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Tian X, Chen S, Wang P, Xu Q, Zhang Y, Zhang X, Wu S, Luo Y, Wang A. The impact of serum acid, arterial stiffness, and hypertension as a mediating factor: A cohort study. Hellenic J Cardiol 2024; 77:70-80. [PMID: 37633489 DOI: 10.1016/j.hjc.2023.07.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/18/2023] [Accepted: 07/31/2023] [Indexed: 08/28/2023] Open
Abstract
BACKGROUND Serum uric acid (SUA) has been associated with arterial stiffness. However, previous studies were limited to contradicting cross-sectional studies. This study aimed to examine the longitudinal association between SUA and the progression of arterial stiffness and the potential mechanisms. METHODS Based on the Kailuan study, arterial stiffness progression was assessed by the annual growth rate of repeatedly measured brachial-ankle pulse wave velocity (baPWV). Generalized linear regression models were used to estimate the association of SUA with baseline arterial stiffness (n = 37,659) and arterial stiffness progression (n = 16,506), and Cox regressions were used to investigate the risk of incident arterial stiffness (n = 13,843). Mediation analysis was used to explore the potential mediators of the associations. RESULTS Per standard deviation increase in SUA was associated with an 11.89 cm/s increment (95% confidence interval [CI], 8.60-15.17) in baseline baPWV and a 2.67 cm/s/yr increment in the annual growth rate of baPWV. During the 5.77-year follow-up, there were 1953 cases of incident arterial stiffness. Participants in the highest quartile of SUA had a 39% higher risk of arterial stiffness (HR, 1.39; 95% CI, 1.21-1.60), as compared with those in the lowest quartile of SUA. Furthermore, the observed associations were more pronounced in women than in men (Pint<0.05). The pathological pathway from high SUA to arterial stiffness was mainly mediated through hypertension (mediated proportion: 24.74%). CONCLUSIONS Our study indicates that SUA was positively associated with the risk of arterial stiffness and its progression, especially in women. The association was mainly mediated through hypertension.
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Affiliation(s)
- 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
| | - Shuohua Chen
- Department of Cardiology, Kailuan Hospital, North China University of Science and Technology, Tangshan, China
| | - Penglian Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Qin Xu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yijun 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
| | - Xiaoli Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shouling Wu
- Department of Cardiology, Kailuan Hospital, North China University of Science and Technology, Tangshan, 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.
| | - Anxin Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
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Zhao J, Sha B, Zeng L, Dou Y, Huang H, Liang G, Pan J, Hong K, Zhou G, Yang W, Liu J. J-shaped association of serum uric acid concentrations with all-cause mortality in individuals with osteoarthritis: A prospective cohort study. Joint Bone Spine 2024; 91:105679. [PMID: 38143017 DOI: 10.1016/j.jbspin.2023.105679] [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: 09/10/2023] [Revised: 12/03/2023] [Accepted: 12/11/2023] [Indexed: 12/26/2023]
Abstract
OBJECTIVE The purpose of this study was to explore the relationship between serum uric acid (SUA) concentrations and all-cause mortality in individuals with osteoarthritis (OA). METHODS All participant data were retrieved from the National Health and Nutrition Examination Survey database. A total of 4671 participants (age range: 20 to 85 years old), including 2988 females and 1683 males, were included in this study. The determination of death outcome was based on the National Death Index (up to December 31, 2019). We explored the nonlinear relationship between SUA concentrations and all-cause mortality in OA patients by establishing a Cox proportional risk model and a two-segment Cox proportional risk model and ran an interaction test to identify the high-risk population for all-cause mortality. RESULTS During 30,645 person-years of follow-up, the number of all-cause deaths for females and males was 736 and 516, respectively. After multivariate adjustment, we found a nonlinear relationship between SUA concentrations and all-cause mortality in both females and males with OA. In addition, we found a J-shaped relationship between SUA concentrations and all-cause mortality. The SUA concentration thresholds for all-cause mortality of females and males were stable at 5.6mg/dl and 6.2mg/dl, respectively. Compared with SUA concentrations below the inflection point, the all-cause mortality risk at higher SUA concentrations in females and males with OA increased by 20% (hazard ratio [HR]: 1.2, 95% confidence interval [CI]: 1.1 to 1.2) and 25% (HR: 1.2, 95% CI: 1.12 to 1.39), respectively. CONCLUSIONS There is a nonlinear relationship between SUA concentrations and all-cause mortality in the American OA population (J-shaped association). The all-cause mortality thresholds for SUA concentrations in females and males are 5.6mg/dl and 6.2mg/dl, respectively.
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Affiliation(s)
- Jinlong Zhao
- The Second Clinical College/State Key Laboratory of Traditional Chinese Medicine Syndrome of Guangzhou University of Chinese Medicine, 510405 Guangzhou, China; The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), 510120 Guangzhou, China; The Research Team on Bone and Joint Degeneration and Injury of Guangdong Provincial Academy of Chinese Medical Sciences, 510120 Guangzhou, China
| | - Bangxin Sha
- The Fifth Clinical College of Guangzhou University of Chinese Medicine, 510405 Guangzhou, China
| | - Lingfeng Zeng
- The Second Clinical College/State Key Laboratory of Traditional Chinese Medicine Syndrome of Guangzhou University of Chinese Medicine, 510405 Guangzhou, China; The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), 510120 Guangzhou, China; The Research Team on Bone and Joint Degeneration and Injury of Guangdong Provincial Academy of Chinese Medical Sciences, 510120 Guangzhou, China
| | - Yaoxing Dou
- The Second Clinical College/State Key Laboratory of Traditional Chinese Medicine Syndrome of Guangzhou University of Chinese Medicine, 510405 Guangzhou, China; The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), 510120 Guangzhou, China; The Research Team on Bone and Joint Degeneration and Injury of Guangdong Provincial Academy of Chinese Medical Sciences, 510120 Guangzhou, China
| | - Hetao Huang
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), 510120 Guangzhou, China
| | - Guihong Liang
- The Second Clinical College/State Key Laboratory of Traditional Chinese Medicine Syndrome of Guangzhou University of Chinese Medicine, 510405 Guangzhou, China; The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), 510120 Guangzhou, China; The Research Team on Bone and Joint Degeneration and Injury of Guangdong Provincial Academy of Chinese Medical Sciences, 510120 Guangzhou, China
| | - Jianke Pan
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), 510120 Guangzhou, China
| | - Kunhao Hong
- The Fifth Clinical College of Guangzhou University of Chinese Medicine, 510405 Guangzhou, China; Guangdong Second Chinese Medicine Hospital (Guangdong Province Engineering Technology Research Institute of Traditional Chinese Medicine), 510095 Guangzhou, China
| | - Guanghui Zhou
- The Second Clinical College/State Key Laboratory of Traditional Chinese Medicine Syndrome of Guangzhou University of Chinese Medicine, 510405 Guangzhou, China
| | - Weiyi Yang
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), 510120 Guangzhou, China.
| | - Jun Liu
- The Research Team on Bone and Joint Degeneration and Injury of Guangdong Provincial Academy of Chinese Medical Sciences, 510120 Guangzhou, China; The Fifth Clinical College of Guangzhou University of Chinese Medicine, 510405 Guangzhou, China; Guangdong Second Chinese Medicine Hospital (Guangdong Province Engineering Technology Research Institute of Traditional Chinese Medicine), 510095 Guangzhou, China.
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Tanaka A, Taguchi I, Hisauchi I, Yoshida H, Shimabukuro M, Hongo H, Ishikawa T, Kadokami T, Yagi S, Sata M, Node K. Clinical effects of a selective urate reabsorption inhibitor dotinurad in patients with hyperuricemia and treated hypertension: a multicenter, prospective, exploratory study (DIANA). Eur J Med Res 2023; 28:238. [PMID: 37461063 DOI: 10.1186/s40001-023-01208-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 07/04/2023] [Indexed: 07/20/2023] Open
Abstract
INTRODUCTION Dotinurad is a newer urate-lowering agent that selectively inhibits urate transporter 1 in the renal proximal tubule and increases urinary urate excretion. Currently, little is known about the clinical efficacies of dotinurad in patients with hyperuricemia and hypertension. The aim of this study was to assess the clinical effects of a selective urate reabsorption inhibitor dotinurad on serum uric acid (SUA) levels and relevant vascular markers in patients with hyperuricemia and treated hypertension. METHODS This investigator-initiated, multicenter, prospective, single-arm, open-label, exploratory clinical trial in Japan enrolled patients with hyperuricemia and treated hypertension who received a 24-week dotinurad therapy (a starting dose at 0.5 mg once daily and up-titrated to 2 mg once daily). The primary endpoint was a percentage change in the SUA level from baseline to week 24. The secondary endpoints were cardiovascular and metabolic measurements, including changes in the cardio-ankle vascular index (CAVI) and derivatives of reactive oxygen metabolites (d-ROMs) concentration at week 24. RESULTS Fifty patients (mean age 70.5 ± 11.0 years, with 76.0% being men, and mean SUA level 8.5 ± 1.2 mg/dL) were included in the analysis. The percentage change from baseline in the SUA level at week 24 was - 35.8% (95% confidence interval [CI] - 39.7% to - 32.0%, P < 0.001), with approximately three quarters of patients achieving an SUA level of ≤ 6.0 mg/dL at week 24. The proportional changes from baseline in the geometric mean of CAVI and d-ROMs at week 24 were 0.96 (95% CI 0.92 to 1.00, P = 0.044) and 0.96 (95% CI 0.92 to 1.00, P = 0.044), respectively. CONCLUSION In addition to meaningful SUA-lowering effects, 24 weeks of dotinurad therapy may favorably affect arterial stiffness and oxidative stress markers, suggesting off-target vascular protection of dotinurad. Further research is expected to verify our findings and elucidate the entire off-target effects of dotinurad. Trial registration jRCTs021210013, registration date June 24, 2021.
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Affiliation(s)
- Atsushi Tanaka
- Department of Cardiovascular Medicine, Saga University, 5-5-1 Nabeshima, Saga, 849-8501, Japan.
| | - Isao Taguchi
- Department of Cardiology, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Itaru Hisauchi
- Department of Cardiology, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Hisako Yoshida
- Department of Medical Statistics, Osaka Metropolitan University, Osaka, Japan
| | - Michio Shimabukuro
- Department of Diabetes, Endocrinology, and Metabolism, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Hiroshi Hongo
- Department of Cardiovascular Medicine, Saga University, 5-5-1 Nabeshima, Saga, 849-8501, Japan
| | - Tetsuya Ishikawa
- Department of Cardiology, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Toshiaki Kadokami
- Cardiovascular Medicine, Fukuoka Saiseikai Futsukaichi Hospital, Chikushino, Japan
| | - Shusuke Yagi
- Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima, Japan
| | - Masataka Sata
- Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima, Japan
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University, 5-5-1 Nabeshima, Saga, 849-8501, Japan.
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Mutual effect of homocysteine and uric acid on arterial stiffness and cardiovascular risk in the context of predictive, preventive, and personalized medicine. EPMA J 2022; 13:581-595. [PMID: 36505895 PMCID: PMC9727018 DOI: 10.1007/s13167-022-00298-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 08/26/2022] [Indexed: 12/15/2022]
Abstract
Background Arterial stiffness is a major risk factor and effective predictor of cardiovascular diseases and a common pathway of pathological vascular impairments. Homocysteine (Hcy) and uric acid (UA) own the shared metabolic pathways to affect vascular function. Serum uric acid (UA) has a great impact on arterial stiffness and cardiovascular risk, while the mutual effect with Hcy remains unknown yet. This study aimed to evaluate the mutual effect of serum Hcy and UA on arterial stiffness and 10-year cardiovascular risk in the general population. From the perspective of predictive, preventive, and personalized medicine (PPPM/3PM), we assumed that combined assessment of Hcy and UA provides a better tool for targeted prevention and personalized intervention of cardiovascular diseases via suppressing arterial stiffness. Methods This study consisted of 17,697 participants from Beijing Health Management Cohort, who underwent health examination between January 2012 and December 2019. Brachial-ankle pulse wave velocity (baPWV) was used as an index of arterial stiffness. Results Individuals with both high Hcy and UA had the highest baPWV, compared with those with low Hcy and low UA (β: 30.76, 95% CI: 18.36-43.16 in males; β: 53.53, 95% CI: 38.46-68.60 in females). In addition, these individuals owned the highest 10-year cardiovascular risk (OR: 1.49, 95% CI: 1.26-1.76 in males; OR: 7.61, 95% CI: 4.63-12.68 in females). Of note, males with high homocysteine and low uric acid were significantly associated with increased cardiovascular risk (OR: 1.30, 95% CI: 1.15-1.47), but not the high uric acid and low homocysteine group (OR: 1.02, 95% CI: 0.90-1.16). Conclusions This study found the significantly mutual effect of Hcy and UA on arterial stiffness and cardiovascular risk using a large population and suggested the clinical importance of combined evaluation and control of Hcy and UA for promoting cardiovascular health. The adverse effect of homocysteine on arteriosclerosis should be addressed beyond uric acid, especially for males. Monitoring of the level of both Hcy and UA provides a window opportunity for PPPM/3PM in the progression of arterial stiffness and prevention of CVD. Hcy provides a novel predictor beyond UA of cardiovascular health to identify individuals at high risk of arterial stiffness for the primary prevention and early treatment of CVD. In the progressive stage of arterial stiffness, active control of Hcy and UA levels from the aspects of dietary behavior and medication treatment is conducive to alleviating the level of arterial stiffness and reducing the risk of CVD. Further studies are needed to evaluate the clinical effect of Hcy and UA targeted intervention on arterial stiffness and cardiovascular health. Supplementary Information The online version contains supplementary material available at 10.1007/s13167-022-00298-x.
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Polito L, Bortolotti M, Battelli MG, Bolognesi A. Chronic kidney disease: Which role for xanthine oxidoreductase activity and products? Pharmacol Res 2022; 184:106407. [PMID: 35995347 DOI: 10.1016/j.phrs.2022.106407] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/04/2022] [Accepted: 08/16/2022] [Indexed: 10/15/2022]
Abstract
The present review explores the role of xanthine oxidoreductase (XOR) in the development and progression of chronic kidney disease (CKD). Human XOR is a multi-level regulated enzyme, which has many physiological functions, but that is also implicated in several pathological processes. The main XOR activities are the purine catabolism, which generates uric acid, and the regulation of cell redox state and cell signaling, through the production of reactive oxygen species. XOR dysregulation may lead to hyperuricemia and oxidative stress, which could have a pathogenic role in the initial phases of CKD, by promoting cell injury, hypertension, chronic inflammation and metabolic derangements. Hypertension is common in CKD patients and many mechanisms inducing it (upregulation of renin-angiotensin-aldosterone system, endothelial dysfunction and atherosclerosis) may be influenced by XOR products. High XOR activity and hyperuricemia are also risk factors for obesity, insulin resistance, type 2 diabetes and metabolic syndrome that are frequent CKD causes. Moreover, CKD is common in patients with gout, which is characterized by hyperuricemia, and in patients with cardiovascular diseases, which are associated with hypertension, endothelial dysfunction and atherosclerosis. Although hyperuricemia is undoubtedly related to CKD, controversial findings have been hitherto reported in patients treated with urate-lowering therapies.
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Affiliation(s)
- Letizia Polito
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Alma Mater Studiorum, University of Bologna, Via San Giacomo 14, 40126 Bologna, Italy.
| | - Massimo Bortolotti
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Alma Mater Studiorum, University of Bologna, Via San Giacomo 14, 40126 Bologna, Italy
| | - Maria Giulia Battelli
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Alma Mater Studiorum, University of Bologna, Via San Giacomo 14, 40126 Bologna, Italy
| | - Andrea Bolognesi
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Alma Mater Studiorum, University of Bologna, Via San Giacomo 14, 40126 Bologna, Italy.
