Association between Serum Uric Acid Level and Metabolic Syndrome and Its Sex Difference in a Chinese Community Elderly Population

One-Year Risk Prediction of Elevated Serum Uric Acid Levels in Older Adults: A Longitudinal Cohort Study

Objective

To develop and externally validate a nomogram to predict elevated serum uric acid (SUA) levels in older adults.

Study Design

This is a longitudinal Chinese cohort study.

Methods

A cohort of 2788 older adults was established at Huadong Hospital, followed-up for at least one year, and screened for risk factors for elevated SUA levels. A logistic regression model was built to predict elevated SUA, and its performance was validated.

Results

The risk prediction model showed good discrimination ability in both the development cohort (area under the curve (AUC) = 0.82; 95% confidence interval (CI) =0.79~0.86) and the external validation cohort (AUC=0.76; 95% CI=0.70~0.82). The model was adequately calibrated, and the predictions correlated with the observed outcome (χ 2 = 6.36, P = 0.607). Men were more prone to elevated SUA levels than women were, and a baseline SUA level ≥360 μmol/L was a common risk factor for both males and females. Proteinuria status was an additional risk factor for males, whereas a baseline estimated glomerular filtration rate (eGFR)<60 mL/min·1.73 m2 and diabetes status were additional risk factors for females.

Conclusion

The externally validated nomogram, which is predictive of elevated SUA in older adults, might aid in the detection of individual diseases, the development of preventive interventions and clinical decision-making.

High prevalence of hyperuricemia and the association with metabolic syndrome in the rural areas of Southwestern China: A structural equation modeling based on the Zhuang minority cohort

BACKGROUND AND AIMS

The prevalence of hyperuricemia (HUA) and metabolic syndrome (MetS) in the Zhuang minority had not been examined. We aimed to determine the prevalence of HUA and MetS, and explore the interrelationship among the serum uric acid to creatinine (SUA/Cr) ratio, MetS, and its components.

METHODS AND RESULTS

A cross-sectional study was conducted with structured questionnaire and physical examination based on the Zhuang minority cohort. A Structural Equation Model was performed to examine the hypothesis link between the SUA/Cr ratio, MetS, and its components. 10,902 aged 35-74 years Zhuang minority adults were included. The total prevalence of HUA and MetS was 17.5% and 23.7%, respectively. The SUA/Cr ratio had a positive effect on MetS (the standardized coefficient βr was 0.311 in males and 0.401 in females). The SUA/Cr ratio was positively associated with obesity (βr = 0.215), dyslipidemia (βr = 0.177), and high blood pressure (βr = 0.034) in males and was positively associated with obesity (βr = 0.303), dyslipidemia (βr = 0.162), and hyperglycemia (βr = 0.036) in females.

CONCLUSIONS

The prevalence of HUA in the aged 35-74 years Zhuang minority adults was high while the prevalence of MetS was relatively low. As HUA is an earlier-onset metabolic disorder and the SUA/Cr ratio had a positive effect on MetS and its components, the prevention measures of MetS should be strengthened. And the SUA/Cr ratio can be used as an early warning sign to implement the intervention measures of MetS.

Women with Metabolic Syndrome and Unhealthy Lifestyle Factors Are at a Higher Risk for Hyperuricemia

Hyperuricemia (HUA) has become a significant medical concern due to its complications and links to metabolic syndrome (MetS) and cardiovascular disease (CVD), which result in increased mortality. The pathogenic processes associated with unhealthy behaviors, MetS, and HUA can be cooperative and potentially synergistic in the activation of risk factors. Recent research has shown sex-based differences in the relationship between HUA and its associated risk factors. This study aimed to investigate these differences, particularly in the context of MetS and CVD risk factors and unhealthy lifestyles. We also aimed to evaluate the joint effects of these factors based on sex. We conducted a cross-sectional study using nationally representative survey data from the Korean National Health and Nutritional Examination Survey 2016-2018. We performed multivariable logistic regression analysis, calculating adjusted odds ratios (ORs) with their 95% confidence intervals (CIs). We also conducted subgroup analyses based on sex and the presence of MetS with or without unhealthy lifestyle factors (tobacco use, alcohol intake). We found sex-based differences in the relationships between HUA and MetS, CVD risk factors, and lifestyle behaviors. Our major finding was a significant association between MetS and HUA in both men and women, regardless of alcohol consumption and smoking status, and this association was stronger in women. We also observed a synergistic effect of MetS and lifestyle factors on the risk of HUA, particularly in women, in whom the risk of HUA increased up to four times compared to the reference group. A sex-based clinical strategy for HUA is necessary to reduce related complications and their socio-economic burden.

Association between serum uric acid levels and peripheral artery disease in Chinese adults with hypertension

Background

Higher serum uric acid (SUA) can cause gout, which is principally characterized by arthritis due to monosodium urate crystal deposition in the lower extremities. High levels of SUA have been linked to endothelial dysfunction, oxidative stress, and inflammation, all of which are involved in the pathogenesis of peripheral artery disease(PAD). To date, the relationship between SUA levels and PAD is still poorly understood.

Method

An analysis of 9,839 Chinese adults with essential hypertension from the ongoing China H-type Hypertension Registry Study was conducted in this cross-sectional study. Patients with an ABI ≤0.9 was diagnosed with PAD. Hyperuricemia was defined as SUA levels >420 mol/L in men and >360 mol/L in women. The association between SUA levels and PAD was evaluated using multivariable logistic regression models based on odds ratios (ORs) and their 95% confidence intervals (CIs).

Results

The enrolled subjects ranged in age from 27 to 93 years, with a mean age of 63.14 ± 8.99 years. The proportion of male patients was 46.22%, and the prevalence of hyperuricemia was 50.72%. In males, hyperuricemia was positively associated with the risk of PAD (adjusted OR per SD increase: 1.72, 95% CI 1.17 to 2.53, P =0.006). Males in the highest SUA tertile were significantly more likely to have PAD (adjusted OR: 2.63, 95% CI 1.42 to 4.86, P = 0.002; P for trend = 0.001). However, this positive relationship was not observed in females (adjusted OR: 1.29, 95% CI 0.77 to 2.17, P = 0.327; P for trend = 0.347).

Conclusion

According to this cross-sectional study, higher SUA levels were positively associated with PAD in male hypertensive patients, while this positive relationship disappeared in female participants.

Fatty liver mediates the association of hyperuricemia with prediabetes and diabetes: a weighting-based mediation analysis

Background

Fatty liver, obesity, and dyslipidemia are associated with prediabetes or diabetes risk, and hyperuricemia co-exists. The present study evaluated the role of multiple mediators, namely, fatty liver, body mass index (BMI), and dyslipidemia, in the association between hyperuricemia and diabetes status.

