Regular physical activity prevents development of hypertension in young people with hyperuricemia

Exercise serum regulates uric acid transporters in normal rat kidney cells

Hyperuricemia (HUA) refers to a physiological condition of high serum uric acid (SUA) level in the body, which may cause an increased risk of several chronic diseases. The kidney's impaired uric acid (UA) metabolism is an important reason for HUA. In this study, we tested the hypothesis that circulating factors produced during exercise regulate the expression of ABCC4, ABCG2, URAT1, and GLUT9 in normal rat kidneys and normal rat kidney cells (NRK-52E) and their relationship with NF-κB and NRF-2. NRK-52E cells were separately cultured by serum from 10 healthy SD rats who did not exercise (CON) and 10 healthy SD rats who did aerobic treadmill exercise for 6 weeks. Cells cultured by serum from rats who did aerobic treadmill exercise for 6 weeks were separated by without NRF-2 inhibitor (EXE) and with NRF-2 inhibitor (EXE + ML). SUA level of rats was tested by using dry chemical assays, xanthine oxidase (XOD) activity in serum and liver were tested by using enzyme colorimetry assays, protein expression in kidney and NRK-52E cells were tested by using Western-blot, and UA levels in the upper or lower chamber were tested by colorimetry assays. Aerobic exercise reduced SUA levels in rats but did not significantly affect on liver xanthine oxidase. It also increased the expression of some UA transporters in the kidney and NRK-52E cells and increased the cells' ability in UA excretion. When the NRF-2 was inhibited, the NF-κB and ABCG2 increased, and the expression of ABCC4, URAT1, and GLUT9 decreased. In conclusion, this study suggested that 6 weeks of aerobic treadmill exercise intervention may help to improve the excretion of UA in renal cells, suggesting that long-term aerobic exercise may be a means to prevent hyperuricemia.

Regular physical activity: a major component of isolated systolic hypertension in the young

In the last few decades there has been much debate about the clinical significance of isolated systolic hypertension in youth (ISHY). Purpose of this article is to discuss the epidemiology and pathophysiology of ISHY focusing on the relationship between ISHY and aerobic exercise. There is evidence to suggest that regular physical activity produces favourable long-standing cardiovascular effects in young individuals including the improvement of arterial elasticity as measured from carotid-femoral pulse wave velocity and from small artery compliance. A recent ESH document recognises the heterogeneity of ISHY which may be associated with multiple factors that can interact to determine this BP phenotype. Several studies have shown that long-term training in aerobic sports is one main factor contributing to ISHY. In the athlete, the increased stroke volume secondary to low heart rate and the high arterial elasticity causes an increase in peripheral pulse pressure. This explains why ISHY is more common in physically trained than in sedentary individuals and is considered by some authors as a spurious hypertension. Recent results from the HARVEST study confirm the existence of an association between ISHY and endurance training. In that study the prevalence of ISHY was directly related to physical activity habits being 8.8% in the sedentary subjects and 25.7% in the athletes. Eligibility to competitive athletics of athletes with ISHY should be based on the results of 24-hour ambulatory BP monitoring and careful clinical assessment of all cardiovascular risk factors and target organ involvement in order to establish the global level of risk.

The effects of aerobic exercise on body composition in overweight and obese patients with gout: a randomized, open-labeled, controlled trial

Background

Overweight and obesity are typical risk factors for the increased prevalence and incidence of gout. The existing guidelines unequivocally indicated that exercise is highly advantageous for patients with gout. Nevertheless, there is still a lack of specific guidance and clinical evidence. The effects of exercise on improving gout, and the optimal frequency, timing, and types of exercise have not been fully clarified. The present trial aims to determine the effects of a specific aerobic exercise program on body composition in overweight and obese patients with gout.

