovascular disease in patients with hyperuricemia. We designed the PRIZE study to evaluate the effects of febuxostat on a surrogate marker of cardiovascular disease risk, ultrasonography-based intima-media thickness of the carotid artery in patients with hyperuricemia. METHODS The study is a multicenter, prospective, randomized, open-label and blinded-endpoint evaluation (PROBE) design. A total of 500 patients with asymptomatic hyperuricemia (uric acid >7.0 mg/dL) and carotid intima-media thickness ≥1.1 mm will be randomized centrally to receive either febuxostat (10-60 mg/day) or non-pharmacological treatment. Randomization is carried out using the dynamic allocation method stratified according to age (<65, ≥65 year), gender, presence or absence of diabetes mellitus, serum uric acid (<8.0, ≥8.0 mg/dL), and carotid intima-media thickness (<1.3, ≥1.3 mm). In addition to administering the study drug, we will also direct lifestyle modification in all participants, including advice on control of body weight, sleep, exercise and healthy diet. Carotid intima-media thickness will be evaluated using ultrasonography performed by skilled technicians at a central laboratory. Follow-up will be continued for 24 months. The primary endpoint is percentage change in mean intima-media thickness of the common carotid artery 24 months after baseline, measured by carotid ultrasound imaging. CONCLUSIONS PRIZE will be the first study to provide important data on the effects of febuxostat on atherosclerosis in patients with asymptomatic hyperuricemia. Trial Registration Unique trial Number, UMIN000012911 ( https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr.cgi?function=brows&action=brows&type=summary&recptno=R000015081&language=E ).
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Affiliation(s)
- Jun-ichi Oyama
- />Department of Cardiovascular Medicine, Saga University Faculty of Medicine, 5-1-1 Nabeshima, Saga, 849-8501 Japan
| | - Atsushi Tanaka
- />Department of Cardiovascular Medicine, Saga University Faculty of Medicine, 5-1-1 Nabeshima, Saga, 849-8501 Japan
| | - Yasunori Sato
- />Department of Clinical Research, Chiba University Graduate School of Medicine, Chiba, Japan
| | | | - Masataka Sata
- />Department of Cardiovascular Medicine, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Tomoko Ishizu
- />Department of Clinical Laboratory Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Isao Taguchi
- />Department of Cardiology, Dokkyo Medical University Koshigaya Hospital, Koshigaya, Japan
| | - Takanori Kuroyanagi
- />Department of Cardiology, Dokkyo Medical University Koshigaya Hospital, Koshigaya, Japan
| | - Hiroki Teragawa
- />Department of Cardiovascular Medicine, Hiroshima General Hospital of West Japan Railway Company, Hiroshima, Japan
| | - Nobukazu Ishizaka
- />Internal Medicine (III), Department of Cardiology, Osaka Medical College, Takatsuki, Japan
| | - Yumiko Kanzaki
- />Internal Medicine (III), Department of Cardiology, Osaka Medical College, Takatsuki, Japan
| | - Mitsuru Ohishi
- />Department of Cardiovascular Medicine and Hypertension, Kagoshima University, Kagoshima, Japan
| | - Kazuo Eguchi
- />Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan
| | - Yukihito Higashi
- />Department of Cardiovascular Regeneration and Medicine, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Hirotsugu Yamada
- />Department of Cardiovascular Medicine, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Koji Maemura
- />Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Junya Ako
- />Department of Cardiovascular Medicine, Kitasato University, Sagamihara, Japan
| | - Yasuko K. Bando
- />Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shinichiro Ueda
- />Department of Clinical Pharmacology & Therapeutics, University of the Ryukyus, Nishihara, Japan
| | - Teruo Inoue
- />Department of Cardiovascular Medicine, Dokkyo Medical University, Mibu, Japan
| | - Toyoaki Murohara
- />Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Koichi Node
- />Department of Cardiovascular Medicine, Saga University Faculty of Medicine, 5-1-1 Nabeshima, Saga, 849-8501 Japan
| | - On behalf of the PRIZE Study Investigators
- />Department of Cardiovascular Medicine, Saga University Faculty of Medicine, 5-1-1 Nabeshima, Saga, 849-8501 Japan