Methods

Baseline data from the ongoing Fuqing cohort (5,336 participants) were analyzed to investigate the association of hyperuricemia with diabetes status using a multinomial logistic regression model. Furthermore, causal mediation analysis with the weighting-based approach was performed to estimate hyperuricemia's total natural direct effect (tnde), total natural indirect effect (tnie), and total effect (te) on prediabetes and diabetes risk, mediating jointly via fatty liver, BMI, and dyslipidemia.

Results

In multinomial analysis without considering mediators' effects, hyperuricemia was associated with a higher risk of prediabetes only (odds ratio: 1.25; 95% CI: 1.09-1.43; p < 0.001). When fatty liver, BMI, and dyslipidemia were considered as multiple mediators in the association, hyperuricemia was linked to both prediabetes [tnde: 1.11, 95% CI: 1.04-1.11; tnie: 1.07, 95% CI: 1.05-1.09; and overall proportion mediated (pm): 42%, 95% CI: 27%-73%] and diabetes risk (tnde: 0.96, 95% CI: 0.82-1.14; tnie: 1.25, 95% CI: 1.18-1.33; and pm: 100%, 95% CI: 57%-361%). Hyperuricemia showed significant tnde, te, and tnie, mediated by fatty liver jointly with dyslipidemia (pm = 17%) or BMI (pm = 35%), on prediabetes risk.

Conclusion

Hyperuricemia could increase prediabetes or diabetes risk, partially mediated by fatty liver, BMI, and dyslipidemia. Fatty liver is the crucial mediator in the association between hyperuricemia and prediabetes.

Relationship between renal and liver function with diabetic retinopathy in patients with type 2 diabetes mellitus: a study based on cross-sectional data

This study aims to explore the relationship between abnormal renal- and liver-function and diabetic retinopathy (DR) in patients with type 2 diabetes mellitus (T2DM). A total of 994 T2DM patients who received inpatient treatment in the Endocrinology Department of Henan Province People’s Hospital were included in the study. Logistic regression was performed to identify the relationship between abnormal renal and liver function with DR. Receiver operator characteristic analysis was performed to explore the efficacy of risk factors in predicting DR. Higher urine albumin [OR(95%CI) = 3.344(1.921–5.822), P < 0.001] and urine albumin/creatinine ratio [OR (95%CI) = 2.901(1.911–5.822), P < 0.001] were closely related to the occurrence of DR. People with low TP had a 1.624-times higher risk (95%CI: 1.008–2.617) of developing DR than those with normal total protein (P = 0.046). The more risk factors that are present, the greater the risk of DR. For every one-point incremental increase in the risk-factor score, the risk of DR increased by 31.0% (P < 0.001). The area under receiver operating curve of risk-factor score was 0.839 (0.812, 0.866), with a sensitivity of 81.9% and a specificity of 74.8%. The risk of developing DR increased with an increased risk-factor score. These findings are potentially valuable for DR screening and early diagnosis in patients with T2DM.

The bidirectional relationship between metabolic syndrome and hyperuricemia in China: A longitudinal study from CHARLS

OBJECTIVE

It has been reported that metabolic syndrome (MetS) has been associated with hyperuricemia. However, current findings have been inconclusive regarding the direction of this association. The objective of this study was to clarify the possible directional relationship between hyperuricemia and MetS.

DESIGN

This study used two waves of data from the China Health and Retirement Longitudinal Study (CHARLS) in 2011 and 2015 (N = 6,253, aged ≥40 years). Logistic regression and cross-lagged panel design were performed to evaluate the bidirectional association between uric acid with MetS. MetS score is defined as the number of MetS components present.

RESULTS

New-onset hyperuricemia and MetS were observed in a four-year follow-up study among 719 and 625 participants, respectively. A positive association was observed in the adjusted logistical regression model between baseline MetS score and new-onset hyperuricemia (P for trend <0.001), and also between baseline serum uric acid (SUA) and new-onset MetS (P for trend <0.001). Cross-lagged panel analysis indicated MetS score positively and prospectively predicted SUA, but not vice versa. After stratification by sex, we observed a strong, bidirectional relationship between MetS score and SUA indicating that diagnosis in one illness increased the risk of the other, both men and women. Moreover, this study also found that systolic blood pressure (P < 0.001) and triglycerides (P < 0.001) had a bidirectional relationship with SUA.

CONCLUSIONS

The results of this study indicated a bidirectional relationship between MetS and hyperuricemia.

The relationship between urinary albumin to creatinine ratio and all-cause mortality in the elderly population in the Chinese community: a 10-year follow-up study

BACKGROUND

In patients with diabetes and hypertension, proteinuria is independently associated with all-cause death. However, in the general population, urinary albumin to creatinine ratio (UACR) is less used to predict all-cause mortality. When the urinary albumin to creatinine ratio is within the normal range (UACR< 30 mg/g), the clinical relevance of an increased urinary albumin excretion rate is still debated. We studied the relationship between UACR and all-cause mortality in community populations, and compared UACR groups within the normal range.

METHODS

The participants were the inhabitants from the Wanshoulu community in Beijing, China. The average age is 71.48 years, and the proportion of women is 60.1%. A total of 2148 people completed random urine samples to determine the urinary albumin to creatinine ratio (UACR). The subjects were divided into three groups according to UACR: Group 1 (UACR< 10 mg/g), Group 2 (10 mg/g < UACR< 30 mg/g), Group 3 (UACR> 30 mg/g). We used Kaplan-Meier survival analysis and Cox regression model to verify the relationship between UACR and all-cause mortality.

RESULTS

At an average follow-up of 9.87 years (718,407.3 years), the total mortality rate were 183.4/1000. In the Cox proportional hazards model, after adjusting for possible confounders, those with normal high-value UACR (group 2) showed a higher all-cause mortality than those with normal low-value UACR (group 1) [hazard ratio (HR) 1.289, 95% confidence interval (CI) 1.002 ~ 1.659 for all-cause mortality]. Those with proteinuria (group 3) showed a higher all-cause mortality than those with normal low-value UACR (group 1) [hazard ratio (HR) 1.394, 95% confidence interval (CI) 1.020 ~ 1.905 for all-cause mortality].

CONCLUSION

Urinary albumin to creatinine ratio is an important risk factor for all-cause death in community population. Even if it is within the normal range (UACR< 30 mg/g), it occurs in people with high normal value (10 mg/g < UACR< 30 mg/g), the risk of all-cause death will also increase.