Methods

In this randomized, open-labeled, controlled trial, a total of 60 overweight and obese patients with gout [body mass index (BMI) ≥ 24 kg/m²; age,18–55 years old] are equally randomized (1:1) into two groups (n = 30): moderate-intensity aerobic exercise group (MIAEG), heart rate reserve (HRR) = [(HRmax-HRrest) × 60% intensity] + HRrest, and control group (CG). The moderate-intensity aerobic exercise training program will be conducted for 30–40 min/session and 3 days/week for 12 weeks. Participants in the CG will be asked to avoid making changes in their exercise habits. There will be no limitation in the type of exercise. The primary outcome is the number of patients whose body fat is reduced after 12 weeks. The secondary outcomes include the changes in BMI, waist-to-hip ratio (WHR), insulin resistance index (IRI), serum uric acid (sUA), serum creatinine (SCr), estimated glomerular filtration rate (eGFR), triglycerides (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), hepatic steatosis, and adverse effects after 12 weeks. One-way analysis of variance (ANOVA) will be used to compare the mean values of normally distributed variables between MIAEG and GC.

Discussion

The effect and optimal frequency of exercise for improving the status of overweight and obese patients with gout have not yet been determined. We design a 12-week randomized controlled trial and evaluate the effects of individualized aerobic exercise program on patients with gout. The results may assist such patients with a personalized scientific exercise program based on the disease status and motor abilities, so that patients are prone to exercise under the condition of low risk and achieve the greatest benefits.

Trial registration

ChiCTR2200062153. Registered on July 25, 2022, with ChiCTR. http://www.chictr.org.cn/

Association of Sedentary Behavior and Physical Activity With Hyperuricemia and Sex Differences: Results From the China Multi-Ethnic Cohort Study

OBJECTIVE

To determine the association of physical activity (PA) and sedentary time (ST; leisure and total ST), commuting mode with hyperuricemia in a multiethnic Chinese population, and to analyze the difference between sexes.

METHODS

Baseline data were analyzed from 22,094 participants from the China Multi-Ethnic Cohort study in the Yunnan region, China. PA and sedentary behavior were assessed through questionnaires. Hyperuricemia was defined as serum urate > 7.0 mg/dL among men and > 6.0 mg/dL among women. A restricted cubic spline (RCS) was created to model the possible nonlinear relationship of PA and ST with hyperuricemia. Logistic regression was used to estimate the odds ratio (OR) and 95% CI.

RESULTS

Hyperuricemia prevalence in the observed population was 15.5% (men 25.5%, women 10.7%). Compared to those with light PA, participants with moderate-to-vigorous PA had lower odds of hyperuricemia (adjusted ORs were 0.85 [95% CI 0.77-0.94] and 0.88 [95% CI 0.79-0.97]). However, RCS showed a U-shaped nonlinear relationship between PA and hyperuricemia, and a linear relationship between hyperuricemia prevalence and increasing ST. Total ST ≥ 4 hours/day increased the risk of hyperuricemia in women but not in men. Mode of transportation revealed that sedentary behavior increased the risk of hyperuricemia, but there were inconsistent results based on sex.

CONCLUSION

Moderate PA may be more beneficial in reducing the risk of hyperuricemia. Reducing ST may have a greater effect on preventing hyperuricemia in females than in males.

Impact of sports participation on components of metabolic syndrome in adolescents: ABCD growth study

OBJECTIVES

This study aimed to analyze the impact of sports participation (12 months of practice) on the components of metabolic syndrome (MetS) in both sexes.

METHODS

This is an observational longitudinal study, a part of which is entitled "Analysis of Behaviors of Children During Growth" (ABCD Growth Study), Presidente Prudente, São Paulo, Brazil. The sample was composed of 171 adolescents (112 boys and 59 girls), divided into non-sports and sports groups. High-density lipoprotein-cholesterol (HDL-c), triglycerides, and glucose were analyzed by the colorimetric method of dry chemistry and processed biochemically. Systolic blood pressure and diastolic blood pressure were measured using an automatic device. Body fat was estimated using a densitometry scanner.

RESULTS

Adolescents who practiced sports were younger (p-value=0.001) and had a lower peak height velocity (p-value=0.001) than the non-sports group. The differences (Δ) after 12 months were of greater magnitude for the sports group when compared to the non-sports group (p-value=0.013), glucose (moderate magnitude in favor of the sports group; p-value=0.001), HDL-c (small magnitude in favor of the sports group; p-value=0.0015), and MetS (moderate magnitude in favor of the sports group; p-value=0.001).

CONCLUSIONS

The practice of sports in adolescents had a protective effect on the metabolic components of MetS.