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Genovesi S, Montelisciani L, Viazzi F, Giussani M, Lieti G, Patti I, Orlando A, Antolini L, Salvi P, Parati G. Uric acid and arterial stiffness in children and adolescents: Role of insulin resistance and blood pressure. Front Cardiovasc Med 2022; 9:978366. [PMID: 36035959 PMCID: PMC9403185 DOI: 10.3389/fcvm.2022.978366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 07/25/2022] [Indexed: 11/15/2022] Open
Abstract
Several studies describe the association between serum uric acid (SUA) and arterial stiffness in adults. Uric acid contributes through several mechanisms to the increase in blood pressure (BP) and adversely affects the insulin signaling pathway. Moreover, SUA predict the development of hypertension and insulin resistance up to type 2 diabetes. Early arterial stiffening, estimated by carotid-femoral pulse wave velocity (PWV), may already be present in pediatric age. Aim of our study was to investigate the relationship between SUA and PWV in a pediatric population and its interaction with insulin resistance and BP. In 322 children and adolescents (56.2% male, mean age 11.3 [SD 2.8] years), we measured weight, height, waist circumference, BP and PWV. We also assayed SUA and estimated glomerular filtration rate (eGFR) and calculated HOMA-index as a marker of insulin resistance. Simple and multiple regression analyses were performed to assess variables associated with PWV. Mediation models were applied to identify the direct and indirect effects of individual variables on PWV. On univariate analysis, age (p < 0.001), waist circumference-to-height ratio (p = 0.036), systolic and diastolic BP (SBP and DBP) z-score (p < 0.001), heart rate (p = 0.028), SUA (p = 0.002), HOMA-index (p < 0.001), and eGFR (p = 0.014) were significantly associated with PWV. The multiple regression model showed that only age (p = 0.028), SBP z-score (p = 0.006), and heart rate (p = 0.001) were significantly associated with PWV. The results were superimposable when the DBP z-score replaced the SBP z-score in the model. Mediation models showed that the effect of eGFR on PWV was fully mediated by SUA (p = 0.015) and that the effect of SUA on PWV was totally mediated by HOMA-index (p < 0.001). Both SUA (p < 0.01) and HOMA-index (p < 0.01) had a significant association with higher SBP (DBP) z-scores. The double mediation model including both BP and HOMA-index showed that the SUA effect on PWV was totally mediated by both variables (p = 0.005, for HOMA-index, p = 0.004, for SBP z-score and p = 0.007, for combined effect). The results were superimposable when the DBP z-score replaced the SBP z-score in the model. In conclusion, insulin resistance and BP are both important mediators of the association between SUA and vascular stiffness in pediatric age.
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Affiliation(s)
- Simonetta Genovesi
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy,Cardiology Unit, Istituto Auxologico Italiano, IRCCS, Milan, Italy,*Correspondence: Simonetta Genovesi
| | | | - Francesca Viazzi
- Department of Internal Medicine, University of Study and IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Marco Giussani
- Cardiology Unit, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Giulia Lieti
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Ilenia Patti
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Antonina Orlando
- Cardiology Unit, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Laura Antolini
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Paolo Salvi
- Cardiology Unit, Istituto Auxologico Italiano, IRCCS, Milan, Italy
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Vallée A. Association between serum uric acid and arterial stiffness in a large-aged 40-70 years old population. J Clin Hypertens (Greenwich) 2022; 24:885-897. [PMID: 35748644 PMCID: PMC9278596 DOI: 10.1111/jch.14527] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 05/25/2022] [Accepted: 05/28/2022] [Indexed: 12/24/2022]
Abstract
Arterial stiffness (AS), measured by arterial stiffness index (ASI), is a determinant in cardiovascular (CV) diseases. A high serum uric acid (SUA) level is a known risk factor for CV disease. The authors investigated the relationship between SUA and ASI in the middle-age UK Biobank population study. AS was defined as ASI > 10 m/s. A cross-sectional study was conducted from 126 663 participants. Participants were divided into four quartiles according to SUA levels and sex. Sex multivariate analyses were performed with adjustment for confounding factors. The average ASI for overall participants was 9.3 m/s (SD: 2.9); 9.9 m/s (SD: 2.8) for men and 8.7 m/s (SD: 2.9) for women (P < .001). Men presented higher SUA rate (351.3 mmol/L (SD:67.9)) than women (270.7 mmol/L (SD:64.4)), P < .001. In men multivariate analysis, SUA remained a determinant of AS, with an increase in the strength of the association between the quartiles, Q4 versus Q1, OR = 1.10 [1.05-1.16], P < .001, Q3 versus Q1, OR = 1.09 [1.04-1.14], P < .001 but not between Q2 and Q1 (P = .136). In women, SUA remained significant for AS, with an increase in the strength of the association between the quartiles, Q4 versus Q1, OR = 1.22 [1.15-1.30], P < .001, Q3 versus Q1, OR = 1.13 [1.07-1.19], P < .001 and no difference between Q2 and Q1 (P = .101). When applying continuous SUA values in the multivariate analysis, SUA remained significant (P < .001), with a Youden index value for men = 338.3 mmol/L and for women = 267.3 mmol/L. High SUA levels were associated with AS, suggesting that SUA could be used as a predictor of atherosclerosis.
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Affiliation(s)
- Alexandre Vallée
- Department of Epidemiology-Data-Biostatistics, Delegation of Clinical Research and Innovation (DRCI), Foch hospital, Suresnes, France
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Laučytė-Cibulskienė A, Smaliukaitė M, Dadonienė J, Čypienė A, Mikolaitytė J, Ryliškytė L, Laucevičius A, Badarienė J. Inflammaging and Vascular Function in Metabolic Syndrome: The Role of Hyperuricemia. Medicina (B Aires) 2022; 58:medicina58030373. [PMID: 35334550 PMCID: PMC8953262 DOI: 10.3390/medicina58030373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 02/24/2022] [Accepted: 02/28/2022] [Indexed: 01/10/2023] Open
Abstract
Background and Objectives: Early vascular aging determines a more rapid course of age-related arterial changes. It may be induced by a proinflammatory state, caused by hyperuricemia and metabolic syndrome and their interrelationship. However, the impact of serum uric acid (SUA) on early arterial stiffening and vascular function remains uncertain. Materials and Methods: A total of 696 participants (439 women aged 50–65 and 257 men aged 40–55) from the Lithuanian High Cardiovascular Risk (LitHiR) primary prevention program were enrolled in the study. They underwent anthropometric measurements and laboratory testing along with arterial parameters’ evaluation. Quality carotid stiffness (QCS), carotid-radial pulse wave velocity (crPWV), carotid-femoral pulse wave velocity (cfPWV), flow-mediated dilatation (FMD), and carotid intima-media thickness (CIMT) were registered. Results: We found that hyperuricemia was significantly associated with inflammation, registered by high-sensitivity C-reactive protein in both sexes. A very weak but significant association was observed between cfPWV and SUA in men and in women, while, after adjusting for risk factors, it remained significant only in women. A positive, weak, but significant association was also observed for QCS, both right and left in women. No relationship was observed between crPWV, FMD, CIMT, and SUA.
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Affiliation(s)
- Agnė Laučytė-Cibulskienė
- Department of Clinical Sciences Malmo, Lund University, Skane University Hospital, 205 02 Malmö, Sweden;
- Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania; (J.D.); (A.Č.); (L.R.); (A.L.); (J.B.)
| | - Monika Smaliukaitė
- Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania; (J.D.); (A.Č.); (L.R.); (A.L.); (J.B.)
- Correspondence:
| | - Jolanta Dadonienė
- Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania; (J.D.); (A.Č.); (L.R.); (A.L.); (J.B.)
- State Research Institute Centre for Innovative Medicine, 08406 Vilnius, Lithuania;
| | - Alma Čypienė
- Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania; (J.D.); (A.Č.); (L.R.); (A.L.); (J.B.)
- State Research Institute Centre for Innovative Medicine, 08406 Vilnius, Lithuania;
| | - Jurgita Mikolaitytė
- State Research Institute Centre for Innovative Medicine, 08406 Vilnius, Lithuania;
| | - Ligita Ryliškytė
- Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania; (J.D.); (A.Č.); (L.R.); (A.L.); (J.B.)
| | - Aleksandras Laucevičius
- Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania; (J.D.); (A.Č.); (L.R.); (A.L.); (J.B.)
- State Research Institute Centre for Innovative Medicine, 08406 Vilnius, Lithuania;
| | - Jolita Badarienė
- Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania; (J.D.); (A.Č.); (L.R.); (A.L.); (J.B.)
- State Research Institute Centre for Innovative Medicine, 08406 Vilnius, Lithuania;
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He H, Pan L, Ren X, Wang D, Du J, Cui Z, Zhao J, Wang H, Wang X, Liu F, Pa L, Peng X, Wang Y, Yu C, Shan G. The Effect of Body Adiposity and Alcohol Consumption on Serum Uric Acid: A Quantile Regression Analysis Based on the China National Health Survey. Front Nutr 2022; 8:724497. [PMID: 35111792 PMCID: PMC8801605 DOI: 10.3389/fnut.2021.724497] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 12/20/2021] [Indexed: 12/31/2022] Open
Abstract
Adiposity and alcohol consumption are reported to be associated with a higher level of serum uric acid (SUA), but whether their effect differs on SUA percentile distribution is still unclear. In this study, we aimed to investigate how alcohol intake and body fat percentage (%BF) integrated with body mass index (BMI) influence the distribution of SUA in Chinese adults. Data from the China National Health Survey (CNHS) which included adults from 10 provinces of China were used (n = 31,746, aged 20–80 years, 40% male). %BF and BMI were integrated into eight expanded body composition groups to understand how excess body adiposity affects the distribution of SUA in the populational level. Self-report alcohol intake information was collected by face-to-face questionnaire interview. Quantile regression (QR) was used to analyze the data. We found that adiposity and alcohol consumption were associated with SUA, especially at the upper percentile in both sexes. In obese men, the QR coefficients at the 75th and 95th percentiles were 74.0 (63.1–84.9) and 80.9 (52.5–109.3) μmol/L, respectively. The highest quartile of %BF in men had a 92.6 (79.3–105.9) μmol/L higher SUA levels at its 95th percentile than the 5th quartile (p < 0.001). Compared with normal or underweight with the lowest %BF group (NWBF1), the obesity-highest %BF group (OBBF4) had the strongest positive effect on SUA, especially at the higher percentile of SUA. In BMI-defined normal or underweight participants, a higher quartile of %BF had greater effect size in all SUA percentiles. In men, current alcohol drinking had the strongest effect at the 95th percentile of SUA (QR coefficient: 31.8, with 95% CI: 22.6–41.0) comparing with 14.5, 95% CI of 8.4 to 20.6 in the 5th SUA percentile. High risk of alcohol consumption had a greater effect on SUA, especially in the higher SUA percentile. The observation of stronger association at the higher percentile of SUA suggests that decreasing body adiposity and alcohol intake at the populational level may shift the upper tails of the SUA distributions to lower values, thereby reducing the incidence of hyperuricemia.
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Affiliation(s)
- Huijing He
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Li Pan
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Xiaolan Ren
- Department of Chronic and Noncommunicable Disease Prevention and Control, Gansu Provincial Center for Disease Control and Prevention, Lanzhou, China
| | - Dingming Wang
- Department of Chronic and Noncommunicable Disease Prevention and Control, Guizhou Provincial Center for Disease Control and Prevention, Guiyang, China
| | - Jianwei Du
- Department of Chronic and Noncommunicable Disease Prevention and Control, Hainan Provincial Center for Disease Control and Prevention, Haikou, China
| | - Ze Cui
- Department of Chronic and Noncommunicable Disease Prevention and Control, Hebei Provincial Center for Disease Control and Prevention, Shijiazhuang, China
| | - Jingbo Zhao
- Department of Epidemiology and Statistics, School of Public Health, Harbin Medical University, Harbin, China
| | - Hailing Wang
- Department of Chronic and Noncommunicable Disease Prevention and Control, Inner Mongolia Autonomous Region Center for Disease Control and Prevention, Hohhot, China
| | - Xianghua Wang
- Integrated Office, Institute of Biomedical Engineering, Chinese Academy of Medical Sciences, Peking Union Medical College, Tianjin, China
| | - Feng Liu
- Department of Chronic and Noncommunicable Disease Prevention and Control, Shaanxi Provincial Center for Disease Control and Prevention, Xi'an, China
| | - Lize Pa
- Department of Chronic and Noncommunicable Disease Prevention and Control, Xinjiang Uyghur Autonomous Region Center for Disease Control and Prevention, Urumqi, China
| | - Xia Peng
- Department of Chronic and Noncommunicable Disease Prevention and Control, Yunnan Provincial Center for Disease Control and Prevention, Kunming, China
| | - Ye Wang
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Chengdong Yu
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Guangliang Shan
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College, Beijing, China
- *Correspondence: Guangliang Shan
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10
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Angoff R, Mosarla RC, Tsao CW. Aortic Stiffness: Epidemiology, Risk Factors, and Relevant Biomarkers. Front Cardiovasc Med 2021; 8:709396. [PMID: 34820427 PMCID: PMC8606645 DOI: 10.3389/fcvm.2021.709396] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 09/30/2021] [Indexed: 12/19/2022] Open
Abstract
Aortic stiffness (AoS) is a maladaptive response to hemodynamic stress and both modifiable and non-modifiable risk factors, and elevated AoS increases afterload for the heart. AoS is a non-invasive marker of cardiovascular health and metabolic dysfunction. Implementing AoS as a diagnostic tool is challenging as it increases with age and varies amongst races. AoS is associated with lifestyle factors such as alcohol and smoking, as well as hypertension and comorbid conditions including metabolic syndrome and its components. Multiple studies have investigated various biomarkers associated with increased AoS, and this area is of particular interest given that these markers can highlight pathophysiologic pathways and specific therapeutic targets in the future. These biomarkers include those involved in the inflammatory cascade, anti-aging genes, and the renin-angiotensin aldosterone system. In the future, targeting AoS rather than blood pressure itself may be the key to improving vascular health and outcomes. In this review, we will discuss the current understanding of AoS, measurement of AoS and the challenges in interpretation, associated biomarkers, and possible therapeutic avenues for modulation of AoS.
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Affiliation(s)
- Rebecca Angoff
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Ramya C Mosarla
- Division of Cardiology, Department of Medicine, New York University Langone Health, New York, NY, United States
| | - Connie W Tsao
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
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11
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Prevalence and modifiable risk factors of degenerative valvular heart disease among elderly population in southern China. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2021; 18:523-533. [PMID: 34404989 PMCID: PMC8352778 DOI: 10.11909/j.issn.1671-5411.2021.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Objective To investigate the prevalence and modifiable risk factors of degenerative valvular heart disease (DVHD) among elderly population in southern China. Methods A stratified multistage sampling method was used to recruit subjects. The contents of the survey included the questionnaire, laboratory examination, echocardiography, and other auxiliary examinations. The possible risk factors of DVHD were analyzed by logistic regression analysis. Results A total of 3538 subjects ≥ 65 years of age were enrolled. One thousand three hundred and seven subjects (36.9%) were diagnosed with DVHD. Degenerative was the most common etiology of VHD. Prevalence of DVHD increased with advancing age. The prevalence of DVHD differed by living region (χ2 = 45.594, P < 0.001), educational level ( χ2 = 50.557, P < 0.001), and occupation ( χ2 = 36.961, P < 0.001). Risk factors associated with DVHD included age (two-fold increased risk for each 10-year increase in age), elevated level C-reactive protein (OR = 1.346, 95% CI: 1.100−1.646), elevated level low density lipoprotein (OR = 1.243, 95% CI: 1.064−1.451), coronary artery disease (OR = 1.651, 95% CI: 1.085−2.513), smoking (OR = 1.341, 95% CI: 1.132−1.589), and hypertension (OR = 1.414, 95% CI: 1.221−1.638). Other significant risk factors included reduced or elevated level red blood cell (OR = 1.347, 95% CI: 1.031−1.761; OR = 1.599, 95% CI: 1.097−2.331; respectively), elevated level platelets (OR = 1.891, 95% CI: 1.118−3.198), elevated level uric acid (OR = 1.282, 95% CI: 1.112−1.479), and stroke (OR: 1.738, 95% CI = 1.085−2.513).
