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Nie S, Zhao Y, Feng Z, Zou C, Ding F, Gong L, Lu H, Cao Y, Yang G. Effect of Ticagrelor versus Clopidogrel on All-Cause and Cardiovascular Mortality in Acute Coronary Syndrome Patients with Hyperuricemia. Clin Drug Investig 2024; 44:163-174. [PMID: 38326641 DOI: 10.1007/s40261-024-01342-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2024] [Indexed: 02/09/2024]
Abstract
BACKGROUND AND OBJECTIVE The relationship between hyperuricemia and mortality in patients with acute coronary syndrome (ACS) is considerably controversial. Additionally, the strategy of dual antiplatelet therapy (DAPT) has not been evaluated in patients with ACS with hyperuricemia. This study aims to evaluate the impact of hyperuricemia on the prognosis of ACS and explore the efficacy of ticagrelor compared with clopidogrel in patients with hyperuricemia. METHODS The study enrolled 4319 patients divided into hyperuricemia (HUA, n = 1060) and normouricemia (NUA, n = 3259) groups. The inverse probability of treatment weighting (IPTW)-adjusted Cox regression analysis was used to evaluate the impact of ticagrelor versus clopidogrel on all-cause and cardiovascular mortality. RESULTS Hyperuricemia significantly increased the risk of all-cause death compared with patients with NUA at 7 days [adjusted hazard ratio (HR): 4.292, 95% confidence interval (CI) 1.727-10.67]; P = 0.002), 14 days (adjusted HR: 2.871, 95% CI 1.326-6.219; P = 0.0074), 30 days (adjusted HR: 2.168, 95% CI 1.056-4.453; P = 0.035), 3 months (adjusted HR: 2.018, 95% CI 1.152-3.533; P = 0.0144) and 1 year (adjusted HR: 1.702, 95% CI 1.137-2.548; P = 0.009). No significant difference was found between ticagrelor and clopidogrel in 1-year all-cause mortality [7.0% versus 5.5%, adjusted HR: 1.114 (95% CI 0.609-2.037), P = 0.725] among patients with concomitant hyperuricemia. CONCLUSION Hyperuricemia was independently related to an increased risk of all-cause and cardiovascular death in patients with ACS undergoing PCI. At 1-year follow-up, there were no significant differences between ticagrelor and clopidogrel concerning all-cause and cardiovascular death in patients with hyperuricemia.
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Affiliation(s)
- Shanshan Nie
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, 410013, Hunan, China
- Department of Cardiovascular Disease, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, 450000, Henan, China
| | - Yuhang Zhao
- Department of Integrative Medicine, Hushan Hospital, Fudan Hospital, Shanghai, 200040, China
| | - Zeying Feng
- Xiangya School of Pharmaceutical Sciences, Central South University, Changsha, 410013, Hunan, China
| | - Chan Zou
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, 410013, Hunan, China
| | - Fangfang Ding
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, 410013, Hunan, China
| | - Liying Gong
- Department of Intensive Care Unit, The Third Xiangya Hospital, Central South University, Changsha, 410013, Hunan, China
| | - Hongwei Lu
- Center for Experimental Medicine, The Third Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Yu Cao
- Department of Cardiology, Central South University, The Third Xiangya Hospital, Changsha, 410013, Hunan, China.
| | - Guoping Yang
- Center of Clinical Pharmacology, The Third Xiangya Hospital, Central South University, Changsha, 410013, Hunan, China.
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Yang B, Ma K, Xiang R, Yang G, Luo Y, Wu F, Mao M. Uric acid and evaluate the coronary vascular stenosis gensini score correlation research and in gender differences. BMC Cardiovasc Disord 2023; 23:546. [PMID: 37940848 PMCID: PMC10634079 DOI: 10.1186/s12872-023-03581-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 10/26/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND AND AIMS Recent studies have shown that the negative effect of uric acid (UA) on coronary arteries determines the severity of atherosclerotic disease. This study aims to explore the relationship between serum UA level and Gensini score, which reflects the severity of coronary artery disease. METHODS A total of 860 patients with suspected coronary heart disease who were admitted to hospital due to angina pectoris or myocardial ischemia related symptoms and received coronary angiography were selected. Based on the findings of the angiography, they were categorized into two groups: the coronary heart disease (CHD) group (n = 625) and the control group (n = 235). The uric acid levels and other clinical data were compared between these groups. Additionally, the prevalence of coronary heart disease and Gensini score were compared between the groups, considering gender-specific quartiles of uric acid levels. The clinical baseline data were analyzed using appropriate statistical methods, and multivariate logistic regression analysis was conducted to identify independent risk factors for coronary heart disease. RESULTS Of 860 patients (mean age, 63.97 ± 11.87 years), 528 were men (mean age, 62.06 ± 11.5 years) and 332 were women (mean age, 66.99 ± 10.11 years). The proportion of smoking, diabetes, hypertension, and hyperlipidemia in the coronary heart disease group was higher than that in the control group (P < 0.05). HbA1C, Gensini score, BMI, TG and hsCRP in the coronary heart disease group were higher than those in the control group (P < 0.05), and HDL-C was lower than that in the control group (P < 0.05). There were no significant differences in age, heart rate, Cr, TC and LDL-C between the two groups (P > 0.05).Multivariate logistic regression analysis showed that age, hypertension, hsCRP and SUA levels increased the risk of coronary heart disease, and the difference was statistically significant(OR = 1.034,95%CI 1.016-1.052, P = 0.001; OR = 1.469,95%CI 1.007-2.142, P = 0.046;OR = 1.064,95%CI 1.026-1.105, P = 0.001; OR = 1.011,95%CI 1.008-1.014, P < 0.001). CONCLUSION Serum uric acid is positively correlated with Gensini score in patients with coronary heart disease, which is an independent factor for evaluating the degree of coronary artery stenosis and has a predictive effect.