The HARVEST. Looking for optimal management of young people with stage 1 hypertension

In the last few decades there has been much debate about the management of low-risk stage 1 hypertension in youth. In this article, we review the main findings of the HARVEST cohort accrued over 30 years, highlighting the contribution of this study to the existing literature. Tachycardia and sympathetic overdrive were closely intertwined in our HARVEST participants, promoting the development of sustained hypertension, metabolic abnormalities, and increased susceptibility to vascular complications. Short-term blood pressure variability in this age group had a prognostic power even greater than that of average 24h blood pressure. In the HARVEST participants, changes in left ventricular anatomy and contractility were the earliest signs of hypertensive cardiac involvement, whereas left ventricular filling was only marginally affected. Our results highlighted the role of glomerular hyperfiltration in determining microalbuminuria and renal damage in the early stage of hypertension. The genetic approach provided an important contribution to risk stratification and patient management. The HARVEST confirmed the importance of maintaining a good lifestyle for preventing the onset of hypertension, diabetes and cardiovascular events. Isolated systolic hypertension in the first decades of life appeared as a heterogeneous condition. To establish whether antihypertensive drug treatment should be started in this condition the clinician should consider the individual cardiovascular risk profile, the level of office mean BP and central BP. Despite recent progress in our knowledge, systolic hypertension still represents a challenging issue for the clinician. Hopefully, the HARVEST will continue to contribute data that help to fill the present gaps in evidence.

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

AIMS

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

METHODS AND RESULTS

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

CONCLUSION

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

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Key Words

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

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Affiliation(s)

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

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Participation in Non-professional Sports and Cardiovascular Outcomes Among Adolescents: ABCD Growth Study

OBJECTIVES

Sports are an important way to improve health during adolescence. However, it is still unclear whether the association between sports, blood pressure, and metabolic profile could be affected by sex, biological maturation, and trunk fatness. The aim of this study was to analyze the association between sports participation and the cluster of cardiovascular markers among adolescents of both sexes.

METHODS

A cross-sectional study involving 285 adolescents aged from 11 to 17 years of age (202 boys and 83 girls). Cardiovascular variables were composed of systolic blood pressure (SBP), diastolic blood pressure (DBP), resting heart rate (RHR), and carotid (CIMT) and femoral (FIMT) intima-media thickness, which were used to calculate the Cardiovascular_{Z score}. Sports participation was assessed through a face-to-face interview. Age of peak height velocity (APHV) was used as a covariate.

RESULTS

Among girls, the group engaged in sports presented lower values of RHR (sport: - 0.344 [95% CI - 0.650 to - 0.037] versus non-sport: 0.540 [95% CI 0.125 to 0.954]) and Cardiovascular_{Z score} (sport: - 0.585 [95% CI - 1.329 to 0.159] versus non-sport: 0.879 [95% CI - 0.127 to 1.884]), explaining 12.2% and 6.1% of all variance, respectively. Among boys, the group engaged in sports presented lower values of DBP (sport: - 0.158 [95% CI - 0.335 to 0.018] versus non-sport: 0.160 [95% CI - 0.091 to 0.412]) and FIMT (sport: - 0.128 [95% CI - 0.300 to - 0.044] versus non-sport: 0.211 [95% CI - 0.032 to 0.454]), explaining 2.2% and 2.6% of all variance, respectively.

CONCLUSIONS FOR PRACTICE

Adolescents engaged in sports presented healthier cardiovascular parameters, and sports participation seems to affect cardiovascular health differently in boys and girls.

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

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

Association of Serum Uric Acid with Cardiovascular Disease Risk Scores in Koreans

As the prevalence of gout and hyperuricemia increases, the comorbidities of gout and hyperuricemia have become a public health burden. In particular, risks of cardiovascular disease (CVD)-related complications are increasing. However, a few guidelines exist for the management of hyperuricemia. This cross-sectional study aimed to investigate the association of serum uric acid with CVD risk in the general population of Korean adults. We examined cross-sectional data from the first and second years of the seventh Korea National Health and Nutrition Examination Survey 2016–2017. Among 16,277 participants, 8781 were analyzed. We estimated the CVD risk using a 10-year CVD risk score prediction formula. There was a significant association of serum uric acid with 10-year CVD risk scores after adjusting for physical activity, body mass index, serum creatinine, and alcohol consumption in both sexes (p < 0.001). In the fitted fractional polynomial model, an approximate U-shaped association between serum uric acid levels and 10-year CVD risk scores was found in men. At the serum uric acid level of 6.9 mg/dL, the CVD risk was lowest. An approximate J-shaped association between serum uric acid levels and 10-year CVD risk scores was found in women. Our study showed that hyperuricemia was associated with an increased CVD risk. Hypouricemia was also associated with an increased CVD risk in men. We, therefore, recommend proper management of uric acid levels in the general population to reduce CVD risks.