- />Department of Clinical Research, Chiba University Graduate School of Medicine, Chiba, Japan
- />Department of Cardiology, Tokyo Medical University, Tokyo, Japan
- />Department of Cardiovascular Medicine, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
- />Department of Clinical Laboratory Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
- />Department of Cardiology, Dokkyo Medical University Koshigaya Hospital, Koshigaya, Japan
- />Department of Cardiovascular Medicine, Hiroshima General Hospital of West Japan Railway Company, Hiroshima, Japan
- />Internal Medicine (III), Department of Cardiology, Osaka Medical College, Takatsuki, Japan
- />Department of Cardiovascular Medicine and Hypertension, Kagoshima University, Kagoshima, Japan
- />Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan
- />Department of Cardiovascular Regeneration and Medicine, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
- />Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- />Department of Cardiovascular Medicine, Kitasato University, Sagamihara, Japan
- />Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
- />Department of Clinical Pharmacology & Therapeutics, University of the Ryukyus, Nishihara, Japan
- />Department of Cardiovascular Medicine, Dokkyo Medical University, Mibu, Japan
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Abstract
In recent years, there has been an increase in the prevalence of hyperuricemia, and the latter has attracted attention as an adult lifestyle-associated disease, together with hypertension, diabetes, and dyslipidemia. Although hyperuricemia is known to be an independent risk factor for hypertension, whether it is an independent risk factor for cardiovascular disease remains controversial. Recently, some small-scale interventional studies on antihyperuricemic medications showed that the latter improved angina symptoms and prevented cardiovascular disease. Here, we will mainly explain the cause of hyperuricemia and the associations between hyperuricemia, hypertension, and cardiovascular disease based on the latest published evidence.
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Affiliation(s)
- Masanari Kuwabara
- Department of Cardiology, Toranomon Hospital, and Department of Cardiology, St. Luke's International Hospital, Tokyo, Japan
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44
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Zhang W, Iso H, Murakami Y, Miura K, Nagai M, Sugiyama D, Ueshima H, Okamura T. Serum Uric Acid and Mortality Form Cardiovascular Disease: EPOCH-JAPAN Study. J Atheroscler Thromb 2016; 23:692-703. [PMID: 26887218 DOI: 10.5551/jat.31591] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIM To investigate the relationship between serum uric acid levels and cardiovascular disease in Asians. METHODS We examined the above relationship using the data of Evidence for Cardiovascular Prevention from Observational Cohorts in Japan (EPOCH-JAPAN Study). The data of 36,313 subjects (15,628 men and 20,685 women aged 35-89 years without histories of stroke, coronary heart disease, or cancer at baseline) were used for the analyses. Sex-specific hazard ratios (HRs) of mortality from cardiovascular disease were estimated according to the quintiles of serum uric acid using Cox hazard models stratified by cohorts. RESULTS During 441,771 person-years of follow-up, we documented 1,288 cardiovascular deaths. A J- or U-shaped relationship between serum uric acid level and cardiovascular disease mortality was observed. Compared with the lowest quintile of serum uric acid levels, the highest quintile was associated with an increased cardiovascular disease mortality in men [HR: 1.28; 95% confidence interval (CI): 1.01-1.63] and women (HR: 1.51; 95% CI: 1.14-1.99). However, there was no significant association with mortality from stroke, coronary heart disease or heart failure in both men and women. CONCLUSION This large pooled analysis in Japan suggested a J- or U-shaped relationship between serum uric acid levels and cardiovascular mortality. The highest quintile of serum uric acid levels was associated with increased cardiovascular disease mortality in both Japanese men and women.