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Affiliation(s)
- Bao Yang
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Yuzhong, Chongqing, 400010, China
| | - Kanghua Ma
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Yuzhong, Chongqing, 400010, China
| | - Rui Xiang
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Yuzhong, Chongqing, 400010, China
| | - Guoli Yang
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Yuzhong, Chongqing, 400010, China
| | - Yue Luo
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Yuzhong, Chongqing, 400010, China
| | - Fan Wu
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Yuzhong, Chongqing, 400010, China
| | - Min Mao
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Yuzhong, Chongqing, 400010, China.
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Georgoulis M, Mikhailidis DP, Panagiotakos DB. Are serum uric acid levels predictors of cardiovascular risk? An update. Curr Opin Cardiol 2023; 38:337-343. [PMID: 36789778 DOI: 10.1097/hco.0000000000001029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
PURPOSE OF REVIEW The aim of this review was to update the evidence regarding the link between serum uric acid and cardiovascular risk, as well as the role of nutrition in the prevention and management of hyperuricaemia. RECENT FINDINGS The review focuses on recent epidemiological evidence concerning the role of elevated serum uric acid levels in cardiovascular risk prediction. The dietary prevention and management of hyperuricaemia is also discussed with an emphasis on the adoption of prudent dietary patterns. SUMMARY There is evidence supporting that elevated serum uric acid levels are positively associated with cardiovascular disease risk and might represent a useful additional marker for risk stratification. The association of serum uric acid with all-cause and cardiovascular mortality seems to be U-shaped, suggesting that both very low and very high serum uric acid levels might be detrimental for survival, the former being mediated by malnutrition. Apart from medication, the dietary management of hyperuricaemia should focus on the adoption of a prudent dietary pattern, such as the Mediterranean diet, which can both prevent gout and mitigate cardiometabolic risk.
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Affiliation(s)
- Michael Georgoulis
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Athens, Greece
| | - Dimitri P Mikhailidis
- Department of Clinical Biochemistry and Department Surgical Biotechnology, Division of Surgery and Interventional Science, Medical School, University College London (UCL), London, UK
| | - Demosthenes B Panagiotakos
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Athens, Greece
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Alunno A, Carubbi F, Mariani FM, Martini C, Campanozzi E, Ferri C. The Interplay between Cardiovascular Risk, Cardiovascular Events, and Disease Activity in Primary Sjögren's Syndrome: Is Uric Acid the Missing Link? Nutrients 2023; 15:nu15071563. [PMID: 37049403 PMCID: PMC10096655 DOI: 10.3390/nu15071563] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/18/2023] [Accepted: 03/22/2023] [Indexed: 04/14/2023] Open
Abstract
(1) Background: Uric acid is a well-known cardiovascular (CV) risk factor in the general population but its role in the setting of rheumatic diseases other than gout is unclear. (2) Methods: This is a retrospective study investigating a cohort of 105 pSS patients recording clinical, serological, and CV-related variables including adherence to the Mediterranean diet. (3) Results: We observed a strong relationship between disease activity, interstitial lung disease (ILD), and CV events. The association between ILD and CV events was dependent on higher SUA levels but independent of other traditional CV risk factors. All three cases of previous non-fatal stroke were reported by females aged <65 years, with higher SUA levels, and two of them also had pSS-ILD. Forty (38%) patients had a 10-year risk of fatal and non-fatal CV disease events beyond the cut-off recommended for their age, and using the correction factor of 1.5 currently applied only to rheumatoid arthritis, we could better identify patient subsets characterized by different CV risk profiles including different SUA levels. (4) Conclusions: This study is the first to investigate in depth the role of SUA in the CV scenario of pSS. Our findings underpin the importance of assessing SUA levels in pSS in addition to the other traditional CV risk factors and to consider applying the correction factor for CV risk assessment tools to achieve a better stratification of CV risk.