Conclusions The survey characterized the baseline conditions of DVHD cohort of elderly population in Guangzhou city. The established and emerging risk factors for DVHD may represent challenges and opportunities for therapy.
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Serum Uric Acid and Coronary Arterial Disease in Predialysis Chronic Kidney Disease Patients. INDIAN JOURNAL OF CLINICAL CARDIOLOGY 2021. [DOI: org/10.1177/26324636211030731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background–Aim: Uric acid is considered a marker of high cardiovascular risk. We investigated the association between serum uric acid and coronary arterial disease (CAD) in pre-dialysis chronic kidney disease (CKD) patients. Methods: We enrolled 110 subjects on mean age 69.02 ± 14.3 years old. The participants were categorized for both estimated glomerular filtration rate (eGFR) and albuminuria according to criteria 2012 of the Kidney Disease Improving Global Outcomes. Estimated pulse wave velocity (ePWV) was calculated using an equation including the age and mean blood pressure. The CAD prevalence rate was recorded. Results: The patients were divided in two groups according to uric acid cutoff point value related to high ePWV. The patients with higher uric acid were older and they had significantly higher systolic blood pressure, pulse pressure, and parathyroid hormone, but significantly lower eGFR and 1,25(OH)2 Vit D3 levels. The association between high uric acid and both high ePWV and CAD occurrence was found to be significant ( x2 = 6.7, P = .008 and x2 = 4.1, P = .03, respectively), although the relationship with albuminuria was found to be nonsignificant. In a built multifactorial model, the low serum uric acid rather than the high was found to be an independent predictor for CAD demonstration entering traditional and specific confounders. Conclusion: The low serum uric acid levels were proved to be a significant predictor for CAD accounting potential covariates, even though the high uric acid per se was found to be connected with cardiovascular disease characteristics including arterial stiffness in predialysis CKD patients.
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Hamid H, Kurra V, Choudhary MK, Bouquin H, Niemelä O, Kähönen MAP, Mustonen JT, Pörsti IH, Koskela JK. Plasma uric acid is related to large arterial stiffness but not to other hemodynamic variables: a study in 606 normotensive and never-medicated hypertensive subjects. BMC Cardiovasc Disord 2021; 21:257. [PMID: 34039285 PMCID: PMC8152327 DOI: 10.1186/s12872-021-02072-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 05/19/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Elevated level of plasma uric acid (PUA) has been associated with cardiovascular disease, but whether uric acid is an independent risk factor or merely a marker remains controversial. METHODS We investigated in a cross-sectional setting the association of PUA with hemodynamics in 606 normotensive and never-medicated hypertensive subjects (295 men, 311 women, age range 19-73 years) without cardiovascular disease or gout. In all except 15 individuals, PUA was within the normal range. Supine hemodynamics were recorded using whole-body impedance cardiography and radial tonometric pulse wave analysis. RESULTS The mean concentrations of PUA in age, sex and body mass index adjusted quartiles were 234, 278, 314, and 373 µmol/l, respectively. The highest PUA quartile presented with higher aortic to popliteal pulse wave velocity (PWV) than the lowest quartile (8.7 vs. 8.2 m/s, p = 0.026) in analyses additionally adjusted for plasma concentrations of C-reactive protein, low density lipoprotein cholesterol, triglycerides, and mean aortic blood pressure. No differences in radial and aortic blood pressure, wave reflections, heart rate, cardiac output, and systemic vascular resistance were observed between the quartiles. In linear regression analysis, PUA was an independent explanatory factor for PWV (β = 0.168, p < 0.001, R2 of the model 0.591), but not for systolic or diastolic blood pressure. When the regression analysis was performed separately for men and women, PUA was an independent predictor of PWV in both sexes. CONCLUSIONS PUA concentration was independently and directly associated with large arterial stiffness in individuals without cardiovascular disease and PUA levels predominantly within the normal range. Trial registration ClinicalTrials.gov NCT01742702.
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Affiliation(s)
- Humam Hamid
- Faculty of Medicine and Health Technology, Tampere University, FI-33014, Tampere, Finland
| | - Venla Kurra
- Faculty of Medicine and Health Technology, Tampere University, FI-33014, Tampere, Finland
| | - Manoj Kumar Choudhary
- Faculty of Medicine and Health Technology, Tampere University, FI-33014, Tampere, Finland
| | - Heidi Bouquin
- Faculty of Medicine and Health Technology, Tampere University, FI-33014, Tampere, Finland
| | - Onni Niemelä
- Faculty of Medicine and Health Technology, Tampere University, FI-33014, Tampere, Finland
- Laboratory and Medical Research Unit, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Mika A P Kähönen
- Faculty of Medicine and Health Technology, Tampere University, FI-33014, Tampere, Finland
- Department of Clinical Physiology, Tampere University Hospital, Tampere, Finland
| | - Jukka T Mustonen
- Faculty of Medicine and Health Technology, Tampere University, FI-33014, Tampere, Finland
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Ilkka H Pörsti
- Faculty of Medicine and Health Technology, Tampere University, FI-33014, Tampere, Finland.
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland.
| | - Jenni K Koskela
- Faculty of Medicine and Health Technology, Tampere University, FI-33014, Tampere, Finland
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
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Nakano H, Shiina K, Takahashi T, Kumai K, Fujii M, Iwasaki Y, Matsumoto C, Chikamori T, Yamashina A, Tomiyama H. Mediation of Arterial Stiffness for Hyperuricemia-Related Decline of Cardiac Systolic Function in Healthy Men. Circ Rep 2021; 3:227-233. [PMID: 33842728 PMCID: PMC8024016 DOI: 10.1253/circrep.cr-21-0013] [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] [Indexed: 12/20/2022] Open
Abstract
Background:
This prospective observational study examined whether hyperuricemia may be associated with impaired left ventricular (LV) systolic function and increased cardiac load resulting from increased arterial stiffness. Methods and Results:
In 1,880 middle-aged (mean [±SD] age 45±9 years) healthy men, serum uric acid (UA) levels, pre-ejection period/ejection time (PEP/ET) ratio, serum N-terminal pro B-type natriuretic peptide (NT-proBNP) levels, and brachial-ankle pulse wave velocity (baPWV) were measured at the start and end of the 3-year study period. Linear regression analysis revealed that serum UA levels measured at baseline were significantly associated with the PEP/ET ratio, but not with serum NT-proBNP levels, measured at baseline (β=0.73×10−1, P<0.01) and at the end of the study period (β=0.68×10−1, P<0.01). The change in the PEP/ET ratio during the study period was significantly greater in the High-UA (UA >7 mg/dL in 2009 and 2012) than Low-UA (UA ≤7 mg/dL in 2009 and 2012) group. Mediation analysis demonstrated both direct and indirect (via increases in baPWV) associations between serum UA measured at baseline and the PEP/ET ratio measured at the end of the study period. Conclusions:
In healthy middle-aged Japanese men, hyperuricemia may be associated with an accelerated decline in ventricular systolic function, both directly and indirectly, via increases in arterial stiffness.
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Affiliation(s)
- Hiroki Nakano
- Department of Cardiology, Tokyo Medical University Tokyo Japan
| | - Kazuki Shiina
- Department of Cardiology, Tokyo Medical University Tokyo Japan
| | | | - Kento Kumai
- Department of Cardiology, Tokyo Medical University Tokyo Japan
| | - Masatsune Fujii
- Department of Cardiology, Tokyo Medical University Tokyo Japan
| | - Yoichi Iwasaki
- Department of Cardiology, Tokyo Medical University Tokyo Japan
| | - Chisa Matsumoto
- Department of Cardiology, Tokyo Medical University Tokyo Japan
| | | | - Akira Yamashina
- Department of Cardiology, Tokyo Medical University Tokyo Japan
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15
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Kobalava ZD, Troitskaya EA. [Asymptomatic Hyperuricemia and Risk Of Cardiovascular and Renal Diseases]. KARDIOLOGIIA 2020; 60:113-121. [PMID: 33228514 DOI: 10.18087/cardio.2020.10.n1153] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 07/29/2020] [Indexed: 12/15/2022]
Abstract
Asymptomatic hyperuricemia (HU) is common in the population and significantly contributes to the general cardiovascular risk. Despite extensive study of this condition there is still no conclusive answers to questions about detection of asymptomatic HU and its effect on the risk for development and progression of cardiovascular and kidney diseases. This review summarizes key information about these issues, which has been accumulated by the present time.
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Affiliation(s)
- Zh D Kobalava
- People`s Friendship University of Russia (RUDN University), Moscow
| | - E A Troitskaya
- People`s Friendship University of Russia (RUDN University), Moscow
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Hong M, Park JW, Yang PS, Hwang I, Kim TH, Yu HT, Uhm JS, Joung B, Lee MH, Jee SH, Pak HN. A mendelian randomization analysis: The causal association between serum uric acid and atrial fibrillation. Eur J Clin Invest 2020; 50:e13300. [PMID: 32474920 DOI: 10.1111/eci.13300] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 04/07/2020] [Accepted: 05/20/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Observational studies have shown that high levels of serum uric acid (UA) were associated with atrial fibrillation (AF). However, the causal effect of urate on the risk of AF is still unknown. To clarify the potential causal association between UA and AF, we performed a Mendelian randomization (MR) analysis using genetic instrumental variables (IVs). MATERIALS AND METHODS From the Korean GWAS dataset of 633 patients with AF (mean age 50.6 ± 7.8 years, 80.9% male, Yonsei AF Ablation cohort) who underwent radiofrequency catheter ablation and the data from 3533 controls (from the Korea Genome Epidemiology Study), we selected 9 SNPs, with a P value less than .05, associated with an increased UA serum level. Additionally, we calculated the weighted genetic risk score (wGRS) using the selected 9 SNPs, to use it as an instrumental variable. A Mendelian randomization analysis was calculated by a 2-stage estimator method. RESULTS The conventional association between the serum UA and AF was significant (P = .001) after adjusting for potential confounding factors. The SNP rs1165196 on SLC17A1 (F-statistics = 208.34, 0.18 mg/mL per allele change, P < .001) and wGRS (F-statistics = 222.26, 0.20 mg/mL per 1SD change, P < .001) were significantly associated with an increase in the UA level. The MR analysis was causally associated with rs1165196 (estimated odds ratio (OR), 0.21, 95% confidence interval (CI), 0.06-0.75, P = .017), but not wGRS (estimated OR, 1.07, 95% CI, 0.57-2.01, P = .832). CONCLUSION The serum UA level was independently associated with the AF risk.
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Affiliation(s)
- Myunghee Hong
- Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, Korea
| | - Je-Wook Park
- Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, Korea
| | - Pil-Sung Yang
- Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Inseok Hwang
- Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, Korea
| | - Tae-Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, Korea
| | - Hee Tae Yu
- Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, Korea
| | - Jae-Sun Uhm
- Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, Korea
| | - Boyoung Joung
- Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, Korea
| | - Moon-Hyoung Lee
- Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, Korea
| | - Sun Ha Jee
- Department of Epidemiology and Health Promotion, Yonsei University, Seoul, Korea
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, Korea
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17
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Niu X, Chen J, Wang J, Li J, Zeng D, Wang S, Hong X. Association between the uric acid and hypertension in community-based Chinese population: stratified analysis based on body mass index and age. J Thromb Thrombolysis 2020; 51:1113-1119. [PMID: 32885382 DOI: 10.1007/s11239-020-02256-8] [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: 12/01/2022]
Abstract
Many studies have shown that uric acid was related to hypertension. However, the association dependence on body mass index (BMI) or age was unclear. This study was performed with a group of 4012 Chinese population aged 30 to 92 years old. Subjects were divided into four groups according to the quartiles of uric acid (UA) concentration [First group: ≤ 231 μmol/L (reference), Second group: 231-289 μmol/L, Third group: 289-362 μmol/L, Fourth group: > 362 μmol/L]. Hypertension was defined as newly measured blood pressure ≥ 140/90 mmHg or taking antihypertensive drugs. Stratified analysis based on BMI (< 28 kg/m2 vs ≥ 28 kg/m2) and age (< 60 years old vs ≥ 60 years old) to analyze the association between UA and hypertension. Subjects were 54.50 (45.00, 63.00) years old, and 40.98% were male, 38.33% were hypertension. Adjusted odds ratios (95% confidence intervals) for the association of UA and hypertension were 2.226 (1.662, 2.980), 4.340 (3.253, 5.790), 5.898 (4.434, 7.845) and 6.557 (4.927, 8.727) in the four groups among ≥ 60 years old respectively comparing with first group among < 60 years old. Adjusted odds ratios (95% confidence intervals) for the association between UA and hypertension were 2.170 (1.236, 3.808), 5.260 (3.267, 8.468), 9.056 (5.509, 14.888) and 3.730 (2.529, 5.550) in the four groups among BMI ≥ 28 kg/m2 respectively comparing with first group among BMI < 28 kg/m2. Uric acid was significantly associated with the hypertension. The association was stronger among subjects ≥ 60 years old or BMI ≥ 28 kg/m2.
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Affiliation(s)
- XiaoNa Niu
- First Affiliated Hospital of Hunan Normal University, Hunan Provincial People's Hospital, Changsha, China.,Key Laboratory of Molecular Epidemiology of Hunan Province, School of Medicine, Hunan Normal University, Changsha, China
| | - Jian Chen
- First Affiliated Hospital of Hunan Normal University, Hunan Provincial People's Hospital, Changsha, China
| | - Jia Wang
- First Affiliated Hospital of Hunan Normal University, Hunan Provincial People's Hospital, Changsha, China
| | - Jing Li
- First Affiliated Hospital of Hunan Normal University, Hunan Provincial People's Hospital, Changsha, China
| | - Dan Zeng
- First Affiliated Hospital of Hunan Normal University, Hunan Provincial People's Hospital, Changsha, China
| | - ShuLing Wang
- First Affiliated Hospital of Hunan Normal University, Hunan Provincial People's Hospital, Changsha, China
| | - XiuQin Hong
- First Affiliated Hospital of Hunan Normal University, Hunan Provincial People's Hospital, Changsha, China. .,Key Laboratory of Molecular Epidemiology of Hunan Province, School of Medicine, Hunan Normal University, Changsha, China.
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18
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Meneses-León J, León-Maldonado L, Macías N, Torres-Ibarra L, Hernández-López R, Rivera-Paredez B, Flores M, Flores YN, Barrientos-Gutiérrez T, Quezada-Sánchez AD, Velázquez-Cruz R, Salmerón J. Sugar-sweetened beverage consumption and risk of hyperuricemia: a longitudinal analysis of the Health Workers Cohort Study participants in Mexico. Am J Clin Nutr 2020; 112:652-660. [PMID: 32644154 PMCID: PMC7458765 DOI: 10.1093/ajcn/nqaa160] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 05/29/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The elevated consumption of sugar-sweetened beverages (SSBs) in Mexico is an important public health concern. However, the association between SSB consumption and hyperuricemia has been scarcely studied and not well documented. OBJECTIVES To prospectively evaluate the association between SSB consumption and risk of hyperuricemia in Mexican adults. METHODS A longitudinal analysis was conducted using data from the Health Workers Cohort Study. Participants were followed from 2004 to 2018, with measurements every 6 y. The analysis sample consisted of 1300 adults, aged 18 to 85 y. SSB consumption during the previous year was evaluated through a semiquantitative FFQ. Hyperuricemia was defined as a concentration of uric acid ≥7.0 mg/dL in men and ≥5.7 mg/dL in women. We evaluated the association of interest using 2 methodologies: fixed-effects logistic regression and generalized estimating equations (GEEs). Potential confounders were included in both approaches. RESULTS At baseline, median intake of SSBs was 472.1 mL/wk (IQR: 198.8-1416.4 mL/wk), and 233 participants had hyperuricemia. Uric acid was higher in participants with an SSB intake ≥7 servings/wk, compared with those with an intake <1 serving/wk (P < 0.001). Participants who changed from the lowest to the highest category of servings consumption experienced 2.6 increased odds of hyperuricemia (95% CI: 1.27, 5.26). Results from the GEE model indicated the odds of hyperuricemia increased by 44% (OR=1.44; 95% CI: 1.13, 1.84) in the 2-6 servings/wk group, and by 89% (OR=1.89; 95% CI: 1.39, 2.57) in the ≥7 servings/wk categories, compared with the <1 serving/wk category. Diet soft drinks were not associated with hyperuricemia. CONCLUSIONS Our results suggest that the consumption of SSBs is associated with an increased risk of hyperuricemia in Mexican adults, but diet soft drink consumption is not, which supports the need to strengthen existing recommendations to reduce the intake of SSBs.The Health Workers Cohort Study (HWCS) has been approved by the Institutional Review Board of the Mexican Social Security Institute (12CEI 09 006 14), and the National Institute of Public Health of Mexico (13CEI 17 007 36).