Serum Uric Acid Is Associated with Metabolic Syndrome and Insulin Resistance among Health Personnel from Peru

We explored the association between serum uric acid (SUA) and metabolic syndrome (MetS) and insulin resistance (IR) among health personnel from a public hospital in Peru in a cross-sectional study with data from the Plan for the Prevention and Surveillance of Communicable and Noncommunicable Diseases of Huaycán Hospital. MetS was defined according to Latin American Diabetes Association (ALAD) criteria and IR with surrogate IR markers, triglyceride-to-HDL-C ratio (TG/HDL-C), and triglyceride-to-glucose index (TyG). The association between SUA and MetS and IR was determined using Poisson regression models in a sample of 292 participants with an average age of 46.2 ± 10.6 years. The total prevalence of MetS was 38%, and the individuals with MetS presented mainly alterations in anthropometric parameters (obesity and body fat). Finally, the adjusted regression models showed that women with SUA in the highest tertile increased the prevalence of MetS (PR: 1.71, 95% CI: 1.07-2.74) compared to the lowest tertile of SUA in women, while SUA increased hypertriglyceridemia and IR (TG/HDL-C and TyG) in both sexes. We concluded that SUA is strongly associated with MetS in women, and SUA increases hypertriglyceridemia and IR in both sexes. On the contrary, more research is required regarding the female population.

Evaluation of uric acid disorders and associated factors in essential hypertensive patients at Wolkite University specialized hospital, Southern Ethiopia

BACKGROUND

Essential hypertension is a condition characterized by a rise in blood pressure of undetermined cause, includes 90% of all hypertensive cases and is a highly important public health challenge with major modifiable cause of morbidity and mortality. Uric acids disorders in particular hyperuricemia are significant problems in essential hypertensive patients and can cause substantial morbidity and mortality. Determination of uric acid disorders may play a major role in the management and early aversion of complications in hypertensive patient. Therefore, this study aimed to determine uric acid disorders and associated factors among essential hypertensive adults in the outpatient department at Wolkite University specialized Hospital, Southern Ethiopia from November 1 to February 30, 2021.

METHODS AND MATERIALS

An institional based cross sectional study was conducted on 270 essential hypertensive adults on follow-up in outpatient department from November 1 to February 30, 2021. Structured questionnaires through face to face interviews and participants' medical records were used to collect information on determinants related with uric acid disorders. The blood specimen was collected and level of serum uric acid, blood sugar and lipid profile was measured using standard principles and procedures with an ABX Pentra 400 automated chemistry analyzer. Bivariate and multivariate logistic regression analyses were done to identify factors associated with hyperuricemia. The p-value was set at <0.05 with a 95% confidence interval of the adjusted odds ratio.

RESULTS

A total of 270 adult essential hypertensive patients were participated in the study, among those 196(27.4%) of study participants were hyperuricemic with 95%CI (21.9, 33.3). Being alcoholic [(AOR: 15.68, 95% CI: (5.93, 21.41)], taking antihypertensive medication [(AOR: 11.56, 95% CI: (3.94, 23.80)], BMI > = 30 [(AOR: 4.89, 95% CI: (1.46, 25.5)] and being centrally obese [(AOR: 6.87, 95% CI: (2.53, 18.63)] were factors significantly associated with hyperuricemia.

CONCLUSION

In this study, the high burden of hyperuricemia (27.4%) was observed in essential hypertensive patients with follow-up in outpatient department. Taking alcohol and antihypertensive medication, being overweight and centrally obese were identified factors of uric acid disorders. The finding of this study should be taken into consideration to implement preventive interventions on identified predictors in hypertensive patients. Taking fruit and vegetable, and promoting physical exercise and determinations of serum uric acid level in adult essential hypertensive patients was recommended to minimize the emergence of hyperuricemia.

The association between serum uric acid and features of metabolic disturbances in young adults

INTRODUCTION

The increase in the number of people affected by different metabolic disturbances, especially among young people, is alarming. It seems worthwhile to reappraise the usefulness of commonly used laboratory parameters potentially associated with metabolic and metabolically obese normal weight syndrome. Serum uric acid may be considered as an indicator and/or a predictor of metabolic disorders. We evaluated serum uric acid concentration in relation to metabolic syndrome, as well as metabolically obese normal weight features, and examined its usefulness in improving metabolic and metabolically obese normal weight syndrome diagnosis in young people.

MATERIAL AND METHODS

In 349 apparently healthy people, aged 18-31, features of metabolic and metabolically obese normal weight syndrome and serum uric acid concentration were examined under fasting conditions.

RESULTS

Prevalence of metabolic syndrome increased in uric acid quartiles, while the percentage of metabolically obese normal weight syndrome was at a similar level in all uric acid quartiles. A relationship between uric acid concentration and features of metabolic disorders in quartile and correlation analysis was revealed. Data mining techniques did not indicate the usefulness of uric acid for distinguishing people with metabolic syndrome from those with metabolically obese normal weight syndrome.

CONCLUSIONS

We confirmed that in young people an increase in uric acid levels is more closely related to metabolic syndrome features than insulin resistance. Serum uric acid concentration could not be recommended as an independent, strong marker of metabolic or metabolically obese normal weight syndrome occurrence in young people, but finding its elevated concentration should be an indicator for screening for other disturbances associated with metabolic syndrome.

Associations of serum uric acid level and gout with cardiac structure, function and sex differences from large scale asymptomatic Asians

Hyperuricemia (HU) is a marker for heart failure. There are relatively few data in the Asian population regarding the effects of hyperuricemia and gouty disorders on cardiac remodeling and diastolic dysfunction (DD), an intermediate stage in the development of heart failure. We consecutively recruited asymptomatic Asian individuals to undergo cardiovascular surveys. We categorized them into Non-HU, HU, and Gout groups. We measured cardiac structure and indices for diastolic function, including tissue Doppler (TDI)-derived LV e’ and E/e’. Among 5525 participants, 1568 had HU and 347 had gout. The presence of gout and higher uric acid levels (SUA) (<4, 4–6, 6–8, 8–10, > = 10 mg/dL) were associated with greater LV wall thickness, greater LV mass/volumes, larger LA volume, lower LV e’ and higher E/e’. Higher SUA was associated with greater LV mass index (adjusted coefficient: 0.37), greater mass/volume ratio (adjusted coefficient: 0.01) and larger LA volume index (adjusted coefficient: 0.39, all p<0.05). Both HU and Gout groups were associated with lower LV e’ (coefficient: -0.086, -0.05), higher E/e’ (coefficient: 0.075, 0.35, all p <0.05), larger LA volume, and higher DD risk (adjusted ORs: 1.21 and 1.91 using Non-HU as reference, respectively, both p <0.05). SUA set at 7.0 mg/dL provided the optimal cut-off for identifying DD, with markedly lower e’ (HU: 8.94 vs 8.07, Gout: 7.94 vs 7.26 cm/sec) and higher LV E/e’ in HU/Gout women than in men (HU: 7.84 vs 9.79 cm/sec for men and women, respectively, all p <0.05). Hyperuricemia, even at a relatively low clinical cut-off, was associated with unfavorable remodeling and was tightly linked to diastolic dysfunction. The presence of gout likely aggravated these conditions. Women with hyperuricemia or gout had worse diastolic indices than men despite similar degrees of LV remodeling.