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Affiliation(s)
- Alessia Alunno
- Internal Medicine and Nephrology Division, Department of Life, Health & Environmental Sciences, San Salvatore Hospital, University of L'Aquila, ASL 1 Avezzano-Sulmona-L'Aquila, 67100 L'Aquila, Italy
| | - Francesco Carubbi
- Internal Medicine and Nephrology Division, Department of Life, Health & Environmental Sciences, San Salvatore Hospital, University of L'Aquila, ASL 1 Avezzano-Sulmona-L'Aquila, 67100 L'Aquila, Italy
| | - Francesco Maria Mariani
- Internal Medicine and Nephrology Division, Department of Life, Health & Environmental Sciences, San Salvatore Hospital, University of L'Aquila, ASL 1 Avezzano-Sulmona-L'Aquila, 67100 L'Aquila, Italy
| | - Cecilia Martini
- Internal Medicine and Nephrology Division, Department of Life, Health & Environmental Sciences, San Salvatore Hospital, University of L'Aquila, ASL 1 Avezzano-Sulmona-L'Aquila, 67100 L'Aquila, Italy
| | - Elena Campanozzi
- Internal Medicine and Nephrology Division, Department of Life, Health & Environmental Sciences, San Salvatore Hospital, University of L'Aquila, ASL 1 Avezzano-Sulmona-L'Aquila, 67100 L'Aquila, Italy
| | - Claudio Ferri
- Internal Medicine and Nephrology Division, Department of Life, Health & Environmental Sciences, San Salvatore Hospital, University of L'Aquila, ASL 1 Avezzano-Sulmona-L'Aquila, 67100 L'Aquila, Italy
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Khameneh Bagheri R, Najafi MN, Ahmadi M, Saberi M, Maleki M, Baradaran Rahimi V. Investigation of the association between serum uric acid levels and HEART risk score in patients with acute coronary syndrome. Physiol Rep 2022; 10:e15513. [PMID: 36394077 PMCID: PMC9669611 DOI: 10.14814/phy2.15513] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 10/23/2022] [Accepted: 10/26/2022] [Indexed: 06/16/2023] Open
Abstract
The association between uric acid (UA) and cardio-metabolic conditions has been recognized for a long time. However, recently, a body of evidence has highlighted the independent role of UA in a series of conditions, including renal and cardiovascular diseases. In this light, data regarding the prognostic role of UA in acute coronary syndrome (ACS) is scarce. A total number of 100 patients, 59 males and 41 females, diagnosed with ACS were recruited in this study. At the time of admission to the hospital, the serum level of UA was measured. In addition, the HEART score was calculated based on each patients' profile. Participants were on average 61.37 ± 12.08 years old. The most prevalent risk factors were hypertension (48%), a history of coronary artery disease (40%), and diabetes mellitus (33%). The average serum level of UA was 5.81 ± 1.81 mg/dl, and the calculated HEART score had a median of six (minimum of two and maximum of ten). A positive yet statistically insignificant correlation was found between the measured UA level and the calculated HEART score (R = 0.375, p = 0.090). However, further studies with larger sample size are required to assess the direct association of UA level with major adverse cardiac events in patients with cardiovascular disease.
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Affiliation(s)
- Ramin Khameneh Bagheri
- Department of Cardiovascular Diseases, Faculty of MedicineMashhad University of Medical SciencesMashhadIran
| | - Mona Najaf Najafi
- Clinical Research Center, Imam Reza Hospital, Faculty of MedicineMashhad University of Medical SciencesMashhadIran
| | - Mostafa Ahmadi
- Department of Cardiovascular Diseases, Faculty of MedicineMashhad University of Medical SciencesMashhadIran
| | - Mohsen Saberi
- Department of Cardiovascular Diseases, Faculty of MedicineMashhad University of Medical SciencesMashhadIran
| | - Mina Maleki
- Department of Cardiovascular Diseases, Faculty of MedicineMashhad University of Medical SciencesMashhadIran
| | - Vafa Baradaran Rahimi
- Department of Cardiovascular Diseases, Faculty of MedicineMashhad University of Medical SciencesMashhadIran
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Foote CA, Soares RN, Ramirez-Perez FI, Ghiarone T, Aroor A, Manrique-Acevedo C, Padilla J, Martinez-Lemus LA. Endothelial Glycocalyx. Compr Physiol 2022; 12:3781-3811. [PMID: 35997082 PMCID: PMC10214841 DOI: 10.1002/cphy.c210029] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
The glycocalyx is a polysaccharide structure that protrudes from the body of a cell. It is primarily conformed of glycoproteins and proteoglycans, which provide communication, electrostatic charge, ionic buffering, permeability, and mechanosensation-mechanotransduction capabilities to cells. In blood vessels, the endothelial glycocalyx that projects into the vascular lumen separates the vascular wall from the circulating blood. Such a physical location allows a number of its components, including sialic acid, glypican-1, heparan sulfate, and hyaluronan, to participate in the mechanosensation-mechanotransduction of blood flow-dependent shear stress, which results in the synthesis of nitric oxide and flow-mediated vasodilation. The endothelial glycocalyx also participates in the regulation of vascular permeability and the modulation of inflammatory responses, including the processes of leukocyte rolling and extravasation. Its structural architecture and negative charge work to prevent macromolecules greater than approximately 70 kDa and cationic molecules from binding and flowing out of the vasculature. This also prevents the extravasation of pathogens such as bacteria and virus, as well as that of tumor cells. Due to its constant exposure to shear and circulating enzymes such as neuraminidase, heparanase, hyaluronidase, and matrix metalloproteinases, the endothelial glycocalyx is in a continuous process of degradation and renovation. A balance favoring degradation is associated with a variety of pathologies including atherosclerosis, hypertension, vascular aging, metastatic cancer, and diabetic vasculopathies. Consequently, ongoing research efforts are focused on deciphering the mechanisms that promote glycocalyx degradation or limit its syntheses, as well as on therapeutic approaches to improve glycocalyx integrity with the goal of reducing vascular disease. © 2022 American Physiological Society. Compr Physiol 12: 1-31, 2022.