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Affiliation(s)
- Joacim Meneses-León
- Research Center in Policy, Population, and Health, School of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Leith León-Maldonado
- CONACYT, Center for Population Health Research, National Institute for Public Health, Cuernavaca, Morelos, Mexico
| | - Nayeli Macías
- Center for Nutrition and Health Research, National Institute for Public Health, Cuernavaca, Morelos, Mexico
| | - Leticia Torres-Ibarra
- Research Center in Policy, Population, and Health, School of Medicine, National Autonomous University of Mexico, Mexico City, Mexico,Center for Population Health Research, National Institute for Public Health, Cuernavaca, Morelos, Mexico
| | - Rubí Hernández-López
- Research Center in Policy, Population, and Health, School of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Berenice Rivera-Paredez
- Research Center in Policy, Population, and Health, School of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Mario Flores
- Center for Nutrition and Health Research, National Institute for Public Health, Cuernavaca, Morelos, Mexico
| | - Yvonne N Flores
- Unidad de Investigación Epidemiológica y en Servicios de Salud, Delegación Morelos, Instituto Mexicano del Seguro Social, Cuernavaca, Morelos, Mexico,UCLA Department of Health Policy and Management, Center for Cancer Prevention and Control Research, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA
| | | | | | - Rafael Velázquez-Cruz
- Genomics of Bone Metabolism Laboratory, National Institute of Genomic Medicine, Mexico City, Mexico
| | - Jorge Salmerón
- Research Center in Policy, Population, and Health, School of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
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Yuan Q, Karmacharya U, Liu F, Chen BD, Ma X, Ma YT. Uric acid and its correlation with hypertension in postmenopausal women: A multi-ethnic study (Observational study). Clin Exp Hypertens 2020; 42:559-564. [PMID: 32163303 DOI: 10.1080/10641963.2020.1739697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
We investigate the association of uric acid with hypertension among Han, Uygur, and Kazakh populations in the Xinjiang Province of Western China. Our study aims to evaluate the relationships of serum uric acid (SUA) with hypertension in the Chinese population according to the menopausal status. Medical data of 1684 Han, 1895 Uygur, and 294 Kazakh people was examined. The prevalence of hypertension was calculated by the quartiles of SUA. Correlation between hypertension-related risk factors calculated and compared between men and women. SUA was higher in men than in women. The level was significantly higher in postmenopausal than premenopausal women (4.40 ± 1.75 v.s 4.06 ± 1.63 mg/dl, P < .01). Logistic regression analysis showed Body mass index (BMI) [OR = 1.08, P < .01]; and eGFR<60 vs.≥60 [OR = 1.22, P = .04] were independent risk factors for hypertension in women. Age and diabetes were independent risk factors for the participants with hypertension [OR = 1.04, P < .01] and [OR = 2.24, P < .01]. High quartile SUA group has increased the risk for hypertension in postmenopausal women [OR = 1.34, P = .048]. We found that postmenopausal women have high SUA compared to premenopausal women. The high SUA quartiles uric acid may be an independent risk for hypertension in postmenopausal women.
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Affiliation(s)
- Qinghua Yuan
- Department of Cardiology, The Seventh Affiliated Hospital of Sun Yat-sen University , Shenzhen, Guangdong, China
| | - Ujit Karmacharya
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University , Urumqi, Xinjiang, China
| | - Fen Liu
- Department of Cardiology, Xinjiang Key Laboratory of Cardiovascular Disease Research , Urumqi, P.R. China
| | - Bang-Dang Chen
- Department of Cardiology, Xinjiang Key Laboratory of Cardiovascular Disease Research , Urumqi, P.R. China
| | - Xiang Ma
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University , Urumqi, Xinjiang, China.,Department of Cardiology, Xinjiang Key Laboratory of Cardiovascular Disease Research , Urumqi, P.R. China
| | - Yi-Tong Ma
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University , Urumqi, Xinjiang, China.,Department of Cardiology, Xinjiang Key Laboratory of Cardiovascular Disease Research , Urumqi, P.R. China
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20
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Valente FM, de Andrade DO, Cosenso-Martin LN, Cesarino CB, Guimarães SM, Guimarães VB, Lacchini R, Tanus-Santos JE, Yugar-Toledo JC, Vilela-Martin JF. Plasma levels of matrix metalloproteinase-9 are elevated in individuals with hypertensive crisis. BMC Cardiovasc Disord 2020; 20:132. [PMID: 32164582 PMCID: PMC7066730 DOI: 10.1186/s12872-020-01412-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 03/02/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Matrix metalloproteinase-9 (MMP-9) participates in the degradation of components of the extracellular matrix and it is involved in vascular remodeling and vasomotor changes. The aim of this study was to investigate the plasma levels of MMP-9 in acute vascular alterations due to hypertensive crisis. METHODS This cross-sectional study was performed in 40 normotensive (NT) and 58 controlled hypertensive subjects (CHyp) followed up in outpatient clinic. Moreover, 57 patients with hypertensive emergency (HypEmerg) and 43 in hypertensive urgency (HypUrg), seen in emergency department, were also included. Hypertensive crisis was divided into HypEmerg, which was characterized by levels of systolic blood pressure (BP) ≥ 180 mmHg and/or diastolic BP ≥ 120 mmHg complicated with target-organ damage (TOD), and HypUrg, defined by BP elevation without TOD. Univariate and multivariate regression analysis was performed to identify the influence of independent variables on MMP-9 levels. A p-value < 0.05 was considered statistically significant. RESULTS The mean age was 43.5 years in the NT group (11 men); 57.7 years in the CHyp group (29 men); 59.4 years in the HypUrg group (21 men) and 62.4 years in the HypEmerg group (31 men). The age was statistically different in the NT group compared to other 3 groups. The mean BP was 116.5 ± 13.9/72.4 ± 10.6 mmHg for NT, 123.2 ± 12.6/79 ± 9.2 for CHyp, 194.1 ± 24.3/121.4 ± 17.3 for HypUrg and 191.6 ± 34.3/121.7 ± 18.8 mmHg for HypEmerg, respectively (p-value< 0.0001 between groups). MMP-9 levels were statistically different between the HypEmerg (2.31 ± 0.2 ng/mL) and HypUrg groups (2.17 ± 0.3 ng/mL) compared to the NT (1.94 ± 0.3 ng/mL) (p-value < 0.01 and p-value < 0.05, respectively) and CHyp groups (1.92 ± 0.2 ng/mL) (p-value < 0.01). Uric acid was the only independent variable for predicting MMP-9 levels (p-value = 0.001). CONCLUSION MMP-9 concentrations are significantly higher in the hypertensive crisis groups (urgency and emergency) compared to the control groups. Therefore, MMP-9 may be a biomarker or mediator of pathophysiologic pathways in cases of acute elevations of blood pressure.
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Affiliation(s)
- Flavia Mariana Valente
- Internal Medicine Department, Hypertension Clinic, State Medical School at Sao Jose do Rio Preto (FAMERP), Ave Brig Faria Lima, 5416, Sao Jose do Rio Preto, SP, 15090-000, Brazil
| | - Days Oliveira de Andrade
- Internal Medicine Department, Hypertension Clinic, State Medical School at Sao Jose do Rio Preto (FAMERP), Ave Brig Faria Lima, 5416, Sao Jose do Rio Preto, SP, 15090-000, Brazil
| | - Luciana Neves Cosenso-Martin
- Internal Medicine Department, Hypertension Clinic, State Medical School at Sao Jose do Rio Preto (FAMERP), Ave Brig Faria Lima, 5416, Sao Jose do Rio Preto, SP, 15090-000, Brazil
| | - Cláudia Bernardi Cesarino
- Internal Medicine Department, Hypertension Clinic, State Medical School at Sao Jose do Rio Preto (FAMERP), Ave Brig Faria Lima, 5416, Sao Jose do Rio Preto, SP, 15090-000, Brazil
| | - Sérgio Mussi Guimarães
- Internal Medicine Department, Hypertension Clinic, State Medical School at Sao Jose do Rio Preto (FAMERP), Ave Brig Faria Lima, 5416, Sao Jose do Rio Preto, SP, 15090-000, Brazil
| | | | - Riccardo Lacchini
- Department of Psychiatric Nursing and Human Sciences, Ribeirao Preto College of Nursing, University of Sao Paulo, R. Prof. Helio Lourenço, Ribeirao Preto, SP, 3900, Brazil
| | - José Eduardo Tanus-Santos
- Department of Pharmacology, Ribeirao Preto Medical School, University of Sao Paulo, Ave Bandeirantes, Ribeirao Preto, SP, 3900, Brazil
| | - Juan Carlos Yugar-Toledo
- Internal Medicine Department, Hypertension Clinic, State Medical School at Sao Jose do Rio Preto (FAMERP), Ave Brig Faria Lima, 5416, Sao Jose do Rio Preto, SP, 15090-000, Brazil
| | - José Fernando Vilela-Martin
- Internal Medicine Department, Hypertension Clinic, State Medical School at Sao Jose do Rio Preto (FAMERP), Ave Brig Faria Lima, 5416, Sao Jose do Rio Preto, SP, 15090-000, Brazil.
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21
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Rebora P, Andreano A, Triglione N, Piccinelli E, Palazzini M, Occhi L, Grassi G, Valsecchi MG, Giannattasio C, Maloberti A. Association between uric acid and pulse wave velocity in hypertensive patients and in the general population: a systematic review and meta-analysis. Blood Press 2020; 29:220-231. [PMID: 32138547 DOI: 10.1080/08037051.2020.1735929] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Purpose: The association between serum uric acid (SUA) and pulse wave velocity (PWV), has been extensively evaluated but with some discrepancies in results. A further limitation refers to the fact that only few data were analyzed taking into account the possible effects of gender. The purpose of this study was to estimate the association between SUA and arterial stiffness in general population and hypertensive patients, as a whole population and as divided by gender, by pooling results from existing studies.Materials and methods: Carotid-femoral and brachial-ankle PWV (cf- and ba-PWV) have been analyzed separately and subgroup analyses by gender are reported. Among 692 potentially relevant works, 24 articles were analyzed.Results: Seven studies referred to cf-PWV in the general population with an overall positive association at adjusted analysis for both males and females (beta regression coefficient (ß): 0.07; 95%CI: 0.03; 0.11 and ß: 0.06; 95%CI: 0.03; 0.09, respectively). Twelve studies referred to ba-PWV in the general population with the finding of a positive association at adjusted analysis for females (ß: 0.04; 95% confidence interval (CI): 0.01;0.07), but not for males (ß: 0.13; 95%CI: -0.09; 0.34). In hypertensive patients only four studies evaluated cf-PWV and one ba-PWV with only one study (with cf-PWV) finding positive association.Conclusion: The association between SUA and cf-PWV resulted significant in general population in both males and females while it was only significant for female regarding ba-PWV. Furthermore, the few available studies found no significant relationship between SUA and both cf- and ba-PWV in hypertensive subjects.
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Affiliation(s)
- Paola Rebora
- Center of Biostatistics for Clinical Epidemiology, School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Anita Andreano
- Center of Biostatistics for Clinical Epidemiology, School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Nicola Triglione
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Enrico Piccinelli
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Matteo Palazzini
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Lucia Occhi
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Guido Grassi
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Maria Grazia Valsecchi
- Center of Biostatistics for Clinical Epidemiology, School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Cristina Giannattasio
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.,Cardiology IV, "A.De Gasperis" Department, ASTT GOM Niguarda Ca' Granda, Milan, Italy
| | - Alessandro Maloberti
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.,Cardiology IV, "A.De Gasperis" Department, ASTT GOM Niguarda Ca' Granda, Milan, Italy
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22
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Sung SH, Chuang SY, Liu WL, Cheng HM, Hsu PF, Pan WH. Hyperuricemia and pulse pressure are predictive of incident heart failure in an elderly population. Int J Cardiol 2020; 300:178-183. [PMID: 31718824 DOI: 10.1016/j.ijcard.2019.11.001] [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: 05/24/2019] [Revised: 10/02/2019] [Accepted: 11/04/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE This study investigated the associations between hyperuricemia, pulse pressure (PP) and heart failure (HF) hospitalization among the elders in a community population. BACKGROUND Hyperuricemia and PP have been related to the development of HF. Whether PP acts synergistically with hyperuricemia or mediates the causal relationship of HF, especially in the elderly, remains elucidated. METHODS This cohort included 1665 adults aged ≥65 years from the National Nutrition and Health Survey in Taiwan Elderly were followed. HF hospitalization (ICD-9-CM:428) was defined by the National Health Insurance Dataset. A Cox proportional hazard model and a Fine and Grays model were adjusted for the conventional cardiovascular risk factors and death as a competing risk to estimate the association between hyperuricemia, PP and HF hospitalization. RESULTS A total of 228 elders occurred HF hospitalization, and 692 died during a median of 12 years follow-up period, from 1999 to 2012. The incidence of HF was 14.2 per 1000 person-years. High PP (top quartile) and hyperuricemia (≥6.0 mg/dL [women] and 7.0 mg/dL [Men]) significantly correlated with incident HF (hazard ratio and 95% confidence intervals: 2.131;1.625-2.794 and 1.433;1.071-1.918, respectively). Compared with normal uric acid level and PP, combined hyperuricemia and high PP was additively related to incident HF (4.186:2.874-6.099). The associations remained after accounting for traditional cardiovascular risks, coronary heart disease as a time-dependent covariate, and mortality as a competing risk factor in the study population. CONCLUSION Both hyperuricemia and high PP were associated with HF hospitalization in this elderly population. Combine hyperuricemia and high PP would further improve the risk stratification in the prediction of incident HF.
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Affiliation(s)
- Shih-Hsien Sung
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Public Health, National Yang-Ming University, Taipei, Taiwan.
| | - Shao-Yuan Chuang
- Institution of Population Health Sciences Research, National Health Research Institutes, Miaoli, Taiwan.
| | - Wen-Ling Liu
- Institution of Population Health Sciences Research, National Health Research Institutes, Miaoli, Taiwan.
| | - Hao-Min Cheng
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Public Health, National Yang-Ming University, Taipei, Taiwan.
| | - Pai-Feng Hsu
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Public Health, National Yang-Ming University, Taipei, Taiwan.
| | - Wen-Harn Pan
- Institution of Population Health Sciences Research, National Health Research Institutes, Miaoli, Taiwan; Institute of Biomedical Science, Academic Sinica, Taipei, Taiwan.
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Albu A, Para I, Porojan M. Uric Acid and Arterial Stiffness. Ther Clin Risk Manag 2020; 16:39-54. [PMID: 32095074 PMCID: PMC6995306 DOI: 10.2147/tcrm.s232033] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 12/01/2019] [Indexed: 12/21/2022] Open
Abstract
Hyperuricemia is usually associated with hypertension, diabetes mellitus, metabolic syndrome and chronic kidney disease. Accumulating data from epidemiological studies indicate an association of increased uric acid (UA) with cardiovascular diseases. Possible pathogenic mechanisms include enhancement of oxidative stress and systemic inflammation caused by hyperuricemia. Arterial stiffness may be one of the possible pathways between hyperuricemia and cardiovascular disease, but a clear relationship between increased UA and vascular alterations has not been confirmed. The review summarizes the epidemiological studies investigating the relationship between UA and arterial stiffness and highlights the results of interventional studies evaluating arterial stiffness parameters in patients treated with UA-lowering drugs.