Hyperuricemia is associated with metabolic syndrome in the community very elderly in Chengdu

Hyperuricemia is a risk factor for cardiovascular metabolic diseases. However, in the very elderly, the relationship between hyperuricemia and the metabolic syndrome (MetS) is not yet clear. This study was aimed to investigate the potential association between hyperuricemia and MetS in community very elderly in Chengdu. In this cross-sectional study, 1056 very elderly in the community were enrolled. Serum uric acid (SUA), fast plasma glucose, triglycerides and high–density lipoprotein cholesterol were measured, and then MetS components were calculated. Logistic regression models were used to explore risk factors for MetS in the very elderly. Finally, 1035 participants were included in analysis whose ages ranged between 80 and 100 with a mean age of 83.6 ± 3.4 years. The mean SUA level was 356.2 ± 95.0 µmol/L. The estimated prevalence of MetS in the very elderly was 25.0% vs. 21.6% (international diabetes federation (IDF) criteria vs. Chinese guideline), which was significantly higher for women (IDF criteria:17.3% in men vs 33.6% in women, p < 0.001). Logistic regression has found that participants with hyperuricemia (SUA level > 416 µmol/L in men and > 357 µmol/L in women) had a higher risk (IDF criteria: odds ratio (OR): 2.136, 95% confidence interval(CI): 1.525–2.993, p < 0.001. Chinese guideline: OR: 1.769, 95%CI: 1.249–2.503, p = 0.001) of MetS in very elderly Chinese. MetS is common in the community of very elderly Chinese in Chengdu. Hyperuricemia is associated with MetS in general very elderly and lifestyle changing should also be considered in the very elderly.

Sex-specific differences in the prevalence of and risk factors for hyperuricemia among a low-income population in China: a cross-sectional study

Objectives: China has already entered the aging society, and its aging population is the largest worldwide. Accordingly, several aging-related conditions including hyperuricemia are becoming a public health concern owing to their increasing prevalence in rural areas. However, the sex-specific differences in the risk factors for hyperuricemia among the middle-aged and elderly in rural North China are unclear. Thus, this study aimed to evaluate sex-specific differences in the prevalence of and risk factors for hyperuricemia in low-income adults in rural North China. Methods: This population-based cross-sectional study recruited participants aged ≥50 years from the Tianjin Brain Study between April and August 2019. After excluding those who had cancer, severe psychiatric disturbances, hepatic failure, and serious renal disease (i.e., an estimated glomerular filtration rate (eGFR) of <30 mL/min/1.73 m²), 3119 (1392 men and 1727 women) eligible participants were included. Basic information and blood samples were collected, and data were analyzed using logistic regression models. Results: Hyperuricemia was prevalent in 14.4% (men, 14.2%; women, 14.5%)of the participants, and the prevalence significantly increased with increasing age in both sexes (male, P= 0.034; female, P< 0.001). In multivariate analysis, obesity, metabolic syndrome, and high levels of total cholesterol, 2 h plasma glucose, and blood urea nitrogen were risk factors for hyperuricemia in both men and women. Physical activity was a risk factor in men, while a high white blood cell count was a risk factor in women. A high eGFR was a protective factor in both sexes. Conclusions: Hyperuricemia was highly prevalent in low-income adults in Tianjin, with men and women showing differences in risk profiles and comorbidities. Early management of hyperuricemia according to sex-specific risk factors should be considered in primary care to reduce the prevalence and burden of hyperuricemia in rural China.

The Role of Xuefu Zhuyu Decoction in Prevention of Contrast-Induced Nephropathy after Percutaneous Coronary Intervention

Objective

This study aimed to investigate the effect of Xuefu Zhuyu decoction on preventing contrast-induced nephropathy (CIN) after percutaneous coronary intervention (PCI).

Methods

A total of 256 patients undergoing selective PCI for coronary artery disease were consecutively enrolled and randomly divided into two groups: Group A (n = 126) and Group B (n = 130). Before and after PCI, all patients routinely received antiplatelet aggregation therapy, antilipidemic therapy, and hydration therapy. Besides routine therapy, patients in Group B received Xuefu Zhuyu decoction from 3 days before PCI to 3 days after PCI. Serum creatinine (Scr), estimated glomerular filtration rate (eGFR), superoxide dismutase (SOD), and malondialdehyde (MDA) were measured, respectively, at baseline (72 h before PCI) and at 24, 48, and 72 h after PCI.

Results

Compared with Group A, Group B presented a lower fluctuation of SCr and eGFR (P < 0.01). The incidence of CIN was less in Group B. According to the definition, CIN occurred in 5 patients (2.0%) in the intervention group and 5 (4.0%) in the control group (P=0.167). In terms of oxidative stress, Group B had a lower MDA (P < 0.05), but a higher SOD (P < 0.05).

Conclusions

Compared with the control group, Xuefu Zhuyu decoction intervention therapy increased the level of SOD and reduced MDA. The Xuefu Zhuyu decoction intervention group presented a higher level of eGFR at 24, 48, and 72 h after PCI in patients with coronary heart disease and a lower level of Scr. The results are propitious to prove that Xuefu Zhuyu decoction might play an antioxidative stress role in the prevention of CIN after PCI.

Sex-specific association of hyperuricemia with cardiometabolic abnormalities in a military cohort: The CHIEF study

Hyperuricemia has been associated with metabolic syndrome, and the association with various cardiometabolic risk factors may be affected by sex.We made a cross-sectional examination in a military cohort of 6738 men and 766 women, aged 18 to 50 years of Taiwan in 2013 to 2014. Hyperuricemia were defined as serum uric acid levels ≥7.0 mg/dL for men and ≥5.7 mg/dL for women, respectively. Multivariable logistic regression analyses were used to determine the associations between hyperuricemia and various metabolic abnormalities.In the overall population, hyperuricemia was associated with high blood pressure (odds ratio [OR]: 1.59, and 95% confidence intervals: 1.42-1.77), low high-density lipoprotein (OR: 1.75, 1.56-1.97), high triglycerides (OR: 2.14, 1.90-2.42), high low-density lipoprotein (OR: 1.71, 1.51-1.93), high fasting plasma glucose (OR: 1.29, 1.13-1.48), and central obesity (OR: 2.85, 2.55-3.18) after adjusting for age and serum creatinine concentrations. However, the associations with atherogenic lipid profiles including high triglycerides and high low-density lipoprotein were merely significant in men but not in women. In addition, there was a tendency for a sex difference in the association of hyperuricemia and raised blood pressure ≥130/85 mm Hg, which was greater in women than that in men (OR: 2.92, 1.37-6.25 and 1.54, 1.37-1.72, respectively; P for interaction = .059).Our findings suggest that the association between hyperuricemia and various cardiometabolic abnormalities in young adults may differ by sex, possibly due to a regulation of sex hormones and uneven effects of uric acid at the same levels between sexes on lipid metabolisms and arterial stiffness.