Relationship between oxidative stress and inflammation in hyperuricemia: Analysis based on asymptomatic young patients with primary hyperuricemia

The average age of hyperuricemia patients has gradually decreased, but young patients with primary hyperuricemia often do not exhibit clinical symptoms and have not received sufficient attention. However, a lack of symptoms with primary hyperuricemia does not mean that high serum uric acid (UA) levels cannot lead to pathological effects, such as oxidative stress and inflammation, and the specific damage is still unclear. We aimed to determine the relationship between oxidative stress and inflammation to explore the possible role of pathological damage in asymptomatic young patients with primary hyperuricemia.A total of 333 participants were enrolled in our study: 158 asymptomatic young patients with primary hyperuricemia and 175 healthy persons from a health check-up population. Malondialdehyde (MDA), superoxide dismutase (SOD), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and general biochemical markers were measured.We found no differences in biochemical markers (fasting glucose, TG, TC, LDL-C, HDL-C, SCr, BUN, AST, and ALT) between the patients and healthy persons. Subsequent analyses of oxidative stress and inflammation revealed that the serum levels of MDA, IL-6, and TNF-α in the patients were significantly higher than those in the healthy control group (P < .001), and the SOD activity was significantly lower (P < .001). As the UA levels increased, MDA increased significantly and SOD decreased significantly; likewise, IL-6 and TNF-α increased significantly as the UA level increased. MDA showed a significant positive correlation with IL-6 (r = 0.367, P < .001) and TNF-α (r = 0.319, P < .001), and SOD was negatively correlated with IL-6 (r = -0.241, P < .01) and TNF-α (r = -0.308, P < .001). Multivariable logistic regression analysis showed that UA (OR: 2.379, 95% CI: 1.698-3.286, P < .001; OR: 3.261, 95% CI: 1.729-3.857, P < .001; for IL-6 and TNF-α, respectively) and MDA (OR: 1.836, 95% CI: 1.283-2.517, P < .01; OR: 2.532, 95% CI: 1.693-3.102, P < .001; for IL-6 and TNF-α, respectively) were risk factors for high IL-6 and TNF-α and that SOD (OR: 0.517, 95% CI: 0.428-0.763, P < .01; OR: 0.603, 95% CI: 0.415-0.699, P < .001; for IL-6 and TNF-α, respectively) was a protective factor.In our study, some abnormal pathological effects were found in asymptomatic young patients with hyperuricemia, suggesting that in young hyperuricemia patients, oxidative stress, inflammation and the inflammatory response may be related to the oxidative stress induced by UA. Therefore, we should pay more attention to the pathological damage caused by these alterations.

Antacids' side effect hyperuricaemia could be alleviated by long-term aerobic exercise via accelerating ATP turnover rate

Hyperuricemia is the term for an abnormally high serum uric acid level. Many factors contribute to hyperuricemia, however no definite correlation between proton pump inhibitors (PPIs) and hyperuricemia has been reported before. Physical exercise also decreases serum uric acid levels. However, the detailed biochemical-regulatory mechanisms remain unknown. Here we found that adenylate deaminase activities are much higher in hyperuricemia patients than in the healthy people. Therefore, the patients have higher levels of adenosine metabolites hypoxanthine and uric acid. Acid-inhibitory drugs (antacids) significantly increased serum uric acid level and may lead to gout in the hyperuricemia patient. Long-term aerobic exercise significantly increased serum phosphorus and decreased serum ATP and its metabolites, and therefore decreased serum uric acid. Antacids slow down the ATP turnover rate and result in serum uric acid elevation subsequently. While the long-term aerobic exercise decreases serum uric acid levels by accelerating ATP turnover rate. The results imply that long-term aerobic exercise may be a useful strategy to prevent and treat hyperuricaemia.