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Affiliation(s)
| | - Ioana Para
- 4th Department of Internal Medicine, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
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24
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Radchenko GD, Zhyvylo IO, Titov EY, Sirenko YM. Systemic Arterial Stiffness in New Diagnosed Idiopathic Pulmonary Arterial Hypertension Patients. Vasc Health Risk Manag 2020; 16:29-39. [PMID: 32021226 PMCID: PMC6971813 DOI: 10.2147/vhrm.s230041] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 11/15/2019] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE We suggested: 1) patients with idiopathic pulmonary hypertension (IPAH) have active factors which could damage not only the pulmonary but systemic arteries too as in arterial hypertensive patients; 2) if these changes were present, they might correlate with other parameters influencing on the prognosis. This study is the first attempt to use cardio-ankle vascular index (CAVI) for the evaluation of systemic arterial stiffness in patients with IPAH. METHODS A total of 112 patients were included in the study: group 1 consisted of 45 patients with new diagnosed IPAH, group 2 included 32 patients with arterial hypertension, and in the control group were 35 healthy persons adjusted by age. Right heart catheterization, ECG, a 6-minute walk test (6MWT), echocardiography, blood pressure (BP) measurement and ambulatory BP monitoring, pulse wave elastic artery stiffness (PWVe; segment carotid-femoral arteries) and muscular artery stiffness (PWVm; segment carotid-radial arteries), CAVI, and N-terminal pro-B-type natriuretic peptide (NT-proBNP) level were provided. The Spearman correlation, a linear regression and multivariable binary logistic analysis were performed to indicate the predictors associated with PWV and CAVI. RESULTS The groups were adjusted for principal characteristics influenced on arterial stiffness. IPAH patients had significantly (P<0.001 for all) shorter 6MWT distance and higher Borg dyspnea score than the patients with arterial hypertension (systolic/diastolic BP = 146.1±10.7/94.2±9.8 mmHg) and the control group = 330.2±14.6 vs 523.8±35.3 and 560.9±30.2 m respectively and 6.2±1.8 vs 1.2±2.1 and 0.9±2.8 points. The PWVm and PWVe were the highest in hypertensive patients (10.3±1.5 and 11.42±1.70 m/s). The control group and IPAH did not have significant differences in aorta BP, but PWVm/PWVe values were significantly (P<0.003/0.008) higher in IPAH patients than in the control group (8.1±1.9/8.49±1.92 vs 6.63±1.34/7.29±0.87 m/s). The CAVIs on both sides were significantly lower in the healthy subjects (5.91±0.99/5.98±0.87 right/left side). Patients with IPAH did not differ from the arterial hypertension patients by CAVIs in comparison with the control group (7.40±1.32/7.22±1.32 vs 7.19±0.78/7.2±1.1 PWVe) did not correlate with any parameters except uric acid. PWVm correlated with uric acid (r=0.58, P<0.001), NT-proBNP (r=0.33, P=0.03) and male gender (r=0.37, P=0.013) at Spearman analysis, but not at multifactorial linear regression analysis. The CAVI correlated with age and parameters characterized functional capacity (6MWT distance) and right ventricle function (NT-proBNP, TAPSE) at Spearman analysis and with age and TAPSE at multifactorial linear regression analysis. At binary logistic regression analysis CAVI > 8.0 at right and/or left side had a correlation with age, 6MWT distance, TAPSE, but an independent correlation was only with age (β=1.104, P=0.008, CI 1.026-1.189) and TAPSE (β=0.66, P=0.016, CI 0.474-0.925). CONCLUSION In spite of equal and at normal range BP level, the age-adjusted patients with IPAH had significantly stiffer arteries than the healthy persons and they were comparable with the arterial hypertensive patients. Arterial stiffness evaluated by CAVI correlated with age and TAPSE in IPAH patients. Based on our results it is impossible to conclude the pathogenesis of arterial stiffening in IPAH patients, but the discovered changes and correlations suggest new directions for further studies, including pathogenesis and prognosis researches.
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Affiliation(s)
- GD Radchenko
- Secondary Hypertension Department, State Institution “National Scientific Center “Institute of Cardiology Named After acad.M.D.Strazhesko” of Ukrainian National Academy of Medical Science, Kyiv, Ukraine
| | - IO Zhyvylo
- Secondary Hypertension Department, State Institution “National Scientific Center “Institute of Cardiology Named After acad.M.D.Strazhesko” of Ukrainian National Academy of Medical Science, Kyiv, Ukraine
| | - EY Titov
- Non-Coronary Heart Disease Department, State Institution “National Scientific Center “Institute of Cardiology Named After acad.M.D.Strazhesko” of Ukrainian National Academy of Medical Science, Kyiv, Ukraine
| | - Yuriy M Sirenko
- Secondary Hypertension Department, State Institution “National Scientific Center “Institute of Cardiology Named After acad.M.D.Strazhesko” of Ukrainian National Academy of Medical Science, Kyiv, Ukraine
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Preoperative uric acid predicts in-hospital death in patients with acute type a aortic dissection. J Cardiothorac Surg 2020; 15:21. [PMID: 31941543 PMCID: PMC6964024 DOI: 10.1186/s13019-020-1066-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 01/06/2020] [Indexed: 12/14/2022] Open
Abstract
Background The present study aimed to evaluate the value of admission serum uric acid (UA) level in predicting in-hospital risk of death in patients with acute type A aortic dissection (AAAD). Methods From January 2016 to June 2019, 186 consecutive patients with AAAD who underwent thoracic aortic surgery were retrospectively studied. Serum UA levels were measured on admission. Forward conditional logistic regression was performed to identify independent risk factors for in-hospital death. Receiver operating characteristic (ROC) analysis was performed to assess the most clinical useful level of serum UA for predicting postoperative in-hospital mortality. Results Increased level of serum UA was found in non-survivors compared with those survived (446 ± 123 vs 371 ± 111 umol/L, p < 0.001). Age (OR = 1.063, 95% CI 1.016–1.112, p = 0.009), UA (OR = 1.006, 95% CI 1.002–1.010, p = 0.002), D-dimer (OR = 1.025, 95% CI 1.005–1.013, p = 0.012), operation time (OR = 1.009, 95% CI 1.005–1.013, p < 0.001) and extent of aortic replacement (OR = 0.412, 95% CI 0.220–0.768, p = 0.005) were identified as independent risk factors of in-hospital mortality in AAAD patients. The best cut-off value of admission serum UA in predicting in-hospital mortality was determined to be 415 umol/L. Subgroup analysis showed that in the subgroup of total arch replacement, UA was significantly associated with in-hospital death (OR = 1.010, 95% CI 1.005–1.015, p < 0.001), while in patients underwent ascending aorta replacement or hemiarch replacement, the relationship was no longer significant (OR = 1.001, 95% CI 0.996–1.006, p = 0.611). Conclusions Elevated serum UA level on admission is an independent predictor of in-hospital mortality in patients with AAAD.
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Stewart DJ, Langlois V, Noone D. Hyperuricemia and Hypertension: Links and Risks. Integr Blood Press Control 2019; 12:43-62. [PMID: 31920373 PMCID: PMC6935283 DOI: 10.2147/ibpc.s184685] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 11/27/2019] [Indexed: 12/19/2022] Open
Abstract
Hyperuricemia has long been recognized to be associated with increased cardiovascular risk, including risk of developing hypertension. Epidemiological findings suggest that the link with hypertension is stronger in children and adolescents. Uric acid acts as a strong antioxidant compound in the extracellular environment but has pro-inflammatory effects within the intracellular setting. A chronic phase of microvascular injury is known to occur after prolonged periods of hyperuricemia. This is proposed to contribute to afferent arteriolopathy and elevation of blood pressure that may become unresponsive to uric acid-lowering therapies over time. Studies have struggled to infer direct causality of hyperuricemia due to a vast number of confounders including body mass index. The aim of this review is to present the available data and highlight the need for large scale prospective randomized controlled trials in this area. At present, there is limited evidence to support a role for uric acid-lowering therapies in helping mitigate the risk of hypertension.
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Affiliation(s)
- Douglas J Stewart
- Division of Nephrology, The Hospital for Sick Children, Toronto, Ontario M5G 1X8, Canada
| | - Valerie Langlois
- Division of Nephrology, The Hospital for Sick Children, Toronto, Ontario M5G 1X8, Canada.,Department of Paediatrics, University of Toronto, Toronto, Ontario M5G 1X8, Canada
| | - Damien Noone
- Division of Nephrology, The Hospital for Sick Children, Toronto, Ontario M5G 1X8, Canada.,Department of Paediatrics, University of Toronto, Toronto, Ontario M5G 1X8, Canada
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27
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Liu J, Wang K, Liu H, Zhao H, Zhao X, Lan Y, Huang W, Wang H. Relationship between carotid-femoral pulse wave velocity and uric acid in subjects with hypertension and hyperuricemia. Endocr J 2019; 66:629-636. [PMID: 31092739 DOI: 10.1507/endocrj.ej18-0570] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Increasing of arterial stiffness is the pathophysiological characteristic of hypertension. Carotid-femoral pulse wave velocity (CF-PWV) is an index of arterial stiffness. Serum uric acid has been found to be involved the development of hypertension. We investigated the relationship between CF-PWV and serum uric acid in subjects with hypertension and hyperuricemia. 651 subjects (M/F 271/380) were divided into four groups, group 1: subjects without hypertension and hyperuricemia; group 2: hypertension subjects without hyperuricemia; group 3: hyperuricemia subjects without hypertension; group 4: subjects with hypertension and hyperuricemia. CF-PWV was measured by Complior apparatus. Results showed that levels of CF-PWV (10.75 ± 2.03 vs. 10.06 ± 1.98 m/s, p < 0.001) and serum uric acid (319.33 ± 80.12 vs. 298.78 ± 74.88 umol/L, p = 0.001) were significantly higher in hypertensive (groups 2 + 4) group than in normotensive (groups 1 + 3) group. CF-PWV was significantly higher in group 4 than group 1, group 2 and group 3 (ANOVA analysis: F = 13.348, p < 0.001; 11.78 ± 2.10 vs. 9.98 ± 1.98, 10.52 ± 1.93, 10.56 ± 1.99 m/s, all p < 0.05, respectively). There was positive correlation between CF-PWV and serum uric acid in entire study group (r = 0.187, p < 0.001), even after adjusting for gender, body mass index, systolic blood pressure (SBP) and diastolic blood pressure (r = 0.100, p = 0.015). Multiple linear regressions showed that SBP, age, benzbromarone, statin and serum uric acid were independent associating factors of CFPWV in all subjects (β = 0.310, p < 0.001; β = 0.330, p < 0.001; β = 0.172, p = 0.002; β = -0.143, p = 0.006; β = 0.126, p = 0.027; respectively). In conclusions, CF-PWV was significantly higher in hypertension subjects with hyperuricemia compared to hypertension without hyperuricemia subjects, and serum uric acid was an independent associating factor of CF-PWV.
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Affiliation(s)
- Jinbo Liu
- Department of Vascular Medicine, Peking University Shougang Hospital, Beijing 100144, P. R. of China
| | - Kuanting Wang
- Department of Rheumatology and Immunology, Peking University Shougang Hospital, Beijing 100144, P. R. of China
| | - Huan Liu
- Department of Vascular Medicine, Peking University Shougang Hospital, Beijing 100144, P. R. of China
| | - Hongwei Zhao
- Department of Vascular Medicine, Peking University Shougang Hospital, Beijing 100144, P. R. of China
| | - Xiaoxiao Zhao
- Department of Vascular Medicine, Peking University Shougang Hospital, Beijing 100144, P. R. of China
| | - Yang Lan
- Department of Vascular Medicine, Peking University Shougang Hospital, Beijing 100144, P. R. of China
| | - Wei Huang
- Department of Vascular Medicine, Peking University Shougang Hospital, Beijing 100144, P. R. of China
| | - Hongyu Wang
- Department of Vascular Medicine, Peking University Shougang Hospital, Beijing 100144, P. R. of China
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Maloberti A, Rebora P, Andreano A, Vallerio P, De Chiara B, Signorini S, Casati M, Besana S, Bombelli M, Grassi G, Valsecchi MG, Giannattasio C. Pulse wave velocity progression over a medium-term follow-up in hypertensives: Focus on uric acid. J Clin Hypertens (Greenwich) 2019; 21:975-983. [PMID: 31222917 DOI: 10.1111/jch.13603] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 05/15/2019] [Accepted: 05/27/2019] [Indexed: 12/15/2022]
Abstract
The role of uric acid (UA) on the arterial stiffness progression has been evaluated only in three studies. Our aim was to evaluate its role as a possible determinant of the pulse wave velocity (PWV) progression over a 3.7 ± 0.5 years follow-up period in hypertensive patients. Specific sex analysis was done due to the well-known sex interaction with UA levels. We enrolled 422 consecutive hypertensive outpatients. At baseline anamnestic, blood pressure (BP) and laboratory data as well as PWV were assessed. PWV was performed again at follow-up examination. Hyperuricemia was defined as a UA > 6 mg/dL for women and > 7 mg/dL for men. Baseline age was 53.2 ± 13 years, 58% were males, systolic and diastolic BP (SBP/DBP) 141.7 ± 17.7/86.8 ± 10.8 mm Hg, UA 5.2 ± 1.4 mg/dL, and PWV 8.5 ± 1.9 m/s. At follow-up, despite better BP values (-8.5 ± 24.6 for SBP and -7.5 ± 15.4 for DBP), PWV increases to 9.1 ± 2.3 m/s (P < 0.001) with mean ΔPWV of+ 0.5 ± 2.2 m/s. A total of 61 patients were hyperuricemic (14.4%), and they present higher PWV baseline (9.0 ± 2.5 vs 8.5 ± 1.8 m/s, P = 0.03) without significant differences in ΔPWV. Hyperuricemic female (6.2%, 11 patients) presents higher baseline PWV without significant differences in ΔPWV. No differences were found in arterial stiffness in hyperuricemic males (20.4%, 50 patients). UA showed association with baseline and ΔPWV in the whole population but it loses statistical significance at the linear regression model. Same figures were also for sex analysis. Our findings provide evidence that baseline UA levels are not determinants of PWV progression over a median follow-up of 3.8 years' in hypertensive patients.
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Affiliation(s)
- Alessandro Maloberti
- Cardiology IV, "A.De Gasperis" Department, ASTT GOM Niguarda Ca' Granda, Milan, Italy.,School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Paola Rebora
- Center of Biostatistics for Clinical Epidemiology, School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Anita Andreano
- Center of Biostatistics for Clinical Epidemiology, School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Paola Vallerio
- Cardiology IV, "A.De Gasperis" Department, ASTT GOM Niguarda Ca' Granda, Milan, Italy.,School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Benedetta De Chiara
- Cardiology IV, "A.De Gasperis" Department, ASTT GOM Niguarda Ca' Granda, Milan, Italy
| | | | - Marco Casati
- Laboratory Medicine, San Gerardo Hospital, ASST Monza, Italy
| | - Silvia Besana
- Laboratory Medicine, Desio Hospital, ASST Monza, Italy
| | - Michele Bombelli
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.,Internal Medicine, San Gerardo Hospital, ASST Monza, Italy
| | - Guido Grassi
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.,Internal Medicine, San Gerardo Hospital, ASST Monza, Italy
| | - Maria Grazia Valsecchi
- Center of Biostatistics for Clinical Epidemiology, School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Cristina Giannattasio
- Cardiology IV, "A.De Gasperis" Department, ASTT GOM Niguarda Ca' Granda, Milan, Italy.,School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
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Li S, Cheng J, Cui L, Gurol ME, Bhatt DL, Fonarow GC, Benjamin EJ, Xing A, Xia Y, Wu S, Gao X. Cohort Study of Repeated Measurements of Serum Urate and Risk of Incident Atrial Fibrillation. J Am Heart Assoc 2019; 8:e012020. [PMID: 31213103 PMCID: PMC6662349 DOI: 10.1161/jaha.119.012020] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background Current evidence on the association between serum urate and risk of atrial fibrillation ( AF ) is limited by cross-sectional designs and 1-time measurement of serum urate. The roles of serum urate, gout-related inflammation, and systemic inflammation in the etiology of AF are currently unknown. This gap is important, given that systemic inflammation is a recognized risk factor for AF . Methods and Results We conducted a prospective cohort study of 123 238 Chinese patients from 2006 to 2014. Serum urate concentrations were measured in 2006, 2008, 2010, and 2012. Incident AF cases were identified via biennial 12-lead ECG assessment. We used a Cox proportional hazards model to examine the sex-specific associations of cumulative average serum urate and changes in serum urate accounting for baseline level with risk of incident AF . We also assessed the joint associations of serum urate and high-sensitivity C-reactive protein levels. Comparing extreme categories, participants with the highest quintile of serum urate had 1.91-fold higher risk of AF (adjusted hazard ratio: 1.91; 95% CI, 1.32-2.76; P=0.001 for trend). Participants with both high serum urate and high-sensitivity C-reactive protein had 2.6-fold elevated risk of incident AF compared with those with normal levels of serum urate and high-sensitivity C-reactive protein (adjusted hazard ratio: 2.63; 95% CI, 1.63-4.23). Conclusions High serum urate levels and increases in serum urate over time were associated with increased risk of incident AF . Patients with high levels of both serum urate and high-sensitivity C-reactive protein had substantially higher risk of AF .