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Affiliation(s)
- Christopher A. Foote
- Dalton Cardiovascular Research Center, University of Missouri, Columbia, MO, USA
- Department of Medical Pharmacology and Physiology, University of Missouri, Columbia, MO, USA
| | - Rogerio N. Soares
- Dalton Cardiovascular Research Center, University of Missouri, Columbia, MO, USA
| | | | - Thaysa Ghiarone
- Dalton Cardiovascular Research Center, University of Missouri, Columbia, MO, USA
| | - Annayya Aroor
- Department of Medicine, University of Missouri, Columbia, MO, USA
- Harry S. Truman Memorial Veterans’ Hospital, Columbia, MO, USA
| | - Camila Manrique-Acevedo
- Dalton Cardiovascular Research Center, University of Missouri, Columbia, MO, USA
- Department of Medicine, University of Missouri, Columbia, MO, USA
- Harry S. Truman Memorial Veterans’ Hospital, Columbia, MO, USA
| | - Jaume Padilla
- Dalton Cardiovascular Research Center, University of Missouri, Columbia, MO, USA
- Department of Nutrition and Exercise Physiology, University of Missouri, Columbia, MO, USA
| | - Luis A. Martinez-Lemus
- Dalton Cardiovascular Research Center, University of Missouri, Columbia, MO, USA
- Department of Medical Pharmacology and Physiology, University of Missouri, Columbia, MO, USA
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Preyer O, Concin H, Nagel G, Zitt E, Ulmer H, Brozek W. Serum uric acid is associated with incident hip fractures in women and men - Results from a large Austrian population-based cohort study. Maturitas 2021; 148:46-53. [PMID: 33836935 DOI: 10.1016/j.maturitas.2021.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 01/22/2021] [Accepted: 03/03/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Serum markers that can be used to estimate the risk of bone fractures are rare, and findings for one candidate marker, uric acid, are heterogeneous. Our aim was to investigate the potential of serum uric acid (SUA) to predict hip fractures occurring in people aged 50 years and over. STUDY DESIGN During a medical prevention program over the period 1985-2005 in Vorarlberg, baseline data were collected on SUA levels and covariates (age, BMI, blood pressure, smoking status, diabetes, triglycerides and cholesterol) from 185,397 individuals, of whom 42,488 women and 35,908 men met the inclusion criteria of this population-based cohort study. Information on incident cancer and end-stage kidney disease was acquired from registries. MAIN OUTCOME MEASURE Incident hip fracture occurring in participants aged 50 years and over during the observation period 2003-2013. RESULTS SUA was associated with a rise in female hip fracture risk by 6% per unit increase (HR 1.06, 95 %-CI 1.01-1.10), and risk in the highest vs. lowest SUA quartile was significantly increased (HR 1.17, 95 %-CI 1.01-1.35), but not at hyperuricemic (>5.7 mg/dl) vs. normouricemic (≤5.7 mg/dl) levels. In men, hip fracture risk rose by 15 % per unit increase (HR 1.15, 95 %-CI 1.08-1.22), and risk was significantly higher in the highest vs. lowest SUA quartile (HR 1.50, 95 %-CI 1.17-1.91) as well as at hyperuricemic (>7.0 mg/dl) vs. normouricemic (≤7.0 mg/dl) levels (HR 1.48, 95 %-CI 1.19-1.84). CONCLUSIONS Our results link SUA with increased risk of hip fractures, particularly in men.
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Affiliation(s)
- Oliver Preyer
- Agency for Preventive and Social Medicine, Bregenz, Austria
| | - Hans Concin
- Agency for Preventive and Social Medicine, Bregenz, Austria
| | - Gabriele Nagel
- Agency for Preventive and Social Medicine, Bregenz, Austria; Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Emanuel Zitt
- Agency for Preventive and Social Medicine, Bregenz, Austria; Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Academic Teaching Hospital Feldkirch, Feldkirch, Austria; Department of Nephrology and Dialysis, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Hanno Ulmer
- Agency for Preventive and Social Medicine, Bregenz, Austria; Department of Medical Statistics, Informatics and Health Economics, Innsbruck Medical University, Innsbruck, Austria
| | - Wolfgang Brozek
- Agency for Preventive and Social Medicine, Bregenz, Austria.