The serum uric acid level in females may be a better indicator of metabolic syndrome and its components than in males in a Japanese population

BACKGROUND

Although the level of uric acid (UA) is higher in males, increased UA level in females was reported to be closely associated with prevalence of metabolic syndrome (Mets) leading to atherosclerotic cardiovascular disease (ASCVD). Few data exist regarding the gender diferences in relationship between the serum UA levels and cardo-metabolic risk in the Japanese population, which generally contains a lower proportion of obesity than Western populations.

METHODS

This cross-sectional study was designed to investigate, by gender, the association between the serum UA level and abdominal obesity, and thereby cardio-metabolic risk i.e. presence of Mets and its components using a sample of 8567 apparently healthy subjects females: n = 3334, males: n = 5233 at the Health Planning Center of Nihon University Hospital between September 2015 and August 2016.

RESULTS

Receiver operating characteristic analysis was performed to reveal the accuracy of serum UA level as a predictor of abdominal obesity based on the Japanese criteria of Mets (females vs. males: area under the curve, 0.751 vs 0.609). Furthermore, the serum UA level and proportion of abdominal obesity rose with increasing age in females; in males, however, these parameters did not change in parallel with age. Furthermore, the serum UA levels in females reflected a status of cardio-metabolic risk when compared with males in a multi-logistic regression analysis. It is particularly worth noting that in the above-mentioned multivariate logistic regression analysis, the odds ratio of hyperuricemia in females was generally 1.3-2.5 times higher than that in males.

CONCLUSIONS

Compared with males, increased serum UA level in females might be involved in abdominal obesity and cardio-metabolic risk, possibly leading to the development of ASCVD even in a Japanese population. This may be due to gender differences affecting the development of abdominal obesity and changes in the serum UA levels with age.

CLINICAL TRIAL REGISTRATION

UMIN (http://www.umin.ac.jp/) Study ID:　UMIN000035901retrospectively registered 1 March 2018.

Sex-Specific Association of Serum Uric Acid Level and Change in Hyperuricemia Status with Risk of Type 2 Diabetes Mellitus: A Large Cohort Study in China

BACKGROUND

Conflicting findings have been reported regarding the sex-specific association between serum uric acid (SUA) level and type 2 diabetes mellitus (T2DM) risk, and no study has explored the association between the change in hyperuricemia status and T2DM risk. The study was aimed at exploring the sex-specific association of baseline SUA and changes in hyperuricemia status with T2DM risk.

METHODS

We included 37,296 eligible adults without T2DM at the first examination who attended the baseline examination and at least one follow-up annual examination. Cox and logistic regression models were used to calculate hazard ratios (HRs) and odds ratios (ORs) with their 95% confidence intervals (CIs) for T2DM risk associated with baseline SUA and the change in hyperuricemia status, respectively.

RESULTS

During a median follow-up of 3.09 years, of 37,296 eligible adults, 2,263 developed T2DM. Compared with the first SUA quartile, higher quartiles were associated with an increased risk of T2DM in women (HR 1.78, 95% CI 1.17-2.71 for Q3 and 1.93, 1.27-2.93 for Q4; P _trend < 0.001) but not in men. Compared with women with a persistent normal SUA level at baseline and the last follow-up, T2DM risk increased significantly among those whose SUA status changed from normal at baseline to hyperuricemia at the last follow-up (OR 1.71, 95% CI 1.12-2.55) and those with persistent hyperuricemia at baseline and the last follow-up (OR 2.37, 95% CI 1.60-3.46). However, for men, a nonsignificant association was found between the change in hyperuricemia status and T2DM risk.

CONCLUSIONS

Baseline SUA and the change in hyperuricemia status were associated with T2DM risk only among women. The findings suggest the importance of monitoring SUA levels and maintaining them within a normal range for preventing or reducing incident T2DM in Chinese women.

Association of Serum Uric Acid with Metabolic Syndrome and Its Components: A Cross-Sectional Study in Chinese Coastal Population

Objective: Few studies reported the association between serum uric acid and the prevalence of metabolic syndrome in China's coastal residents. We aimed to examine the association between serum uric acid and the prevalence of metabolic syndrome as well as its components in adults and elderly from Shenzhen (a China's coastal city). Methods: We conducted a survey in a community-based household population in Shenzhen, collecting data about 4049 participants aged 20-69 years. Based on the data, we determined the prevalence of metabolic syndrome in adults and elderly with different serum uric acid concentrations. Results: According to the revised National Cholesterol Education Program Adult Treatment Panel III, the prevalence of the metabolic syndrome in the surveyed participants was 24.69% [95% confidence interval (CI): 23.4%-26.0%]. The prevalence of metabolic syndrome in participants with serum uric acid levels <4, 4-4.9, 5-5.9, 6-6.9, 7-7.9, and ≥8 mg/dL is 10.12% (95% CI: 8.2%-12.0%), 17.92% (95% CI: 15.8%-20.1%), 31.05% (95% CI: 28.1%-34.0%), 39.47% (95% CI: 35.4%-43.8%), 49.39% (95% CI: 43.1%-55.7%), and 52.57% (95% CI: 42.5%-62.5%), respectively. Multivariable logistic regression analysis showed that participants with higher serum uric acid levels were at a higher risk of high triglycerides, low high-density lipoprotein, central obesity, high blood pressure, or high fasting glucose (P < 0.001). Conclusions: Serum uric acid levels were closely associated with metabolic syndrome and its components in Chinese coastal population.

Risk Factors For Hyperuricemia In Chinese Centenarians And Near-Centenarians

Purpose

Hyperuricemia is an important potential pathogenic factor for hypertension, cardiovascular disease and stroke. The current study aimed to investigate the prevalence of hyperuricemia and its relationship to lifestyle characteristics and dietary habits in centenarians and near-centenarians.

Patients and methods

In total, 966 centenarians and 788 near-centenarians were included. Community-based surveys were conducted to collect information about lifestyle. Blood examinations were performed using enzymatic assays. T-tests and χ2 tests were used to investigate significant indicators of hyperuricemia, and multivariate logistic regression was used to analyze the related risk factors. A comprehensive analysis of nineteen modifiable factors, including lifestyle characteristics, dietary habits, general characteristics and blood test indexes, was conducted.

Results

The prevalence of hyperuricemia was 29.02%. The percentage of men, waist circumference (WC), waist-hip ratio, estimated glomerular filtration rate (eGFR), levels of total protein (TP), alanine aminotransferase, aspartate aminotransferase, triglycerides, high-density lipoprotein cholesterol, serum homocysteine, serum uric acid, serum urea and serum creatinine, passive smoking, alcohol consumption, snoring, preference for fried flavors, and meat, seafood and vegetable consumption were significantly different between the hyperuricemia group and the normouricemia group (p<0.05). Multivariate logistic regression analysis showed that WC (OR=1.020), eGFR (OR=0.960), TP level (OR=1.038), serum urea level (OR=1.154), passive smoking (OR=2.589), snoring (OR=2.003), meat consumption (OR=2.506), seafood consumption (OR=1.422) and vegetable consumption (OR=0.521) were significantly associated with the risk of hyperuricemia (p<0.05).