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Affiliation(s)
- Shanshan Li
- 1 Boston University School of Medicine Boston MA
| | - Jin Cheng
- 2 Department of Cardiology Kailuan General Hospital Tangshan People's Republic of China
| | - Liufu Cui
- 3 Department of Rheumatology and Immunology Kailuan General Hospital Tangshan People's Republic of China
| | - M Edip Gurol
- 4 Massachusetts General Hospital Harvard Medical School Boston MA
| | - Deepak L Bhatt
- 5 Brigham and Women's Hospital Harvard Medical School Boston MA
| | - Gregg C Fonarow
- 6 David Geffen School of Medicine University of California Los Angeles CA
| | | | - Aijun Xing
- 2 Department of Cardiology Kailuan General Hospital Tangshan People's Republic of China
| | - YunLong Xia
- 7 Department of Cardiology First Affiliated Hospital of Dalian Medical University Dailian People's Republic of China
| | - Shouling Wu
- 2 Department of Cardiology Kailuan General Hospital Tangshan People's Republic of China
| | - Xiang Gao
- 8 Department of Nutritional Sciences Pennsylvania State University State College PA
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30
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Jeong W, Joo SJ, Kim J, Lee JG, Choi JH. Presence of tophi is a predictive factor of arterial stiffness in patients with gout. Rheumatol Int 2019; 39:1249-1255. [PMID: 31154472 DOI: 10.1007/s00296-019-04313-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 04/25/2019] [Indexed: 10/26/2022]
Abstract
The objective of this study is to determine whether the presence of tophi could predict an increase in arterial stiffness. Between June 2017 and June 2018, the augmentation index (AI) was measured using SphygmoCor® for patients with gout who visited the Jeju National University Hospital in South Korea. Patients were divided into the following groups: group with tophi and group without tophi. Medical records, laboratory data, and AI were retrospectively analyzed. One hundred and twenty patients with gout or participated in the study, with most (96.7%) of the patients being male. The mean duration of the disease was 7.0 years. At the time of the examination, 99 patients (82.5%) were treated with a uric acid-lowering agent. Of the total patients, 24 (19.7%) had tophi. Patients with tophi were significantly older (60.2 ± 11.6 years vs. 53.8 ± 13.0 years, p = 0.031), had longer disease duration (13.0 ± 6.5 years vs 5.5 ± 5.4 years, p < 0.001), and higher AI@75 (28.7 ± 7.8 vs 20.9 ± 10.0, p = 0.001) than those without tophi. In the multiple linear regression analysis, tophi was shown to be a significant predictor of high AI (p = 0.040). The presence of tophi is a predictor of increased arterial stiffness in patients with gout. Therefore, more strict control of cardiovascular disease risk factors is needed in the treatment of patients with tophi.
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Affiliation(s)
- WooSeong Jeong
- Division of Rheumatology, Department of Internal Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, South Korea
| | - Seung-Jae Joo
- Division of Cardiology, Department of Internal Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Aran 13gil (Ara-1-dong), Jeju-Si, Jeju, 63241, South Korea
| | - Jinsoek Kim
- Division of Rheumatology, Department of Internal Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, South Korea
| | - Jae-Geun Lee
- Division of Cardiology, Department of Internal Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Aran 13gil (Ara-1-dong), Jeju-Si, Jeju, 63241, South Korea
| | - Joon Hyouk Choi
- Division of Cardiology, Department of Internal Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Aran 13gil (Ara-1-dong), Jeju-Si, Jeju, 63241, South Korea.
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31
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Abstract
Sodium/glucose co-transporter-2 (SGLT2) inhibitors, which lower blood glucose by increasing renal glucose elimination, have been shown to reduce the risk of adverse cardiovascular (CV) and renal events in type 2 diabetes. This has been ascribed, in part, to haemodynamic changes, body weight reduction and several possible effects on myocardial, endothelial and tubulo-glomerular functions, as well as to reduced glucotoxicity. This review evaluates evidence that an effect of SGLT2 inhibitors to lower uric acid may also contribute to reduced cardio-renal risk. Chronically elevated circulating uric acid concentrations are associated with increased risk of hypertension, CV disease and chronic kidney disease (CKD). The extent to which uric acid contributes to these conditions, either as a cause or an aggravating factor, remains unclear, but interventions that reduce urate production or increase urate excretion in hyperuricaemic patients have consistently improved cardio-renal prognoses. Uric acid concentrations are often elevated in type 2 diabetes, contributing to the "metabolic syndrome" of CV risk. Treating type 2 diabetes with an SGLT2 inhibitor increases uric acid excretion, reduces circulating uric acid and improves parameters of CV and renal function. This raises the possibility that the lowering of uric acid by SGLT2 inhibition may assist in reducing adverse CV events and slowing progression of CKD in type 2 diabetes. SGLT2 inhibition might also be useful in the treatment of gout and gouty arthritis, especially when co-existent with diabetes.
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Affiliation(s)
- Clifford J Bailey
- School of Life and Health Sciences, Aston University, Birmingham, UK
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32
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Cortese F, Giordano P, Scicchitano P, Faienza MF, De Pergola G, Calculli G, Meliota G, Ciccone MM. Uric acid: from a biological advantage to a potential danger. A focus on cardiovascular effects. Vascul Pharmacol 2019; 120:106565. [PMID: 31152976 DOI: 10.1016/j.vph.2019.106565] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 05/26/2019] [Accepted: 05/27/2019] [Indexed: 02/07/2023]
Abstract
Non-communicable diseases represent nowadays the most common cause of death worldwide, having largely overcome infectious diseases. Among them, cardiovascular diseases constitute the majority. Given these premise, great efforts have been made by scientific societies to emphasize the fundamental role of cardiovascular prevention and risk factors control. In addition to classical cardiovascular risk factors such as smoking, arterial hypertension, hypercholesterolemia and male gender, new risk factors are emerging from international literature. Among them, uric acid is the protagonist. Several evidences show a direct role of hyperuricemia in the determinism of metabolic and vascular disorders. From the other hand, some researchers have demonstrated that uric acid is only a marker of cardiovascular damage and not a risk factor for its development. Aim of this review is to evaluate the scientific evidences on the role of uric acid in cardiovascular diseases in order to shed light on this confusing topic.
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Affiliation(s)
- Francesca Cortese
- Cardiological Unit, Cardiovascular Disease Section, Department of Organ Transplantation, University of Bari, Italy.
| | - Paola Giordano
- Department of Biomedicine and Human Oncology, Pediatric Section, University "A.Moro" of Bari, Bari, Italy
| | | | - Maria Felicia Faienza
- Department of Biomedicine and Human Oncology, Pediatric Section, University "A.Moro" of Bari, Bari, Italy
| | - Giovanni De Pergola
- Departmentof Biomedical Sciences and Human Oncology, Section of Internal Medicine and Clinical Oncology, University of Bari Aldo Moro, Bari, Italy
| | | | - Giovanni Meliota
- Cardiological Unit, Cardiovascular Disease Section, Department of Organ Transplantation, University of Bari, Italy
| | - Marco Matteo Ciccone
- Cardiological Unit, Cardiovascular Disease Section, Department of Organ Transplantation, University of Bari, Italy
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33
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Maloberti A, Vallerio P, Triglione N, Occhi L, Panzeri F, Bassi I, Pansera F, Piccinelli E, Peretti A, Garatti L, Palazzini M, Sun J, Grasso E, Giannattasio C. Vascular Aging and Disease of the Large Vessels: Role of Inflammation. High Blood Press Cardiovasc Prev 2019; 26:175-182. [DOI: 10.1007/s40292-019-00318-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 04/25/2019] [Indexed: 11/25/2022] Open
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34
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Afsar B, Sag AA, Oztosun C, Kuwabara M, Cozzolino M, Covic A, Kanbay M. The role of uric acid in mineral bone disorders in chronic kidney disease. J Nephrol 2019; 32:709-717. [DOI: 10.1007/s40620-019-00615-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 04/24/2019] [Indexed: 01/28/2023]
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35
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Uric acid association with pulsatile and steady components of central and peripheral blood pressures. J Hypertens 2019; 36:495-501. [PMID: 28957851 DOI: 10.1097/hjh.0000000000001573] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Whether the cardiovascular risk attributed to elevated uric acid levels may be explained by changes in central and peripheral pulsatile and/or steady blood pressure (BP) components remains controversial. METHODS In a cross-sectional analysis of normotensive and untreated hypertensive participants of the CARTaGENE populational cohort, we examined the relationship between uric acid, and both pulsatile and steady components of peripheral and central BP, using sex-stratified linear regressions. RESULTS Of the 20 004 participants, 10 161 individuals without antihypertensive or uric acid-lowering drugs had valid pulse wave analysis and serum uric acid levels. In multivariate analysis, pulsatile components of BP were not associated with uric acid levels, whereas steady components [mean BP (MBP), peripheral and central DBP] were all associated with higher levels of uric acid levels in women and men (all P < 0.001). Furthermore, there was a gradual increase of central SBP (cSBP), DBP and MBP from the lowest to the highest quintiles of uric acid levels but not for MBP-adjusted cSBP. Peripheral and cSBP, which are aggregate measures of pulsatile and steady BP, were also associated with uric acid levels in women (β = 0.063 and 0.072, respectively, both P < 0.001) and men (β = 0.043 and 0.051, both P ≤ 0.003). After further adjustments for MBP to account for the concomitant increase in steady component of BP, SBPs were no longer associated with uric acid levels. CONCLUSION Serum uric acid levels appear to be associated with both central and peripheral steady but not pulsatile BP, regardless of sex.
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36
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Sun Y, Sun J, Zhang P, Zhong F, Cai J, Ma A. Association of dietary fiber intake with hyperuricemia in U.S. adults. Food Funct 2019; 10:4932-4940. [DOI: 10.1039/c8fo01917g] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Current evidence on the relationship between dietary fiber intake and risk of hyperuricemia is limited.
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Affiliation(s)
- Yongye Sun
- Department of Nutrition and Food Hygiene
- School of Public Health
- Qingdao University
- Qingdao
- China
| | - Jianping Sun
- Qingdao Municipal Center for Disease Control and Prevention
- Qingdao
- China
| | - Peipei Zhang
- Department of Nutrition and Food Hygiene
- School of Public Health
- Qingdao University
- Qingdao
- China
| | - Feng Zhong
- Department of Nutrition and Food Hygiene
- School of Public Health
- Qingdao University
- Qingdao
- China
| | - Jing Cai
- Department of Nutrition and Food Hygiene
- School of Public Health
- Qingdao University
- Qingdao
- China
| | - Aiguo Ma
- Department of Nutrition and Food Hygiene
- School of Public Health
- Qingdao University
- Qingdao
- China
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37
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Syed-Abdul MM, Hu Q, Jacome-Sosa M, Padilla J, Manrique-Acevedo C, Heimowitz C, Parks EJ. Effect of carbohydrate restriction-induced weight loss on aortic pulse wave velocity in overweight men and women. Appl Physiol Nutr Metab 2018; 43:1247-1256. [DOI: 10.1139/apnm-2018-0113] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Increased aortic stiffness, measured by carotid-to-femoral pulse wave velocity (PWV), is an independent predictor of cardiovascular disease, and past data have shown that low-fat and low-energy diets, fed for 8–24 weeks, lower PWV. The purpose of this study was to determine whether a reduction in PWV would be achieved by dietary carbohydrate (CHO) restriction, shown to bring about weight loss over a shorter timeframe. Men (n = 10, age: 41.8 ± 10.2 years, BMI: 34.2 ± 3.0 kg/m2 (mean ± SD)) and women (n = 10, age: 38.6 ± 6.1 years, BMI: 33.5 ± 3.8 kg/m2) with characteristics of insulin resistance and the metabolic syndrome consumed a structured, CHO-restricted diet for 4 weeks (energy deficit, 645 kcal/day). For the whole group, subjects lost 5.4% ± 0.5% (P < 0.001) of body weight and experienced significant reductions in blood pressure (6%–8%), plasma insulin (34%), and triglycerides (34%). PWV was reduced by 6% ± 2% (7.1 ± 0.2 m/s to 6.7 ± 0.2 m/s, P = 0.008) and surprisingly, in women, it fell significantly (from 7.2 ± 0.3 m/s to 6.3 ± 0.3 m/s, P = 0.028), while no changes were observed in men (7.2 ± 0.3 vs. 7.0 ± 0.3 m/s, P = 0.144). This is the first study to demonstrate that weight loss can improve PWV in as little as 4 weeks and that dietary CHO restriction may be an effective treatment for reducing aortic stiffness in women. Future studies are needed to establish the mechanisms by which dietary CHO restriction may confer more cardiovascular benefits to women than to men.
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Affiliation(s)
- Majid M. Syed-Abdul
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, MO 65211, USA
| | - Qiong Hu
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, MO 65211, USA
| | - Miriam Jacome-Sosa
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, MO 65211, USA
| | - Jaume Padilla
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, MO 65211, USA
- Dalton Cardiovascular Research Center, University of Missouri, Columbia, MO 65211, USA
- Department of Child Health, School of Medicine, University of Missouri, Columbia, MO 65212, USA
| | - Camila Manrique-Acevedo
- Division of Endocrinology, School of Medicine, University of Missouri, Columbia, MO 65212, USA
| | | | - Elizabeth J. Parks
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, MO 65211, USA
- Department of Child Health, School of Medicine, University of Missouri, Columbia, MO 65212, USA
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38
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Dumor K, Shoemaker-Moyle M, Nistala R, Whaley-Connell A. Arterial Stiffness in Hypertension: an Update. Curr Hypertens Rep 2018; 20:72. [DOI: 10.1007/s11906-018-0867-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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39
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Alem MM, Alshehri AM, Cahusac PMB, Walters MR. Effect of Xanthine Oxidase Inhibition on Arterial Stiffness in Patients With Chronic Heart Failure. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2018; 12:1179546818779584. [PMID: 29899669 PMCID: PMC5992797 DOI: 10.1177/1179546818779584] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 04/30/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND The xanthine oxidase inhibitor allopurinol improves endothelial function in different populations, including patients with chronic heart failure (CHF). Its effect on arterial stiffness parameters is less clear. We investigated the effect of short-term low-dose allopurinol therapy on arterial stiffness in Saudi patients with stable mild-moderate CHF. METHODS A prospective, randomized, double-blind, placebo-controlled study was performed on 73 patients with mild-moderate CHF. In all, 36 patients were randomized to allopurinol 300 mg daily for 3 months, while 37 patients were randomized to placebo. Arterial stiffness parameters, aortic pulse wave velocity (Ao-PWV) and heart rate corrected augmentation index (c-AIx), were assessed before and after treatment along with serum uric acid. RESULTS A total of 66 patients completed the study. Both groups were matched for age, sex, severity of heart failure, and arterial stiffness. Compared with placebo, allopurinol recipients had a significant fall in uric acid concentration from 6.31 ± 1.4 (SD) mg/dL to 3.81 ± 1.2 (P < .001). Despite that, there was no significant change in arterial stiffness parameters between allopurinol and placebo groups. Post-treatment Ao-PWV was 9.79 ± 2.6 m/s in the allopurinol group and 10.07 ± 3.4 m/s in the placebo group, P = .723. Post-treatment c-AIx was 24.0% ± 9.1% and 22.0% ± 9.9%, respectively, P = .403. CONCLUSIONS We have shown that allopurinol significantly reduced uric acid concentration in Saudi patients with CHF but was not associated with a change in arterial stiffness. Our cohort of patients had worse arterial stiffness values at baseline, which might make them more resistant to change using our study regimen.The study has been registered with the International Standard Randomized Controlled Trial Number registry with an identifier number of ISRCTN58980230.