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Centola M, Maloberti A, Castini D, Persampieri S, Sabatelli L, Ferrante G, Lucreziotti S, Morici N, Sacco A, Oliva F, Rebora P, Giannattasio C, Mafrici A, Carugo S. Impact of admission serum acid uric levels on in-hospital outcomes in patients with acute coronary syndrome. Eur J Intern Med 2020; 82:62-67. [PMID: 32709548 DOI: 10.1016/j.ejim.2020.07.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/03/2020] [Accepted: 07/15/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND To assess the association between admission serum uric acid (SUA) levels and in-hospital outcomes in a real-world patients population with acute coronary syndrome (ACS) and to investigate the potential incremental prognostic value of SUA added to GRACE score (GRACE-SUA score). METHODS The data of consecutive ACS patients admitted to Coronary Care Unit of San Paolo and Niguarda hospitals in Milan (Italy) were retrospectively analyzed. RESULTS 1088 patients (24% female) were enrolled. Mean age was 68 years (IQR 60-78). STEMI and NSTE-ACS patients were 504 (46%) and 584 (54%) respectively. SUA (OR 1.72 95%CI 1.33-2.22, p < 0.0001) and GRACE score (OR 1.04 95%CI 1.02-1.06, p < 0.0001) were significantly associated with an increased risk of in-hospital death at the multivariate analysis. Admission values of SUA were stratified in four quartiles. Rates of acute kidney injury, implantation of intra-aortic balloon pump and non-invasive ventilation use were significantly higher in the last quartile compared to Q1, Q2 and Q3 (p < 0.01). The areas under the ROC curve (AUC) for GRACE score and for SUA were 0.91 (95% CI 0.89-0.93, p < 0.0001) and 0.79 (95% CI 0.76-0.81, p < 0.0001) respectively. The AUC was larger for predicting in-hospital mortality with the GRACE-SUA score (0.94; 95% CI 0.93-0.95). CONCLUSIONS High admission levels of SUA are independently associated with in-hospital adverse outcomes and mortality in a contemporary population of ACS patients. The inclusion of SUA to GRACE risk score seems to lead to a more accurate prediction of in-hospital mortality in this study population.
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Affiliation(s)
- Marco Centola
- Division of Cardiology, ASST Santi Paolo Carlo, Department of Cardio-Respiratory Disease, University of Milan, Milan, Italy.
| | - Alessandro Maloberti
- Cardiology IV, ASST GOM Niguarda, Milan, Italy; School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Diego Castini
- Division of Cardiology, ASST Santi Paolo Carlo, Department of Cardio-Respiratory Disease, University of Milan, Milan, Italy
| | - Simone Persampieri
- Division of Cardiology, ASST Santi Paolo Carlo, Department of Cardio-Respiratory Disease, University of Milan, Milan, Italy
| | - Ludovico Sabatelli
- Division of Cardiology, ASST Santi Paolo Carlo, Department of Cardio-Respiratory Disease, University of Milan, Milan, Italy
| | - Giulia Ferrante
- Division of Cardiology, ASST Santi Paolo Carlo, Department of Cardio-Respiratory Disease, University of Milan, Milan, Italy
| | - Stefano Lucreziotti
- Division of Cardiology, ASST Santi Paolo Carlo, Department of Cardio-Respiratory Disease, University of Milan, Milan, Italy
| | | | - Alice Sacco
- Cardiology I, ASST GOM Niguarda, Milan, Italy
| | | | - Paola Rebora
- Center of Biostatistics for Clinical Epidemiology, School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Cristina Giannattasio
- Cardiology IV, ASST GOM Niguarda, Milan, Italy; School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Antonio Mafrici
- Division of Cardiology, ASST Santi Paolo Carlo, Department of Cardio-Respiratory Disease, University of Milan, Milan, Italy
| | - Stefano Carugo
- Division of Cardiology, ASST Santi Paolo Carlo, Department of Cardio-Respiratory Disease, University of Milan, Milan, Italy
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Jung JH, Chung SJ, Yoo HS, Lee YH, Baik K, Ye BS, Sohn YH, Lee PH. Sex-specific association of urate and levodopa-induced dyskinesia in Parkinson's disease. Eur J Neurol 2020; 27:1948-1956. [PMID: 32441832 DOI: 10.1111/ene.14337] [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] [Received: 04/24/2020] [Accepted: 05/14/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE As a major antioxidant, uric acid (UA) is known to be associated with the clinical progression of Parkinson's disease (PD). This study investigated whether baseline UA levels are associated with the risk for levodopa-induced dyskinesia (LID) in PD in a sex-dependent manner. METHODS In all, 152 patients with de novo PD (78 males and 74 females) who were followed up for >2 years were enrolled. The effect of baseline serum UA levels on LID-free survival was assessed by Cox regression, separately for sex, whilst being adjusted for potential confounding factors. The optimal UA level cut-off value to determine the high-risk group for LID was set using Contal and O'Quigley's method. RESULTS Levodopa-induced dyskinesia developed in 23 (29.5%) male patients and 30 (40.5%) female patients. Cox regression showed a significant interaction between UA level and sex. Higher UA levels were associated with a higher risk for LID in male PD patients (hazard ratio 1.380; 95% confidence interval 1.038-1.835; P = 0.027), although this relationship was not observed in female PD patients. The optimal UA level cut-off for LID in male PD was 7.2 mg/dl, and the high UA group had a 5.7-fold higher risk of developing LID than the low UA group. CONCLUSIONS Contrary to a presumptive beneficial role of UA, the present study demonstrated that higher UA levels are associated with increased risk of LID occurrence in male patients with PD, suggesting a sex-dependent role of UA in LID.