Conclusion

Low eGFR and vegetable consumption, high WC, TP, and serum urea levels, passive smoking, snoring, and high meat and seafood consumption were independent risk factors for hyperuricemia. It is recommended that people at high risk for hyperuricemia should actively limit their intake of fried food, alcohol and purine-rich food, increase their intake of fresh vegetables, actively treat sleep apnea syndrome, avoid passive smoking, maintain a healthy WC and seek to improve their kidney and liver function.

Serum Uric Acid Is Independently Associated with Risk of Obstructive Sleep Apnea-Hypopnea Syndrome in Chinese Patients with Type 2 Diabetes

Purpose

We aimed to investigate the association between serum uric acid (SUA) levels and obstructive sleep apnea-hypopnea syndrome (OSAHS) in patients with type 2 diabetes.

Methods

A cross-sectional study of 212 type 2 diabetes mellitus (T2DM) patients was conducted in Xiamen, China. All patients underwent polysomnography (PSG) recordings for OSAHS diagnosis. Patients were grouped according to the apnea-hypopnea index (AHI) as mild (5-14.9), moderate (15-29.9), and severe (≧30) OSAHS. Patients with AHI ≤ 4.9 served as the control group. Weight, body mass index (BMI), SUA, liver function, renal function, blood pressure, lipid profiles, and glycemic parameters were measured.

Results

A total of 158 patients (101 men and 57 women) with complete data were analyzed in this study. 127 patients were identified as OSAHS. Among the 127 patients with OSAHS, 56 (44.1%), 37 (29.1%), and 34 (26.8%) had mild, moderate, and severe OSAHS, respectively. Correlation analyses showed that the SUA level was significantly related to the apnea-hypopnea index (AHI) (r = 0.194, p = 0.016). The level of SUA was significantly higher among OSAHS patients compared to the control group (control group: 333.14 ± 80.52 μmol/L, mild group: 345.50 ± 90.27 μmol/L, moderate group: 363.59 ± 134.26 μmol/L, and severe group: 428.37 ± 123.58 μmol/L and p = 0.029). Multivariable logistic regression analyses showed that SUA was the independent risk factor for OSAHS (OR: 1.006, 95% CI: 1.001-1.011, p = 0.020).

Conclusions

The SUA level is significantly associated with the severity of OSAHS and should be controlled when managing OSAHS.

The prevalence of thyroid nodules in northwest China and its correlation with metabolic parameters and uric acid

This study aimed to estimate the prevalence of thyroid nodules (TN) and investigate its correlation with metabolic parameters, especially uric acid (UA) in northwest Chinese population. We conducted a large cross-sectional survey with 67,781 residents (33,020 men, 34,761 women), aged from 18 to 86 years in Shanxi, China, from January 2012 to December 2014. A thyroid ultrasound examination was performed with number and size of nodules being recorded. Metabolic parameters including body mass index (BMI), blood pressure (BP), triglycerides (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-c), high-density lipoprotein cholesterol (HDL-c), fasting glucose (FG), and uric acid (UA) were also examined. Our study revealed that approximately 30.7% of men and 39.9% of women in Northwest China had TN, about half of which were multi-nodularity and a quarter of their TN larger than 1 cm. The prevalence of TN increased with aging and increasing BMI, and metabolic disorders, which also related to the increased incident of multi-nodularity and larger TN. Serum UA appeared to be a protective factor for TN in men older than 30 years, but a risk factor in both men younger than 30 years and women older than 30 years. This phenomenon needs to be further investigated.

Fructose metabolism and metabolic disease

Increased sugar consumption is increasingly considered to be a contributor to the worldwide epidemics of obesity and diabetes and their associated cardiometabolic risks. As a result of its unique metabolic properties, the fructose component of sugar may be particularly harmful. Diets high in fructose can rapidly produce all of the key features of the metabolic syndrome. Here we review the biology of fructose metabolism as well as potential mechanisms by which excessive fructose consumption may contribute to cardiometabolic disease.

Relationship between serum uric acid level and mild cognitive impairment in Chinese community elderly

BACKGROUND

To evaluate the association between SUA levels within a normal to high range and the risk of mild cognitive impairment (MCI) among community elderly.

METHODS

The present study was based on 2102 community elderly from a cross-sectional study conducted in a representative urban area of Beijing between 2009 and 2010. The mean age were 71.2 ± 6.6 years old, 59.7% were female. Mini-Mental State Examination (MMSE) was used to assess cognitive function by trained neurology doctors.

RESULTS

The prevalence of hyperuricemia and MCI was 16.7% and 15.9% respectively. With the increase of SUA levels, the prevalence of MCI showed a strong decreasing linear trend. Multiple logistic regression analysis showed ORs for MCI were 1.01(95% CI: 0.69-1.48), 1.50(95% CI: 0.85-2.64), 1.65(95% CI: 1.12-2.43) and 1.53(95% CI: 1.00-2.33), 1.84(95% CI: 1.27-2.90), 1.92(95% CI: 1.02-3.35) for the second, third and highest quarters among men and women respectively (with the lowest quartile as the reference).

CONCLUSIONS

Higher SUA levels, when in the normal range, were positively associated with cognitive function among Chinese community elderly, but this association was not robust among participants with hyperuricemia.

The Associations of Serum Uric Acid with Obesity-Related Acanthosis nigricans and Related Metabolic Indices

Objective. Recent studies have shown that hyperuricemia (HUA) is associated with hypertension, dyslipidemia, insulin resistance, and metabolic syndrome (MetS). We aimed to examine the relationship of serum UA with Acanthosis nigricans (AN) and related metabolic indices in obese patients. Methods. A cross-sectional study with 411 obese patients recruited from our department was analyzed in this study. Weight, body mass index (BMI), UA, lipid profile, liver function, and renal function were measured in all participants. Oral glucose tolerance tests were performed, and serum glucose, insulin, and C peptide were measured at 0, 30, 60, 120, and 180 min. Results. AN group had higher serum UA levels than OB group. Circulating UA levels were associated with BMI, dyslipidemia, hypertension, IR, and AN. In logistic regression analyses (multivariable-adjusted), a high serum UA level was associated with high odds ratios (ORs) (95% confidence interval [CI]) for AN in females (ORs = 3.00 and 95% CI [1.02-8.84]) and males (ORs = 6.07 and 95% CI [2.16-17.06]) in the highest quartile (Q4) of serum UA. Conclusions. Serum UA levels were positively associated with multiple metabolic abnormalities including obesity, hypertension, hyperglycemia, hyperlipidemia, and AN and may be an important risk factor in the development of AN; further evidences in vitro and in vivo are needed to investigate the direct or indirect relationship.