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Affiliation(s)
- Manal M Alem
- Department of Pharmacology, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Abdullah M Alshehri
- Internal Medicine Department, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Peter MB Cahusac
- Department of Pharmacology, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
- Department of Comparative Medicine, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Matthew R Walters
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK
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40
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Li Y, Fan X, Li C, Zhi X, Peng L, Han H, Sun B. The relationships among hyperuricemia, body mass index and impaired renal function in type 2 diabetic patients. Endocr J 2018; 65:281-290. [PMID: 29237999 DOI: 10.1507/endocrj.ej17-0266] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Chronic kidney disease (CKD) is a common chronic microvascular complication and the major cause of death in diabetic patients. This study was conceived to explore the possible mechanisms of how hyperuricemia and obesity contribute to renal function impairment in type 2 diabetic (T2DM) patients. A cross-sectional study in 609 participants recruited from a T2DM population in North China was conducted. The multiplicative interaction between body mass index (BMI) and uric acid (UA) level was assessed using an interaction term in a logistic regression analysis. Our results indicate that male T2DM patients having higher BMI (OR 1.711, p = 0.038), blood urine nitrogen (BUN) (OR 1.100, p = 0.034), and 24-hour urinary micro-albumin levels (OR 1.004, p = 0.021) were much more likely to have high UA. Whereas, for female T2DM patients, the OR of BMI, BUN, and triglyceride were 1.169 (p = 0.001), 1.337 (p = 0.000), and 1.359 (p = 0.006), respectively. In this study population, obesity and elevated UA work together to increase the risk of renal injury. In vitro experiments indicate that reactive oxygen species (ROS) production increased with UA treatment in human renal glomerular endothelial cells (HRGECs), while endothelial nitric oxide synthase (eNOS) production level dropped. UA also increased monocyte chemotactic protein-1 (MCP-1) expression and nuclear factor kappa B (NF-κB) activation. Taken together, our results indicate that high concentrations of UA lead to endothelial dysfunction through the activation of the inflammatory response and induction of oxidative stress, even in non-obese T2DM patients.
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Affiliation(s)
- Yongmei Li
- Key Laboratory of Hormones and Development (Ministry of Health), Tianjin Key Laboratory of Metabolic Diseases, Tianjin Metabolic Diseases Hospital & Institute of Endocrinology, Tianjin Medical University, Tianjin, China
- Department of Pathogenic Biology, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, China
| | - Xing Fan
- Tianjin Medical University General Hospital, Tianjin Medical University, Tianjin, China
| | - Chunjun Li
- Key Laboratory of Hormones and Development (Ministry of Health), Tianjin Key Laboratory of Metabolic Diseases, Tianjin Metabolic Diseases Hospital & Institute of Endocrinology, Tianjin Medical University, Tianjin, China
| | - Xinyue Zhi
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Liyuan Peng
- Department of Physiology and Pathophysiology, Collaborative Innovation Center of Tianjin for Medical Epigenetics, Tianjin Medical University, Tianjin, China
| | - Hongling Han
- Tianjin Medical University General Hospital, Tianjin Medical University, Tianjin, China
| | - Bei Sun
- Key Laboratory of Hormones and Development (Ministry of Health), Tianjin Key Laboratory of Metabolic Diseases, Tianjin Metabolic Diseases Hospital & Institute of Endocrinology, Tianjin Medical University, Tianjin, China
- Department of Physiology and Pathophysiology, Collaborative Innovation Center of Tianjin for Medical Epigenetics, Tianjin Medical University, Tianjin, China
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41
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Hu JW, Wang Y, Chu C, Yan Y, Wang K, Zheng W, Ma Q, Lv YB, Deng Y, Yan B, Mu JJ. The Relationships of the Fractional Excretion of Uric Acid with Brachial-Ankle Pulse Wave Velocity and Ankle Brachial Index in Chinese Young Adults. Kidney Blood Press Res 2018; 43:234-245. [PMID: 29587296 DOI: 10.1159/000487677] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 02/15/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Elevated serum uric acid (UA) was intimately correlated with vascular stiffness and abnormal ankle brachial index (ABI) in various populations. These correlations lost significance after adjustment for estimated glomerular filtration rate (eGFR), indicating that the association of UA and brachial-ankle pulse wave velocity (baPWV) or ABI might be driven by kidney function. UA is predominantly eliminated through the kidneys, and metabolic disorders can influence the clearance of UA. In this study, we aimed to explore the putative correlation between FEUA and baPWV or ABI to determine to what extent the associations with UA were affected by renal function. METHODS This cross-sectional study enrolled 2351 participants, who underwent general health screening in Hanzhong people's hospital from March to June of 2017. BaPWV and ABI were measured using a volume-plethysmographic apparatus (BP-203RPEII; Nihon Colin, Tokyo, Japan). FEUA was divided into quartiles: Q1:FEUA≤3.07; Q2: 3.07<FEUA≤5.32; Q3: 5.32<FEUA≤9.19; and Q4: FEUA> 9.19. RESULTS Lower FEUA predicted a higher prevalence of high baPWV and low ABI (p for trend <0.001). The respective ORs for high baPWV from the first to the third quartiles of FEUA were 1.777(1.323, 2.387); 1.561(1.158, 2.104); and 1.680 (1.250, 2.259). The prevalence of low ABI was greatly elevated with the decrement of FEUA [ORs for the first to third FEUA quartiles were 6.977(2.062, 23.610); 5.123(1.475, 17.790); and 2.685(0.709, 10.171), respectively]. The association of FEUA and ABI was independent of related confounding factors. However, the association between FEUA and baPWV was greatly influenced by corresponding confounders, especially gender. The efficacy of FEUA in the prediction of low ABI was stronger than that of serum UA. However, serum UA was more powerful in the prediction of high baPWV. CONCLUSION Kidney function exerted a profound influence on the relationship between UA and baPWV or ABI, revealing complex interactions among cardiovascular risk factors.
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Affiliation(s)
- Jia-Wen Hu
- Department of Cardiology, First Affiliated Hospital of Medical School, Xi'an Jiaotong University, Xi'an, China.,Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi'an, China
| | - Yang Wang
- Department of Cardiology, First Affiliated Hospital of Medical School, Xi'an Jiaotong University, Xi'an, China.,Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi'an, China
| | - Chao Chu
- Department of Cardiology, First Affiliated Hospital of Medical School, Xi'an Jiaotong University, Xi'an, China.,Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi'an, China
| | - Yu Yan
- Department of Cardiology, First Affiliated Hospital of Medical School, Xi'an Jiaotong University, Xi'an, China.,Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi'an, China
| | - Keke Wang
- Department of Cardiology, First Affiliated Hospital of Medical School, Xi'an Jiaotong University, Xi'an, China.,Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi'an, China
| | - Wenling Zheng
- Department of Cardiology, First Affiliated Hospital of Medical School, Xi'an Jiaotong University, Xi'an, China.,Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi'an, China
| | - Qiong Ma
- Department of Cardiology, First Affiliated Hospital of Medical School, Xi'an Jiaotong University, Xi'an, China.,Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi'an, China
| | - Yong-Bo Lv
- Department of Cardiology, First Affiliated Hospital of Medical School, Xi'an Jiaotong University, Xi'an, China.,Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi'an, China
| | - Yin Deng
- Department of Cardiology, First Affiliated Hospital of Medical School, Xi'an Jiaotong University, Xi'an, China
| | - Bo Yan
- Department of Cardiology, First Affiliated Hospital of Medical School, Xi'an Jiaotong University, Xi'an, China
| | - Jian-Jun Mu
- Department of Cardiology, First Affiliated Hospital of Medical School, Xi'an Jiaotong University, Xi'an, China.,Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi'an, China
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42
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Zheng Z, Harman JL, Coresh J, Köttgen A, McAdams-DeMarco MA, Correa A, Young BA, Katz R, Rebholz CM. The Dietary Fructose:Vitamin C Intake Ratio Is Associated with Hyperuricemia in African-American Adults. J Nutr 2018; 148:419-426. [PMID: 29546301 PMCID: PMC6251529 DOI: 10.1093/jn/nxx054] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 11/27/2017] [Indexed: 11/13/2022] Open
Abstract
Background A high fructose intake has been shown to be associated with increased serum urate concentration, whereas ascorbate (vitamin C) may lower serum urate by competing with urate for renal reabsorption. Objective We assessed the combined association, as the fructose:vitamin C intake ratio, and the separate associations of dietary fructose and vitamin C intakes on prevalent hyperuricemia. Methods We conducted cross-sectional analyses of dietary intakes of fructose and vitamin C and serum urate concentrations among Jackson Heart Study participants, a cohort of African Americans in Jackson, Mississippi, aged 21-91 y. In the analytic sample (n = 4576), multivariable logistic regression was used to examine the separate associations of dietary intakes of fructose and vitamin C and the fructose:vitamin C intake ratio with prevalent hyperuricemia (serum urate ≥7 mg/dL), after adjusting for age, sex, smoking, waist circumference, systolic blood pressure, estimated glomerular filtration rate, diuretic medication use, vitamin C supplement use, total energy intake, alcohol consumption, and dietary intake of animal protein. Analyses for individual dietary factors (vitamin C, fructose) were adjusted for the other dietary factor. Results In the fully adjusted model, there were 17% greater odds of hyperuricemia associated with a doubling of the fructose:vitamin C intake ratio (OR: 1.17; 95% CI: 1.08, 1.28), 20% greater odds associated with a doubling of fructose intake (OR: 1.20; 95% CI: 1.08, 1.34), and 13% lower odds associated with a doubling of vitamin C intake (OR: 0.87; 95% CI: 0.78, 0.97). Dietary fructose and the fructose:vitamin C intake ratio were more strongly associated with hyperuricemia among men than women (P-interaction ≤ 0.04). Conclusion Dietary intakes of fructose and vitamin C are associated with prevalent hyperuricemia in a community-based population of African Americans.
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Affiliation(s)
- Zihe Zheng
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health,
Baltimore, MD
| | - Jane L Harman
- Program in Prevention and Population Sciences, Division of Cardiovascular
Sciences, National Heart, Lung, and Blood Institute, NIH, Bethesda, MD
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health,
Baltimore, MD
| | - Anna Köttgen
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health,
Baltimore, MD,Institute of Genetic Epidemiology, Medical Center and Faculty of Medicine,
University of Freiburg, Freiburg, Germany
| | - Mara A McAdams-DeMarco
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health,
Baltimore, MD
| | - Adolfo Correa
- Departments of Medicine and Pediatrics, University of Mississippi Medical
Center, Jackson, MS,Pediatrics, University of Mississippi Medical Center, Jackson, MS
| | - Bessie A Young
- Veterans Affairs, Puget Sound Health Care Center, Hospital and Specialty
Medicine, Seattle, WA,Kidney Research Institute, Division of Nephrology, Department of Medicine,
University of Washington, Seattle, WA
| | - Ronit Katz
- Kidney Research Institute, Division of Nephrology, Department of Medicine,
University of Washington, Seattle, WA
| | - Casey M Rebholz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health,
Baltimore, MD,Address correspondence to CMR (e-mail: )
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43
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Vanholder R, Pletinck A, Schepers E, Glorieux G. Biochemical and Clinical Impact of Organic Uremic Retention Solutes: A Comprehensive Update. Toxins (Basel) 2018; 10:toxins10010033. [PMID: 29316724 PMCID: PMC5793120 DOI: 10.3390/toxins10010033] [Citation(s) in RCA: 200] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 12/21/2017] [Accepted: 12/23/2017] [Indexed: 02/07/2023] Open
Abstract
In this narrative review, the biological/biochemical impact (toxicity) of a large array of known individual uremic retention solutes and groups of solutes is summarized. We classified these compounds along their physico-chemical characteristics as small water-soluble compounds or groups, protein bound compounds and middle molecules. All but one solute (glomerulopressin) affected at least one mechanism with the potential to contribute to the uremic syndrome. In general, several mechanisms were influenced for each individual solute or group of solutes, with some impacting up to 7 different biological systems of the 11 considered. The inflammatory, cardio-vascular and fibrogenic systems were those most frequently affected and they are one by one major actors in the high morbidity and mortality of CKD but also the mechanisms that have most frequently been studied. A scoring system was built with the intention to classify the reviewed compounds according to the experimental evidence of their toxicity (number of systems affected) and overall experimental and clinical evidence. Among the highest globally scoring solutes were 3 small water-soluble compounds [asymmetric dimethylarginine (ADMA); trimethylamine-N-oxide (TMAO); uric acid], 6 protein bound compounds or groups of protein bound compounds [advanced glycation end products (AGEs); p-cresyl sulfate; indoxyl sulfate; indole acetic acid; the kynurenines; phenyl acetic acid;] and 3 middle molecules [β2-microglobulin; ghrelin; parathyroid hormone). In general, more experimental data were provided for the protein bound molecules but for almost half of them clinical evidence was missing in spite of robust experimental data. The picture emanating is one of a complex disorder, where multiple factors contribute to a multisystem complication profile, so that it seems of not much use to pursue a decrease of concentration of a single compound.
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Affiliation(s)
- Raymond Vanholder
- Nephrology Section, Department of Internal Medicine, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium.
| | - Anneleen Pletinck
- Nephrology Section, Department of Internal Medicine, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium.
| | - Eva Schepers
- Nephrology Section, Department of Internal Medicine, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium.
| | - Griet Glorieux
- Nephrology Section, Department of Internal Medicine, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium.
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Fanning N, Merriman TR, Dalbeth N, Stamp LK. An association of smoking with serum urate and gout: A health paradox. Semin Arthritis Rheum 2017; 47:825-842. [PMID: 29398126 DOI: 10.1016/j.semarthrit.2017.11.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 11/01/2017] [Accepted: 11/16/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND The potential effect of cigarette smoking on levels of serum urate and risk of gout has been considered by a large number of studies, either as the primary variable of interest or as a covariate. METHODS Here we systematically review the published evidence relating to the relationship of smoking with serum urate, hyperuricaemia, and gout. RESULTS Many studies have reported that smoking reduces serum urate, however, the evidence has not been conclusive with other studies pointing to the opposite or no effect. It has also been suggested that smoking reduces the risk of gout, although there is some evidence to contradict this finding. CONCLUSION A consensus has yet to be reached as to the effect of smoking on serum urate levels and the risk of gout.