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Affiliation(s)
- J H Jung
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - S J Chung
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.,Department of Neurology, Yongin Severance Hospital, Yonsei University Health System, Yongin, South Korea
| | - H S Yoo
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Y H Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - K Baik
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - B S Ye
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Y H Sohn
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - P H Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.,Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, South Korea
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Hyperuricemia and Hypertension, Coronary Artery Disease, Kidney Disease: From Concept to Practice. Int J Mol Sci 2020; 21:ijms21114066. [PMID: 33561034 PMCID: PMC7312288 DOI: 10.3390/ijms21114066] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/12/2020] [Accepted: 05/18/2020] [Indexed: 02/07/2023] Open
Abstract
Since the publication of the Framingham Heart Study, which suggested that uric acid should no longer be associated with coronary heart disease after additional adjustment for cardiovascular disease risk factors, the number of publications challenging this statement has dramatically increased. The aim of this paper was to review and discuss the most recent studies addressing the possible relation between sustained elevated serum uric acid levels and the onset or worsening of cardiovascular and renal diseases. Original studies involving American teenagers clearly showed that serum uric acid levels were directly correlated with systolic and diastolic pressures, which has been confirmed in adult cohorts revealing a 2.21-fold increased risk of hypertension. Several studies involving patients with coronary artery disease support a role for serum uric acid level as a marker and/or predictor for future cardiovascular mortality and long-term adverse events in patients with coronary artery disease. Retrospective analyses have shown an inverse relationship between serum uric acid levels and renal function, and even a mild hyperuricemia has been shown to be associated with chronic kidney disease in patients with type 2 diabetes. Interventional studies, although of small size, showed that uric acid (UA)-lowering therapies induced a reduction of blood pressure in teenagers and a protective effect on renal function. Taken together, these studies support a role for high serum uric acid levels (>6 mg/dL or 60 mg/L) in hypertension-associated morbidities and should bring awareness to physicians with regards to patients with chronic hyperuricemia.
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Gamala M, Jacobs JWG. Gout and hyperuricaemia: a worldwide health issue of joints and beyond. Rheumatology (Oxford) 2020; 58:2083-2085. [PMID: 31298293 DOI: 10.1093/rheumatology/kez272] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 06/04/2019] [Indexed: 12/11/2022] Open
Affiliation(s)
- Mihaela Gamala
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Rheumatology, Northwest Clinics, Alkmaar and Den Helder, The Netherlands
| | - Johannes W G Jacobs
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
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Virdis A, Masi S, Casiglia E, Tikhonoff V, Cicero AFG, Ungar A, Rivasi G, Salvetti M, Barbagallo CM, Bombelli M, Dell'Oro R, Bruno B, Lippa L, D'Elia L, Verdecchia P, Mallamaci F, Cirillo M, Rattazzi M, Cirillo P, Gesualdo L, Mazza A, Giannattasio C, Maloberti A, Volpe M, Tocci G, Georgiopoulos G, Iaccarino G, Nazzaro P, Parati G, Palatini P, Galletti F, Ferri C, Desideri G, Viazzi F, Pontremoli R, Muiesan ML, Grassi G, Borghi C. Identification of the Uric Acid Thresholds Predicting an Increased Total and Cardiovascular Mortality Over 20 Years. Hypertension 2019; 75:302-308. [PMID: 31813345 DOI: 10.1161/hypertensionaha.119.13643] [Citation(s) in RCA: 163] [Impact Index Per Article: 32.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Serum uric acid (SUA) levels discriminating across the different strata of cardiovascular risk is still unknown. By utilizing a large population-based database, we assessed the threshold of SUA that increases the risk of total mortality and cardiovascular mortality (CVM). The URRAH study (Uric Acid Right for Heart Health) is a multicentre retrospective, observational study, which collected data from several large population-based longitudinal studies in Italy and subjects recruited in the hypertension clinics of the Italian Society of Hypertension. Total mortality was defined as mortality for any cause, CVM as death due to fatal myocardial infarction, stroke, sudden cardiac death, or heart failure. A total of 22 714 subjects were included in the analysis. Multivariate Cox regression analyses identified an independent association between SUA and total mortality (hazard ratio, 1.53 [95% CI, 1.21-1.93]) or CVM (hazard ratio, 2.08 [95% CI, 1.146-2.97]; P<0.001). Cutoff values of SUA able to discriminate total mortality (4.7 mg/dL [95% CI, 4.3-5.1 mg/dL]) and CVM status (5.6 mg/dL [95% CI, 4.99-6.21 mg/dL]) were identified. The information on SUA levels provided a significant net reclassification improvement of 0.26 and of 0.27 over the Heart Score risk chart for total mortality and CVM, respectively (P<0.001). Sex-specific cutoff values for total mortality and CVM were also identified and validated. In conclusion, SUA levels increasing the risk of total mortality and CVM are significantly lower than those used for the definition of hyperuricemia in clinical practice. Our data provide evidence of a cardiovascular SUA threshold that might contribute in clinical practice to improve identification of patients at higher risk of CVM.