Baseline and Change in Uric Acid Concentration Over Time Are Associated With Incident Hypertension in Large Korean Cohort

BACKGROUND

It is uncertain whether high-baseline uric acid (UA) or change in UA concentration over time is related to development of incident hypertension. To investigate relationships between: (i) baseline serum UA concentration and (ii) change in UA concentration and incident hypertension.

METHODS

About 96,606 Korean individuals (with follow-up UA data available for 56,085 people) participating in a health check program was undertaken. Cox regression models were used to estimate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for incident hypertension according to UA quartiles regarding the lowest UA quartile as the reference, and also according to change in UA concentration comparing individuals with an increase in UA to those with a decrease in UA concentration over time.

RESULTS

Total follow up time was 8 years (median follow-up 3.3 years; interquartile range, 1.9-5.1). About 10,405 cases of incident hypertension occurred. In the fully adjusted regression models, the HRs (95% CI) for incident hypertension comparing the highest vs. the lowest quartiles of UA were 1.29 (1.19-1.38) in men and 1.24 (1.09-1.42) in women, with statistically significant P for trend for both gender. Additionally, stable or increasing UA concentration over time was associated with increased risk of incident hypertension, particularly in participants with baseline UA concentration ≥median (aHRs 1.14; 95% CI (1.03-1.26) and 1.18; 95% CI (0.98-1.40) in men and women, respectively).

CONCLUSIONS

High initial UA concentration and increases in UA concentration over time should be considered independent risk factors for hypertension.

Blueberry Consumption Affects Serum Uric Acid Concentrations in Older Adults in a Sex-Specific Manner

Blueberries are rich in antioxidants and may protect against disease. Uric acid accounts for about 50% of the antioxidant properties in humans. Elevated levels of serum uric acid (SUA) or hyperuricemia is a risk factor for cardiovascular disease (CVD). The aim was to determine the effect of blueberries on SUA in older adults. Participants (n = 133, 65–80 years) experiencing mild cognitive impairment (MCI) were randomized in a double-blind 6-month clinical trial to either blueberry or placebo. A reference group with no MCI received no treatment. The mean (SD) SUA at baseline were 5.45 (0.9), 6.4 (1.3) and 5.8 (1.4) mg/dL in reference, placebo, and treatment groups, respectively. Baseline SUA was different in men and women (6.25 (1.1) vs. 5.35 (1.1), p = 0.001). During the first three months, SUA decreased in the blueberry group and was significantly different from the placebo group in both men and women (p < 0.0003). Sex-specific differences became apparent after 3 months, when only men showed an increase in SUA in the blueberry group and not in the placebo (p = 0.0006) between 3 and 6 months. At 6 months SUA had rebounded in both men and women and returned to baseline levels. Baseline SUA was correlated with CVD risk factors, waist circumference and triglycerides (p < 0.05), but differed by sex. Overall, 6 m SUA changes were negatively associated with triglycerides in men, but not in women. Group-wise association between 6 m SUA changes and CVD risk factors showed associations with diastolic blood pressure, triglycerides and high-density lipoprotein (HDL) cholesterol in women of the Blueberry group but not in men or any sex in the placebo group. In summary, blueberries may affect SUA and its relationship with CVD risk in a sex-specific manner.

Hyperuricemia, Cardiovascular Profile, and Comorbidity in Older Men and Women: The Pro.V.A. Study

Hyperuricemia (HU) is growing worldwide and associates with several medical conditions in the elderly. However, data about older people and possible gender differences are sparse. The aim of this study was to compare HU prevalence rates and association with relevant medical disorders in elderly subjects of both sexes. Pro.V.A. is a survey of 3099 individuals aged 65+, focusing on chronic diseases and disability. Uric acid (UA) levels were dichotomized using 6.0 mg/dL (females) and 7.0 mg/dL (males), and multivariate logistic regression models were used to estimate odds ratios (ORs) between HU and single comorbidity. HU prevalence was 21.5% in females and 15.8% in males. HU was associated with most anthropometric and laboratory variables in women, but not in men. After adjustment for age, body mass index, and renal function, HU was independently associated with the presence of cardiovascular diseases in both sexes. In women, HU was associated with hand osteoarthritis (OR = 1.52; 95%CI: 1.12-2.08) and edentulism (OR = 1.31; 95%CI: 1.01-1.71), while resulted protective for osteoporosis (OR = 0.69; 95%CI: 0.53-0.91). In men, HU was significantly related with knee osteoarthritis (OR = 1.72; 95%CI: 1.06-2.79) and chronic obstructive pulmonary disease (OR = 1.60; 95%CI: 1.04-2.45). The presence of ≥4 comorbidities was a stronger determinant of HU in men (OR = 2.54; 95%CI: 1.21-5.37) than in women (ns). Patterns of age-dependent UA increase are markedly different in men and women. HU prevalence is substantial and its association with other diseases is gender specific, connoting a peculiar clinical profile.

The association between the prevalence, treatment and control of hypertension and the risk of mild cognitive impairment in an elderly urban population in China

It remains unclear whether lowering the blood pressure effectively prevents cognitive impairment. The aim of the current study was to explore the association between the prevalence, treatment and control of hypertension and the risk of mild cognitive impairment (MCI) among elderly Chinese people. This is a cross-sectional study conducted in Beijing, China. A two-stage stratified clustering sampling method was used, and 2065 participants, aged ⩾60 years, were included in the analysis. The Mini-Mental State Examination was used to assess participants' cognitive function. The prevalence of MCI was higher in hypertensive (16.5%) than in normotensive individuals (13.1%; P=0.043). Furthermore, in those hypertensive patients, the prevalence of MCI was lower in those treated (14.9%) than in those not treated (19.9%; P=0.019) and lower in those controlled (13.4%) than in those uncontrolled (17.9%; P=0.042). The adjusted odds ratio (OR; 95% confidence interval (CI)) of having MCI was 1.59 (1.07-2.35) in those with hypertension compared with those normotensive individuals. The assessment of the hypertensive patients revealed the adjusted OR (95% CI) of having MCI in those with treated hypertension was 0.60 (0.42-0.86) compared with those untreated hypertension, and in those with controlled hypertension was 0.64 (0.43-0.93) compared with those non-controlled hypertension (regardless of treatment). However, among the treated hypertensive patients, there was no difference in the prevalence of MCI between the patients who reached and those who did not reach their treatment goal. We suggest that improved diagnoses and optimal therapeutics are needed to achieve the aim of cognitive decline prevention.