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Affiliation(s)
- Niamh Fanning
- Department of Medicine, University of Otago, Christchurch, PO Box 4345, Christchurch, New Zealand.
| | - Tony R Merriman
- Department of Biochemistry, University of Otago, Dunedin, New Zealand
| | - Nicola Dalbeth
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Lisa K Stamp
- Department of Medicine, University of Otago, Christchurch, PO Box 4345, Christchurch, New Zealand
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45
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Nielsen SM, Bartels EM, Henriksen M, Wæhrens EE, Gudbergsen H, Bliddal H, Astrup A, Knop FK, Carmona L, Taylor WJ, Singh JA, Perez-Ruiz F, Kristensen LE, Christensen R. Weight loss for overweight and obese individuals with gout: a systematic review of longitudinal studies. Ann Rheum Dis 2017; 76:1870-1882. [PMID: 28866649 PMCID: PMC5705854 DOI: 10.1136/annrheumdis-2017-211472] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 05/29/2017] [Accepted: 07/01/2017] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Weight loss is commonly recommended for gout, but the magnitude of the effect has not been evaluated in a systematic review. The aim of this systematic review was to determine benefits and harms associated with weight loss in overweight and obese patients with gout. METHODS We searched six databases for longitudinal studies, reporting the effect of weight loss in overweight/obese gout patients. Risk of bias was assessed using the tool Risk of Bias in Non-Randomised Studies of Interventions. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation. RESULTS From 3991 potentially eligible studies, 10 were included (including one randomised trial). Interventions included diet with/without physical activity, bariatric surgery, diuretics, metformin or no intervention. Mean weight losses ranged from 3 kg to 34 kg. Clinical heterogeneity in study characteristics precluded meta-analysis. The effect on serum uric acid (sUA) ranged from -168 to 30 μmol/L, and 0%-60% patients achieving sUA target (<360 μmol/L). Six out of eight studies (75%) showed beneficial effects on gout attacks. Two studies indicated dose-response relationship for sUA, achieving sUA target and gout attacks. At short term, temporary increased sUA and gout attacks tended to occur after bariatric surgery. CONCLUSIONS The available evidence is in favour of weight loss for overweight/obese gout patients, with low, moderate and low quality of evidence for effects on sUA, achieving sUA target and gout attacks, respectively. At short term, unfavourable effects may occur. Since the current evidence consists of a few studies (mostly observational) of low methodological quality, there is an urgent need to initiate rigorous prospective studies (preferably randomised controlled trials). SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42016037937.
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Affiliation(s)
- Sabrina M Nielsen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Else M Bartels
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Marius Henriksen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Department of Physical and Occupational Therapy, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Eva E Wæhrens
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- The Research Initiative for Activity Studies and Occupational Therapy, General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Henrik Gudbergsen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Henning Bliddal
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Arne Astrup
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Filip K Knop
- Center for Diabetes Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- NNF Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - William J Taylor
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Jasvinder A Singh
- Department of Medicine, University of Alabama at Birmingham, & Birmingham Veterans Affairs Medical Center, Birmingham, Alabama, USA
| | | | - Lars E Kristensen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Robin Christensen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
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Abstract
AIMS Elevated serum uric acid (SUA) is often present in conditions associated with increased cardiovascular risk yet it is not recognized as a marker of risk. We evaluated whether SUA was associated with evidence of early markers of cardiovascular risk factor including subclinical early organ damage, sympathetic tone and metabolic profile in a healthy population with a high prevalence of obesity. MATERIAL AND METHODS Data from 281 patients (175 women and 106 men, mean age: 35.5 ± 0.8 years, mean BMI: 33.2 ± 0.5 kg/m) were retrieved from a database. All participants were healthy, nonsmoker and free of medication. Available data included metabolic profile, muscle sympathetic nervous activity (MSNA, microneurography), endothelial function (pulse amplitude tonometry, augmentation index), estimated glomerular filtration rate (eGFR) and echocardiography. RESULTS With participants grouped into sex-adjusted tertiles of SUA, those in the third tertile of SUA had increased waist circumference, worse metabolic profile (fasting glucose, total cholesterol, triglycerides and HDL), elevated MSNA, decreased endothelial function, increased augmentation index and decreased eGFR compared with those in the first tertile of SUA. In multiple regression analysis adjusted for age, sex, BMI and ethnicity, SUA was independently associated with waist circumference, low-density lipoprotein, triglycerides, augmentation index, MSNA and eGFR, providing a combined adjusted R = 0.599 or 60% of the overall variance. CONCLUSION In a healthy population with a high proportion of obesity, SUA is associated with measures of metabolic, end-organ damage and sympathetic tone indicating the potential value of SUA as a marker of early cardiovascular disease development.
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47
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Liu H, Liu J, Zhao H, Zhou Y, Li L, Wang H. Relationship between Serum Uric Acid and Vascular Function and Structure Markers and Gender Difference in a Real-World Population of China-From Beijing Vascular Disease Patients Evaluation Study (BEST) Study. J Atheroscler Thromb 2017; 25:254-261. [PMID: 28904249 PMCID: PMC5868511 DOI: 10.5551/jat.39685] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
AIM The study was done to establish the relationship between serum uric acid (UA) and vascular function and structure parameters including carotid femoral pulse wave velocity (CF-PWV), carotid radial pulse wave velocity (CR-PWV), cardio ankle vascular index (CAVI), ankle brachial index (ABI), and carotid intima-media thickness (CIMT), and the gender difference in a real-world population from China. METHODS A total of 979 subjects were enrolled (aged 60.86±11.03 years, male 416 and female 563). Value of UA was divided by 100 (UA/100) for analysis. RESULTS Body mass index (BMI), diastolic blood pressure (DBP), fasting plasma glucose (FPG), UA, and UA/100 were significantly higher in males compared with females (all p<0.05); pulse pressure (PP), total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), and low density lipoprotein cholesterol (LDL-C) were lower in males than females (all p<0.05). All vascular parameters including CF-PWV, CR-PWV, CAVI, ABI, and CIMT were higher in males than females (all p<0.05). Multiple linear regression analysis showed that UA/100 was independently positively linearly correlated with CAVI (B=0.143, p=0.001) and negatively correlated with ABI in the male population (B=-0.012, p=0.020). In people with higher UA, the risk of higher CF-PWV was 1.593 (p<0.05). CONCLUSIONS 1. All vascular parameters were higher in males than females. There was no gender difference in the relationship between UA and vascular markers except in ABI. 2. UA was independently linearly correlated with CAVI. 3. In people with higher UA level, the risk of higher CF-PWV increased. Therefore, higher UA may influence the vascular function mainly instead of vascular structure.
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Affiliation(s)
- Huan Liu
- Department of Vascular Medicine, Peking University Shougang Hospital
| | - Jinbo Liu
- Department of Vascular Medicine, Peking University Shougang Hospital
| | - Hongwei Zhao
- Department of Vascular Medicine, Peking University Shougang Hospital
| | - Yingyan Zhou
- Department of Vascular Medicine, Peking University Shougang Hospital
| | - Lihong Li
- Department of Vascular Medicine, Peking University Shougang Hospital
| | - Hongyu Wang
- Department of Vascular Medicine, Peking University Shougang Hospital
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48
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Sharaf El Din UA, Salem MM, Abdulazim DO. Uric acid in the pathogenesis of metabolic, renal, and cardiovascular diseases: A review. J Adv Res 2017; 8:537-548. [PMID: 28748119 PMCID: PMC5512153 DOI: 10.1016/j.jare.2016.11.004] [Citation(s) in RCA: 212] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Revised: 11/26/2016] [Accepted: 11/27/2016] [Indexed: 02/07/2023] Open
Abstract
The association between uric acid (UA) on one side and systemic hypertension (Htn), dyslipidemia, glucose intolerance, overweight, fatty liver, renal disease and cardiovascular disease (CVD) on the other side is well recognized. However, the causal relationship between UA and these different clinical problems is still debatable. The recent years have witnessed hundreds of experimental and clinical trials that favored the opinion that UA is a probable player in the pathogenesis of these disease entities. These studies disclosed the strong association between hyperuricemia and metabolic syndrome (MS), obesity, Htn, type 2 diabetes mellitus (DM), non-alcoholic fatty liver disease, hypertriglyceridemia, acute kidney injury, chronic kidney disease (CKD), coronary heart disease (CHD), heart failure and increased mortality among cardiac and CKD patients. The association between UA and nephrolithiasis or preeclampsia is a non-debatable association. Recent experimental trials have disclosed different changes in enzyme activities induced by UA. Nitric oxide (NO) synthase, adenosine monophosphate kinase (AMPK), adenosine monophosphate dehydrogenase (AMPD), and nicotinamide adenine dinucleotide phosphate (NADPH)-oxidase are affected by UA. These changes in enzymatic activities can lead to the observed biochemical and pathological changes associated with UA. The recent experimental, clinical, interventional, and epidemiologic trials favor the concept of a causative role of UA in the pathogenesis of MS, renal, and CVDs.
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Affiliation(s)
- Usama A.A. Sharaf El Din
- Nephrology Unit, Internal Medicine Department, School of Medicine, Cairo University, Egypt
- Corresponding author. Fax: +20 222753890.
| | - Mona M. Salem
- Endocrinology Unit, Internal Medicine Department, School of Medicine, Cairo University, Egypt
| | - Dina O. Abdulazim
- Rheumatology and Rehabilitation Department, School of Medicine, Cairo University, Egypt
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刘 骏, 杜 瑞, 王 亮, 朱 兵, 骆 雷. [Relationship between blood pressure variability and combined cardiovascular events in 5-10 years in hypertensive patients]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2017; 37:919-923. [PMID: 28736368 PMCID: PMC6765515 DOI: 10.3969/j.issn.1673-4254.2017.07.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To explore the relationship between blood pressure variability (BPV) and combined cardiovascular events in 5-10 years in patients with hypertension. METHODS A total of 367 hypertensive patients treated in our hospital from January, 2000 to January, 2005 were analyzed, and their BPV was assessed in comparison with 145 normotensive individuals. The hypertensive patients were classified into high BPV group and low BPV group, and the general clinical data and biochemical profiles were compared. The relationship between BPV and combined cardiovascular events of the patients within 5-10 years were explored. RESULTS Compared with the normotensive individuals, the hypertensive patients showed significantly increased standard deviation and coefficient of variation of 24-h systolic blood pressure (SBP), 24-h diastolic blood pressrue (DBP), daytime SBP, daytime DBP, night-time SBP and night-time DBP (P<0.01). The percentages of drinking, smoking, diabetes and coronary heart disease were significantly higher in patients with high BPV than those with lower BPV (P<0.01 or 0.05); uric acid, homocysteine, urinary protein/creatinine ratio and urinary microalbumin increased more significantly in patients with high BPV (P<0.01 or 0.05). In addition, the combined cardiovascular events in 5-10 years were significantly higher in the patients with higher BPV than those with lower BPV (P<0.01 or 0.05). Logistic multivariate logistic regression analysis showed that alcohol, diabetes, coronary heart disease, uric acid and homocysteine were independent risk factors for cardiovascular events in hypertensive patients (P<0.01 or 0.05). CONCLUSION In hypertensive patients, BPV is closely correlated with the long-term combined cardiovascular events, and a high BPV is associated with a greater likeliness of combined cardiovascular events.
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Affiliation(s)
- 骏 刘
- 解放军医学院,北京 100853Medical School of Chinese PLA, Beijing 100853, China
- 广州军区广州总医院干部病房一科,广东 广州 510010Department of Gerontology, Guangzhou General Hospital of Guangzhou Command, Guangzhou 510010, China
| | - 瑞雪 杜
- 解放军总医院南楼临床部心血管二科,北京 100853Second Department of Geriatric Cardiology, General Hospital of PLA, Beijing 100853, China
| | - 亮 王
- 解放军总医院南楼临床部心血管二科,北京 100853Second Department of Geriatric Cardiology, General Hospital of PLA, Beijing 100853, China
| | - 兵 朱
- 解放军总医院南楼临床部心血管二科,北京 100853Second Department of Geriatric Cardiology, General Hospital of PLA, Beijing 100853, China
| | - 雷鸣 骆
- 解放军总医院南楼临床部心血管二科,北京 100853Second Department of Geriatric Cardiology, General Hospital of PLA, Beijing 100853, China
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50
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Spiga R, Marini MA, Mancuso E, Di Fatta C, Fuoco A, Perticone F, Andreozzi F, Mannino GC, Sesti G. Uric Acid Is Associated With Inflammatory Biomarkers and Induces Inflammation Via Activating the NF-κB Signaling Pathway in HepG2 Cells. Arterioscler Thromb Vasc Biol 2017; 37:1241-1249. [DOI: 10.1161/atvbaha.117.309128] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 04/03/2017] [Indexed: 12/28/2022]
Abstract
Objective—
Serum uric acid (UA) has been associated with increased risk of cardiovascular and metabolic diseases. However, the causal mechanisms linking elevated UA levels to cardio-metabolic diseases are still unsettled. One potential explanation for how UA might contribute to cardio-metabolic disease might be its ability to induce systemic inflammation.
Approach and Results—
Herein, we report a positive relationship between serum UA and acute-phase reactants, such as high-sensitivity C-reactive protein, fibrinogen, ferritin, complement C3, and erythrocyte sedimentation rate, in a cohort of 2731 nondiabetic adults. The relationship remains significant after adjustment for several confounders, including age, sex, adiposity, anti-hypertensive treatments or diuretics use. To confirm the existence of a causal relationship, we examined the effect of UA on the expression of inflammatory biomarkers in human hepatoma HepG2 cells and characterized the signaling pathway by which UA acts. We show that UA stimulates the expression of C-reactive protein, fibrinogen, ferritin, and complement C3 in a dose-dependent fashion. The proinflammatory effects of UA were abrogated by benzbromarone, a specific inhibitor of UA transporters. Exposure of cells to UA resulted in activation of the IκB kinase/IκBα/NF-κB signaling pathway that was attenuated by benzbromarone. The effect of UA was completely blocked by the antioxidant
N
-acetylcysteine.
Conclusions—
These in vivo and in vitro data suggest that hyperuricemia might induce the expression of hepatic inflammatory molecules by activating the proinflammatory NF-κB signaling cascade. Because inflammation has an important pathogenetic role in metabolic and cardiovascular disease, our study may help understanding the mechanism by which hyperuricemia may contribute to organ damage.
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Affiliation(s)
- Rosangela Spiga
- From the Department of Medical and Surgical Sciences, University Magna-Græcia of Catanzaro, Italy (R.S., E.M., C.D.F., A.F., F.P., F.A., G.C.M., G.S.); and Department of Systems Medicine, University of Rome Tor Vergata, Italy (M.A.M.)
| | - Maria Adelaide Marini
- From the Department of Medical and Surgical Sciences, University Magna-Græcia of Catanzaro, Italy (R.S., E.M., C.D.F., A.F., F.P., F.A., G.C.M., G.S.); and Department of Systems Medicine, University of Rome Tor Vergata, Italy (M.A.M.)
| | - Elettra Mancuso
- From the Department of Medical and Surgical Sciences, University Magna-Græcia of Catanzaro, Italy (R.S., E.M., C.D.F., A.F., F.P., F.A., G.C.M., G.S.); and Department of Systems Medicine, University of Rome Tor Vergata, Italy (M.A.M.)
| | - Concetta Di Fatta
- From the Department of Medical and Surgical Sciences, University Magna-Græcia of Catanzaro, Italy (R.S., E.M., C.D.F., A.F., F.P., F.A., G.C.M., G.S.); and Department of Systems Medicine, University of Rome Tor Vergata, Italy (M.A.M.)
| | - Anastasia Fuoco
- From the Department of Medical and Surgical Sciences, University Magna-Græcia of Catanzaro, Italy (R.S., E.M., C.D.F., A.F., F.P., F.A., G.C.M., G.S.); and Department of Systems Medicine, University of Rome Tor Vergata, Italy (M.A.M.)
| | - Francesco Perticone
- From the Department of Medical and Surgical Sciences, University Magna-Græcia of Catanzaro, Italy (R.S., E.M., C.D.F., A.F., F.P., F.A., G.C.M., G.S.); and Department of Systems Medicine, University of Rome Tor Vergata, Italy (M.A.M.)
| | - Francesco Andreozzi
- From the Department of Medical and Surgical Sciences, University Magna-Græcia of Catanzaro, Italy (R.S., E.M., C.D.F., A.F., F.P., F.A., G.C.M., G.S.); and Department of Systems Medicine, University of Rome Tor Vergata, Italy (M.A.M.)
| | - Gaia Chiara Mannino
- From the Department of Medical and Surgical Sciences, University Magna-Græcia of Catanzaro, Italy (R.S., E.M., C.D.F., A.F., F.P., F.A., G.C.M., G.S.); and Department of Systems Medicine, University of Rome Tor Vergata, Italy (M.A.M.)
| | - Giorgio Sesti
- From the Department of Medical and Surgical Sciences, University Magna-Græcia of Catanzaro, Italy (R.S., E.M., C.D.F., A.F., F.P., F.A., G.C.M., G.S.); and Department of Systems Medicine, University of Rome Tor Vergata, Italy (M.A.M.)
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