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Affiliation(s)
- Agostino Virdis
- From the Department of Clinical and Experimental Medicine, University of Pisa, Italy (A.V., S.M.)
| | - Stefano Masi
- From the Department of Clinical and Experimental Medicine, University of Pisa, Italy (A.V., S.M.)
| | - Edoardo Casiglia
- Studium Patavinum, Department of Medicine (E.C., P.P.), University of Padua, Italy
| | | | - Arrigo F G Cicero
- Department of Medical and Surgical Science, Alma Mater Studiorum University of Bologna, Italy (C.B., A.F.G.C.)
| | - Andrea Ungar
- Department of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Italy (A.U., G.R.)
| | - Giulia Rivasi
- Department of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Italy (A.U., G.R.)
| | - Massimo Salvetti
- Department of Clinical and Experimental Sciences, University of Brescia, Italy (M.L.M., M.S.)
| | - Carlo M Barbagallo
- Biomedical Department of Internal Medicine and Specialistics, University of Palermo, Italy (C.M.B.)
| | - Michele Bombelli
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy (M.B., R.D., G. Grassi)
| | - Raffaella Dell'Oro
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy (M.B., R.D., G. Grassi)
| | - Berardino Bruno
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Italy (B.B., C.F., G.D.)
| | - Luciano Lippa
- Italian Society of General Medicine, Avezzano, L'Aquila, Italy (L.L.)
| | - Lanfranco D'Elia
- Department of Clinical Medicine and Surgery (F.G., L.D.), Federico II University of Naples Medical School, Italy
| | | | - Francesca Mallamaci
- CNR-IFC, Clinical Epidemiology of Renal Diseases and Hypertension, Reggio Cal Unit, Reggio Calabria, Italy (F.M.)
| | - Massimo Cirillo
- Department of Public Health (M.C.), Federico II University of Naples Medical School, Italy
| | - Marcello Rattazzi
- Department of Medicine, Medicina Interna 1°, Ca' Foncello University Hospital, University of Padova, Treviso, Italy (M.R.)
| | - Pietro Cirillo
- Department of Emergency and Organ Transplantation-Nephrology, Dialysis and Transplantation Unit, Aldo Moro University of Bari, Italy (P.C., L.G.)
| | - Loreto Gesualdo
- Department of Emergency and Organ Transplantation-Nephrology, Dialysis and Transplantation Unit, Aldo Moro University of Bari, Italy (P.C., L.G.)
| | - Alberto Mazza
- Department of Internal Medicine, Hypertension Unit, General Hospital, Rovigo, Italy (A.M.)
| | - Cristina Giannattasio
- Cardiology IV, A. De Gasperis Department, Niguarda Ca' Granda Hospital, Health Science Department, Milano-Bicocca University, Italy (C.G., A.M.)
| | - Alessandro Maloberti
- Cardiology IV, A. De Gasperis Department, Niguarda Ca' Granda Hospital, Health Science Department, Milano-Bicocca University, Italy (C.G., A.M.)
| | - Massimo Volpe
- Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome Sapienza, Sant'Andrea Hospital, Italy (M.V., G.T.).,IRCCS Neuromed, Pozzilli (IS), Italy (M.V., G.T.)
| | - Giuliano Tocci
- Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome Sapienza, Sant'Andrea Hospital, Italy (M.V., G.T.).,IRCCS Neuromed, Pozzilli (IS), Italy (M.V., G.T.)
| | - Georgios Georgiopoulos
- First Department of Cardiology, Hippokration Hospital, University of Athens, Medical School, Greece (G. Georgiopoulos)
| | - Guido Iaccarino
- Department of Advanced Biomedical Sciences (G.I.), Federico II University of Naples Medical School, Italy
| | - Pietro Nazzaro
- Department of Medical Basic Sciences, Neurosciences and Sense Organs, University of Bari Medical School, Italy (P.N.)