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Affiliation(s)
- Wen Zhang
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine
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45
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Kamei K, Konta T, Ichikawa K, Sato H, Suzuki N, Kabasawa A, Suzuki K, Hirayama A, Shibata Y, Watanabe T, Kato T, Ueno Y, Kayama T, Kubota I. Serum uric acid levels and mortality in the Japanese population: the Yamagata (Takahata) study. Clin Exp Nephrol 2016; 20:904-909. [DOI: 10.1007/s10157-016-1228-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 01/07/2016] [Indexed: 11/28/2022]
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Serum uric acid as a predictor for cardiovascular and all-cause mortality in women versus men. Int J Cardiol 2015; 185:125-8. [DOI: 10.1016/j.ijcard.2015.03.121] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 03/07/2015] [Indexed: 11/20/2022]
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47
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Chen Y, Xu B, Sun W, Sun J, Wang T, Xu Y, Xu M, Lu J, Li X, Bi Y, Wang W, Ning G. Impact of the Serum Uric Acid Level on Subclinical Atherosclerosis in Middle-aged and Elderly Chinese. J Atheroscler Thromb 2015; 22:823-32. [PMID: 25740202 DOI: 10.5551/jat.26260] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIM The carotid intima-media thickness (CIMT) is now validated as a sensitive marker of atherosclerosis and is directly associated with an increased risk of cardiovascular disease. Considering that the independent association between the serum uric acid level and CIMT remains controversial due to the complex interrelationship with other known cardiovascular risk factors, further studies are needed. The aim of the present study is to explore the association between the serum uric acid level and CIMT in a general Chinese population and determine whether the association differs according to varied metabolic status. METHODS The present study was cross-sectional in design. A total of 10,281 community-based participants 40 years of age or older from Shanghai, China were included in the current analysis. All participants underwent a detailed questionnaire interview, anthropometric measurements and ultrasonography to assess the CIMT. Blood and urine samples were collected for the biochemical measurements. RESULTS The serum uric acid levels were positively associated with obesity- and diabetes-related parameters and the CIMT. In a logistic regression model controlling for potential confounders, compared with the participants in the first quartile of the uric acid level, those in the fourth quartile had a higher odds of an elevated CIMT in both men (odds ratio [OR]=1.37; 95% confidence interval [CI]=1.07-1.75) and women (OR=1.48; 95% CI=1.12-1.94). The subgroup analyses revealed that an association between an elevated CIMT and the serum uric acid level persisted regardless of diuretic use and the hypertension, diabetes mellitus and chronic kidney disease status. However, the association disappeared in the patients who consumed alcohol and in premenopausal women. CONCLUSIONS The serum uric acid level is positively associated with an elevated CIMT in middle-aged and elderly Chinese subjects, independent of known risk determinants of cardiovascular disease.
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Affiliation(s)
- Ying Chen
- Key Laboratory for Endocrine and Metabolic Diseases of Ministry of Health, Rui-Jin Hospital, Shanghai Jiao Tong University School of Medicine, E-Institute of Shanghai Universities
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48
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Aribas A, Akilli H, Kayrak M, Alibasic H, Yildirim O, Sertdemir AL, Karanfil M, Ozdemir K. Effect of serum uric acid on the positive predictive value of dobutamine stress echocardiography. Heart Vessels 2014; 31:382-9. [PMID: 25502950 DOI: 10.1007/s00380-014-0609-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 12/01/2014] [Indexed: 11/29/2022]
Abstract
There is controversial data regarding the relationship between uric acid (UA) and coronary artery disease and cardiovascular events. Despite the deleterious effects of hyperuricemia on endothelial function, the effect of UA on myocardial ischemia has not been previously studied. We aimed to investigate the relationship between UA and myocardial ischemia that was identified using dobutamine stress echocardiography (DSE). In this retrospective study, the laboratory and DSE reports of 548 patients were reviewed. The patients were divided into two groups based on the presence of ischemia and further subdivided into three groups according to the extent of ischemia (none, ischemia in 1-3 segments, ischemia in >3 segments). Serum UA levels were compared. Determinants of ischemia were assessed using a regression model. UA was increased in patients with ischemia and was correlated with the number of ischemic segments (p < 0.001). A cutoff value of UA > 5 mg/dl had 63.9 % sensitivity, 62.0 % specificity, 42.5 % positive predictive value (PPV), and 79.6 % negative predictive value for ischemia. When the positive DSE exams were further sorted according to the UA cutoff, the PPV of DSE increased from 80.2 to 94.0 %. Uric acid (odds ratio 1.51; 95 % CI 1.14-1.99), diabetes mellitus, HDL and glomerular filtration rate were found to be independent determinants of myocardial ischemia in DSE. Increased UA is associated with both the presence and extent of DSE-identified myocardial ischemia. A UA cutoff may be a good method to improve the PPV of DSE.
