Mediating effects of insulin resistance on the development of hypertension associated with elevated serum uric acid: a prospective cohort study

Association between the Triglyceride Glucose Index and Hyperuricemia in Patients with Primary Hypertension: A Cross-Sectional Study

Objective

The aim of this study was to investigate the association between the triglyceride glucose (TyG) index and hyperuricemia (HUA) in patients with grades 1-3 hypertension. Study Design. This is a cross-sectional study. A total of 1,707 patients from the cardiovascular department of Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine were studied. In this study, 899 patients with grades 1-2 hypertension were included, of which 151 had HUA; additionally, 808 patients with grade 3 hypertension were included, of which 162 patients had HUA. This study obtained all patient data from the electronic medical record system of the Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine. The TyG index was calculated as Ln (triglycerides × fasting glucose/2). Hyperuricemia was defined as uric acid ≥420 μmol/L (7 mg/dL). Multivariate logistic regression, penalized spline regression, and generalized additive models were used to evaluate the association between the TyG index and HUA. Stratified analyses were performed to assess the association in populations with different grades of hypertension.

Results

The average TyG index was 8.71 ± 0.58. After adjusting for correlated variables, the logistic regression analysis revealed a positive correlation between the TyG index and HUA (OR = 1.83; 95% CI: 1.40-2.39). Smooth curve fitting showed that this correlation was linear in the whole range of the TyG index. In the subgroup analysis, the TyG index more strongly associated with HUA in the grades 1-2 hypertension group (OR = 2.22; 95% CI: 1.44-3.42) compared to that in the grade 3 hypertension group (OR = 1.58; 95% CI: 1.11-2.24; P for interaction = 0.03). In addition, this association was consistent in all models.

Conclusion

The TyG index was positively associated with HUA in patients with hypertension, and the association was more strongly confirmed in those with grades 1-2 hypertension rather than in those with grade 3 hypertension.

Role of Insulin Resistance as a Mediator of the Relationship between Body Weight, Waist Circumference, and Systolic Blood Pressure in a Pediatric Population

Excess weight and high waist circumference (WC) are associated with increased blood pressure (BP), starting from the pediatric age. Insulin resistance is associated with elevated BP in childhood. The aim of the study was to assess the role of insulin resistance in mediating the relationship between body mass index (BMI), WC, and BP values in a pediatric population referred to a cardio-pediatric center for the presence of one or more cardiovascular risk factors. In 419 children (mean age 10.7 [standard deviation, SD 2.5] years), the following parameters were collected both in basal conditions and after 18.6 (SD 9.3) months of follow-up during which a treatment based on lifestyle and dietary modifications was given: systolic and diastolic BP (SBP and DBP), WC, plasma glucose, and insulin values. The HOMA (Homeostasis Model Assessment)-index was considered as an expression of insulin resistance. At baseline there was a significant correlation between HOMA-index and SBP z-score (β = 0.081, p = 0.003), and insulin resistance was a mediator of the relationship between BMI and SBP z-score (p = 0.015), and between waist circumference to height (WtHr) and SBP z-score (p = 0.008). The effect of BMI z-score modifications on SBP z-score changes from baseline to follow-up was totally mediated by HOMA-index changes (p = 0.008), while HOMA-index only partially mediated the effect of WtHr modifications on SBP z-score changes (p = 0.060). Our study strongly suggests that, in a pediatric population at cardiovascular risk, the HOMA-index is an important mediator of the relationship between BMI, WC and SBP.

Reduced Incidence of Stroke in Patients with Gout Using Benzbromarone

Gout is strongly associated with the incidence of atherosclerotic events, including stroke and myocardial infarction. Considering the increased prevalence of stroke in the population with gout, the aim of this study was to evaluate the effects of benzbromarone, a uricosuric agent, on the incidence of stroke in the population with gout. We used data from the Taiwanese National Health Insurance Registration Database (NHIRD). The benzbromarone user cohort included 15,143 patients; each patient was age- and sex-matched with one non-user randomly selected from the population with gout. Cox proportional hazard regression analysis was conducted to estimate the effects of benzbromarone on the incidence of stroke in the population with gout. The incidence of stroke was significantly lower in benzbromarone users than in benzbromarone non-users. The HR for the incidence of stroke was lower in male benzbromarone users than in non-users. An analysis of three age groups (<40, 40–59, and ≥60 years) indicated that the HRs in those aged 40–59 years and ≥60 years were significantly lower among benzbromarone users than non-users. In the population with gout, the incidence of stroke was lower in benzbromarone users than in benzbromarone non-users.

Triglyceride-glucose index is a predictive index of hyperuricemia events in elderly patients with hypertension: a cross-sectional study

BACKGROUND

To analyze the association between triglyceride-glucose index (TYG index) and hyperuricemia (HUA) in elderly patients with hypertension.

METHODS

A total of 428 inpatients with primary hypertension from March 2018 to March 2021 in Qinghai Provincial People's Hospital were retrospectively analyzed. Grouped by sex and serum uric acid. Serum uric acid (SUA), fasting blood glucose (FPG), total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), serum creatinine (Scr), urea nitrogen (BUN), triglycerides (TG), high-sensitivity C-reactive protein (HS-CRP) and other biochemical indicators were measured, and the TYG index was calculated. The TYG index and SUA levels of each group were compared, and the correlation between TYG index and hyperuricemia was analyzed. Multivariate Logistic regression was performed to analyze the relationship between TYG index and the risk of HUA in elderly patients with hypertension. The ROC curve was used to evaluate the predictive value of TYG index in elderly patients with hypertension associated with HUA.

RESULTS

TYG index was significantly higher in the HUA group than in the normal group in both men and women (P < .05). Spearson correlation analysis showed that TYG index positively correlated with TC, TG, FPG, SUA, and LDL-C(r = 0.327, 0.975, 0.412, 0.214, 0.215, P = .000, 0.000, 0.000, 0.000, 0.000), and negatively correlated with age and HDL-C (r = -0.166, -0.248, P = .001, 0.000). Logistic regression analysis showed that Scr, BUN, HS-CRP and TYG index were the risk factors for HUA in elderly patients with hypertension (P < .05).The ROC curve showed an area under the TYG exponential curve of 0.617(95%CI:0.561 ~ 0.673) with a sensitivity of 64.4% and a specificity of 57.4%.

CONCLUSION

TYG index in elderly hypertensive patients is closely related to hyperuricemia, and the increase of TYG index is an independent risk factor for HUA in elderly hypertensive patients.