| | - Gianfranco Parati
- Department of Cardiovascular, Neural and Metabolic Sciences, S. Luca Hospital, Istituto Auxologico Italiano and University of Milan-Bicocca, Italy (G.P.)
| | - Paolo Palatini
- Studium Patavinum, Department of Medicine (E.C., P.P.), University of Padua, Italy
| | - Ferruccio Galletti
- Department of Clinical Medicine and Surgery (F.G., L.D.), Federico II University of Naples Medical School, Italy
| | - Claudio Ferri
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Italy (B.B., C.F., G.D.)
| | - Giovambattista Desideri
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Italy (B.B., C.F., G.D.)
| | - Francesca Viazzi
- Department of Internal Medicine, University of Genoa and Policlinico San Martino, Genova, Italy (R.P., F.V.)
| | - Roberto Pontremoli
- Department of Internal Medicine, University of Genoa and Policlinico San Martino, Genova, Italy (R.P., F.V.)
| | - Maria Lorenza Muiesan
- Department of Clinical and Experimental Sciences, University of Brescia, Italy (M.L.M., M.S.)
| | - Guido Grassi
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy (M.B., R.D., G. Grassi)
| | - Claudio Borghi
- Department of Medical and Surgical Science, Alma Mater Studiorum University of Bologna, Italy (C.B., A.F.G.C.)
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Mayburd AL, Baranova A. Increased lifespan, decreased mortality, and delayed cognitive decline in osteoarthritis. Sci Rep 2019; 9:18639. [PMID: 31819096 PMCID: PMC6901554 DOI: 10.1038/s41598-019-54867-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 11/13/2019] [Indexed: 12/19/2022] Open
Abstract
In absence of therapies targeting symptomatic dementia, better understanding of the biology underlying a cognitive decline is warranted. Here we present the results of a meta-analysis of the impact of osteoarthritis (OA) on cognitive decline and overall mortality. Across 7 independent datasets obtained in studies of populations in the USA, EU and Australia (NBER, NSHAP, TILDA, NACC, Kaiser Permanente, GRIM BOOKS, OAI, with a total of >7 × 107 profiles), OA cohorts demonstrated higher cognitive scores, later dementia onset as well as longer lifespan and lower age-specific all-cause mortality. Moreover, generalized OA with multiple localizations is associated with more significant reduction of mortality and dementia than a singly localized OA or no arthritis. In OA patients with younger ages, all-cause mortality was disproportionally reduced as compared to that in controls, while exponential term of Gompert'z hazard function was increased, accelerating mortality accrual at later ages. Up to 8-10% of poly-osteoarthritic patients are predicted and observed to reach centenarian lifespan, while in matched non-OA population the same benchmark is reached by less than 1% of patients. These results point at a possibility of life-extending and cognition preserving impacts of OA-conditioned immune system.
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Affiliation(s)
- Anatoly L. Mayburd
- George Mason University, School of Systems Biology, Manassas, VA 22030 USA
- Neurocombinatorix, 5902 Mount Eagle Dr, Suite 1103, Alexandria, VA 22303 USA
| | - Ancha Baranova
- George Mason University, School of Systems Biology, Manassas, VA 22030 USA
- Research Centre for Medical Genetics, Moskvorechie str., 1, Moscow, Russia
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Risk of Acute Myocardial Infarction Among New Users of Allopurinol According to Serum Urate Level: A Nested Case-Control Study. J Clin Med 2019; 8:jcm8122150. [PMID: 31817395 PMCID: PMC6947524 DOI: 10.3390/jcm8122150] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 12/03/2019] [Indexed: 12/22/2022] Open
Abstract
Objectives: To test the hypothesis that allopurinol reduces the risk of acute myocardial infarction (AMI) in hyperuricemic patients and to assess whether the effect is dependent on dose, duration and serum uric acid (SUA) level attained after treatment. Methods: Nested case-control study over the period 2002–2015. From a cohort of patients aged 40–99 years old, we identified incident AMI cases and randomly selected five controls per case, matched for exact age, sex and index date. Adjusted odds ratios (AOR) and 95% CI were computed through unconditional logistic regression. Only new users of allopurinol were considered. Results: A total of 4697 AMI cases and 18,919 controls were included. Allopurinol use was associated with a reduced risk of AMI mainly driven by duration of treatment (AOR ≥180 days = 0.71; 95% CI: 0.60–0.84). Among long-term users (≥180 days), the reduced risk was only observed when the SUA level attained was below 7 mg/dL (AOR<6 mg/dL = 0.64; 95% CI: 0.49–0.82; AOR6–7mg/dL = 0.64; 95%CI:0.48-0.84); AOR>7mg/dL = 1.04; 95% CI: 0.75–1.46; p for trend = 0.001). A dose-effect was observed but faded out once adjusted for the SUA level attained. The reduced risk of AMI occurred in both patients with gout and patients with asymptomatic hyperuricemia. Conclusions: The results confirm a cardioprotective effect of allopurinol which is strongly dependent on duration and SUA level attained after treatment.
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