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Affiliation(s)
- Alpay Aribas
- Department of Cardiology, Necmettin Erbakan University Meram School of Medicine, Meram, Konya, Turkey.
| | - Hakan Akilli
- Department of Cardiology, Necmettin Erbakan University Meram School of Medicine, Meram, Konya, Turkey
| | - Mehmet Kayrak
- Department of Cardiology, Necmettin Erbakan University Meram School of Medicine, Meram, Konya, Turkey
| | | | | | - Ahmet Lutfi Sertdemir
- Department of Cardiology, Necmettin Erbakan University Meram School of Medicine, Meram, Konya, Turkey
| | - Mustafa Karanfil
- Department of Cardiology, Necmettin Erbakan University Meram School of Medicine, Meram, Konya, Turkey
| | - Kurtulus Ozdemir
- Department of Cardiology, Necmettin Erbakan University Meram School of Medicine, Meram, Konya, Turkey
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Huda N, Hossain S, Rahman M, Karim MR, Islam K, Mamun AA, Hossain MI, Mohanto NC, Alam S, Aktar S, Arefin A, Ali N, Salam KA, Aziz A, Saud ZA, Miyataka H, Himeno S, Hossain K. Elevated levels of plasma uric acid and its relation to hypertension in arsenic-endemic human individuals in Bangladesh. Toxicol Appl Pharmacol 2014; 281:11-8. [PMID: 25281834 DOI: 10.1016/j.taap.2014.09.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 09/16/2014] [Accepted: 09/19/2014] [Indexed: 12/22/2022]
Abstract
Blood uric acid has been recognized as a putative marker for cardiovascular diseases (CVDs). CVDs are the major causes of arsenic-related morbidity and mortality. However, the association of arsenic exposure with plasma uric acid (PUA) levels in relation to CVDs has not yet been explored. This study for the first time demonstrated the associations of arsenic exposure with PUA levels and its relationship with hypertension. A total of 483 subjects, 322 from arsenic-endemic and 161 from non-endemic areas in Bangladesh were recruited as study subjects. Arsenic concentrations in the drinking water, hair and nails of the study subjects were measured by inductively coupled plasma mass spectroscopy. PUA levels were measured using a colorimetric method. We found that PUA levels were significantly (p<0.001) higher in males and females living in arsenic-endemic areas than those in non-endemic area. Arsenic exposure (water, hair and nail arsenic) levels showed significant positive correlations with PUA levels. In multiple regression analyses, arsenic exposure levels were found to be the most significant contributors on PUA levels among the other variables that included age, body mass index, blood urea nitrogen, and smoking. There were dose-response relationships between arsenic exposure and PUA levels. Furthermore, diastolic and systolic blood pressure showed significant positive correlations with PUA levels. Finally, the average PUA levels were significantly higher in the hypertensive group than those in the normotensive group in both males and females living in arsenic-endemic areas. These results suggest that arsenic exposure-related elevation of PUA levels may be implicated in arsenic-induced CVDs.
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Affiliation(s)
- Nazmul Huda
- Department of Biochemistry and Molecular Biology, Rajshahi University, Rajshahi 6205, Bangladesh; Department of Medicine, Rajshahi Medical College, Rajshahi 6000, Bangladesh
| | - Shakhawoat Hossain
- Department of Biochemistry and Molecular Biology, Rajshahi University, Rajshahi 6205, Bangladesh
| | - Mashiur Rahman
- Department of Biochemistry and Molecular Biology, Rajshahi University, Rajshahi 6205, Bangladesh
| | - Md Rezaul Karim
- Department of Applied Nutrition and Food Technology, Islamic University, Kushtia 7003, Bangladesh
| | - Khairul Islam
- Department of Biochemistry and Molecular Biology, Mawlana Bhashani Science and Technology University, Santosh, Tangail 1902, Bangladesh
| | - Abdullah Al Mamun
- Department of Biochemistry and Molecular Biology, Rajshahi University, Rajshahi 6205, Bangladesh
| | - Md Imam Hossain
- Department of Biochemistry and Molecular Biology, Rajshahi University, Rajshahi 6205, Bangladesh
| | - Nayan Chandra Mohanto
- Department of Biochemistry and Molecular Biology, Rajshahi University, Rajshahi 6205, Bangladesh
| | - Shahnur Alam
- Department of Biochemistry and Molecular Biology, Rajshahi University, Rajshahi 6205, Bangladesh
| | - Sharmin Aktar
- Department of Biochemistry and Molecular Biology, Rajshahi University, Rajshahi 6205, Bangladesh
| | - Afroza Arefin
- Department of Biochemistry and Molecular Biology, Rajshahi University, Rajshahi 6205, Bangladesh
| | - Nurshad Ali
- Department of Biochemistry and Molecular Biology, Rajshahi University, Rajshahi 6205, Bangladesh
| | - Kazi Abdus Salam
- Department of Biochemistry and Molecular Biology, Rajshahi University, Rajshahi 6205, Bangladesh
| | - Abdul Aziz
- Department of Biochemistry and Molecular Biology, Rajshahi University, Rajshahi 6205, Bangladesh
| | - Zahangir Alam Saud
- Department of Biochemistry and Molecular Biology, Rajshahi University, Rajshahi 6205, Bangladesh
| | - Hideki Miyataka
- Laboratory of Molecular Nutrition and Toxicology, Faculty of Pharmaceutical Sciences, Tokushima Bunri University, Tokushima 770-8514, Japan
| | - Seiichiro Himeno
- Laboratory of Molecular Nutrition and Toxicology, Faculty of Pharmaceutical Sciences, Tokushima Bunri University, Tokushima 770-8514, Japan
| | - Khaled Hossain
- Department of Biochemistry and Molecular Biology, Rajshahi University, Rajshahi 6205, Bangladesh.
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Dziuba J, Alperin P, Racketa J, Iloeje U, Goswami D, Hardy E, Perlstein I, Grossman HL, Cohen M. Modeling effects of SGLT-2 inhibitor dapagliflozin treatment versus standard diabetes therapy on cardiovascular and microvascular outcomes. Diabetes Obes Metab 2014; 16:628-35. [PMID: 24443793 DOI: 10.1111/dom.12261] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Revised: 07/16/2013] [Accepted: 01/11/2014] [Indexed: 01/10/2023]
Abstract
AIMS Dapagliflozin, a sodium-glucose cotransporter 2 (SGLT-2) inhibitor, has been shown to lower glycated hemoglobin (HbA1c), weight, blood pressure and serum uric acid in clinical trials. Plasma lipids were also evaluated as exploratory variables. The goal of this study was to estimate the long-term cardiovascular (CV) and microvascular outcomes of dapagliflozin added to the standard of care (SOC) versus SOC using simulation methodology. METHODS The Archimedes Model, a validated model of human physiology, diseases and healthcare systems, was used to model a type 2 diabetes mellitus (T2DM) population derived from National Health and Nutrition Examination Survey (NHANES) with HbA1c 7-10%, taking a single oral antidiabetic agent [metformin, sulfonylureas SU or thiazolidinedione (TZD)] at the beginning of the trial. A 20-year trial was simulated comparing dapagliflozin 10 mg, given in addition to SOC, with SOC alone. SOC was based on American Diabetes Association (ADA)/European Association for the Study of Diabetes (EASD) 2012 guidelines and included diet, metformin, SU, TZD, dipeptidyl peptidase-4 (DPP-4), glucagon-like peptide-1 (GLP-1), and insulin therapies, with usage levels reflective of those in NHANES. Dapagliflozin effects were derived from phase 3 clinical trial results. End points included CV and microvascular outcomes. RESULTS Over a 20-year period, patients on dapagliflozin were projected to experience relative reductions in the incidence of myocardial infarction (MI), stroke, CV death, and all-cause death of 13.8, 9.1, 9.6 and 5.0%, respectively, and relative reductions in the incidence of end-stage renal disease (ESRD), foot amputation, and diabetic retinopathy of 18.7, 13.0 and 9.8%, respectively, when compared with SOC. CONCLUSIONS On the basis of simulation results, adding dapagliflozin to currently available treatment options is projected to further decrease the CV and microvascular complications associated with T2DM.
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Affiliation(s)
- J Dziuba
- Department of Science, Archimedes, Inc., San Francisco, CA, USA
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