Leptin and uric acid as predictors of metabolic syndrome in jordanian adults

BACKGROUND/OBJECTIVES

Metabolic syndrome (MetS) is a set of interrelated metabolic risk factors that increase the risk of cardiovascular morbidity and mortality. Studies regarding the specificity and sensitivity of serum levels of leptin and uric acid as predictors of MetS are limited. The aim of this study was to evaluate the serum levels of leptin and uric acid in terms of their specificity and sensitivity as predictors of MetS in the studied Jordanian group.

SUBJECTS/METHODS

In this cross sectional study, 630 adult subjects (308 men and 322 women) were recruited from the King Hussein Medical Center (Amman, Jordan). The diagnosis of MetS was made according to the 2005 International Diabetes Federation criteria. Receiver operating characteristic curves were used to determine the efficacy of serum levels of leptin and uric acid as predictors of MetS in the studied Jordanian group.

RESULTS

Study results showed that for identification of subjects with MetS risk, area under the curve (AUC) for leptin was 0.721 and 0.683 in men and women, respectively. Serum uric acid levels in men showed no significant association with any MetS risk factors and no significant AUC, while uric acid AUC was 0.706 in women.

CONCLUSION

Serum leptin levels can be useful biomarkers for evaluation of the risk of MetS independent of baseline obesity in both men and women. On the other hand, serum uric acid levels predicted the risk of MetS only in women.

The impact of serum uric acid on the natural history of glomerular filtration rate: a retrospective study in the general population

Serum uric acid (SUA) level has been proposed to have important connections with chronic kidney disease (CKD), while the impact of SUA level on the natural history of glomerular filtration rate (GFR) decline remains unknown. The present study aims to study the association of the SUA level with the GFR decline in a general population. Two thousand, seven hundred and eighty-nine subjects who visited the Health Checkup Clinic both at 2008 and 2013 were identified. A significant inverse correlation was observed between change in SUA from 2008–2013 (ΔSUA) and change in eGFR (ΔeGFR) during the same period. Multivariate regression analysis of ΔeGFR indicated that the increase in SUA over time were a negative predictor of the change in eGFR. Our result indicates that the decline of eGFR over years is larger in subjects with an increased SUA level, which helps to underline the importance of SUA level management in the context of kidney function preservation.

Association of high-sensitivity C-reactive protein and uric acid with the metabolic syndrome components

Metabolic syndrome (MetS) has been found to be associated with inflammatory molecules. This study was conducted among 125 MetS patients at B P Koirala Institute of Health Sciences, Dharan, Nepal to find an association of high-sensitivity C-reactive protein (hs-CRP) and serum uric acid with MetS components. Anthropometric measurements, blood pressure, medical history and blood samples were taken. Estimation of hs-CRP, serum uric acid, blood glucose, triglyceride and high density lipoprotein (HDL) cholesterol was done. hs-CRP had positive correlation with blood glucose (r = 0.2, p = 0.026) and negative with HDL cholesterol (r = −0.361, p < 0.001). Serum uric acid had positive correlation with waist circumference (r = 0.178, p = 0.047). Patients with elevated hs-CRP and uric acid had higher waist circumference (p = 0.03), diastolic BP (p = 0.002) and lower HDL cholesterol (p = 0.004) than others. Elevated hs-CRP and high uric acid were individually associated with higher odds for low HDL cholesterol (7.992; 1.785–35.774, p = 0.002) and hyperglycemia (2.471; 1.111–5.495, p = 0.029) respectively. Combined rise of hs-CRP and uric acid was associated with severity of MetS (p < 0.001) and higher odds for hyperglycemia (8.036; 2.178–29.647, p = 0.001) as compared to individual rise of hs-CRP or uric acid. The present study demonstrates that hs-CRP and serum uric acid are associated with MetS components, and the combined rise of hs-CRP and uric acid is associated with the increase in severity of MetS.

The Power of Serum Uric Acid in Predicting Metabolic Syndrome Diminishes With Age in an Elderly Chinese Population

OBJECTIVES

Although serum uric acid (sUA) is not a criterion for diagnosing metabolic syndrome (MetS), many studies have identified a positive association between sUA and MetS in patients of various ages and ethnicities. This association has not been fully established in the very elderly.

DESIGN

Cross-sectional and longitudinal study.

SETTING AND PARTICIPANTS

A total of 18,906 Chinese elderly aged 65 and older undergoing routine health checkups in Taiwan were enrolled.

MEASUREMENTS

Modified Adult Treatment Panel III criteria were used to define MetS. All participants were further divided into nine groups with gender specification according to age (the young-old, 65 to 74; old-old, 75 to 84; and oldest-old, 85 and over) and sUA concentration tertile (males: sUAG1, <5.7 mg/dL; sUAG2, 5.7-6.7 mg/dL; and sUAG3, > 6.7 mg/dL; females: sUAG1, <4.9 mg/dL; sUAG2, 4.9-5.9 mg/dL; and sUAG3, > 5.9 mg/dL). A cross-sectional study was first performed to determine the correlation between sUA and MetS and its components. A longitudinal study then excluded subjects with MetS at baseline to explore the risk of MetS according to sUA levels in 3 age groups.

RESULTS

In the cross-sectional study, we observed a graded, positive association between sUA and MetS components that diminished after age 75. Subjects with higher sUA levels had higher odds ratios (OR) for the occurrence of MetS in the young-old and old-old groups of both sexes (P<0.001) except sUAG2 males in the old-old group. However, the association diminished with age and only a higher OR was observed in sUAG2 males in the oldest-old group (OR, 3.38; 95% CI, 1.11-10.30; P = 0.032). In the longitudinal study, the Kaplan-Meier plot showed that higher sUA levels were associated with a higher risk of MetS in the young-old group of both genders (P < 0.001 sUAG3 vs. sUAG1 and sUAG2). Cox regression analysis further confirmed these results (young-old group: sUAG3 HR, 1.90; 95% CI, 1.42-2.54; P < 0.001; old-old group males: HR, 2.20; 95% CI, 1.04-4.65; P = 0.039; young-old females: HR, 1.83; 95% CI, 1.38 - 2.43; P < 0.001).

CONCLUSIONS

Higher sUA levels in the young-old group of Chinese elderly were associated with a higher risk of developing MetS. sUA levels are thus regarded as a potential tool for early diagnosis of MetS. However, this association diminished in those over 75 years of age.

High serum uric acid levels increase the risk of metabolic syndrome in elderly women: The PRO.V.A study

BACKGROUND AND AIMS

Serum uric acid (SUA) is the end-product of purine metabolism in humans, and its levels often increase in subjects with metabolic syndrome (MetS). Despite several studies demonstrating a relationship between increased SUA levels and the prevalence of MetS, prospective data on SUA as a predictor of the incidence of MetS in the elderly are limited. Our aim was to conduct a prospective study on the association between SUA concentrations and the onset of MetS in an elderly Italian cohort.

METHODS AND RESULTS

This is a cohort study (Progetto Veneto Anziani; Pro.V.A.) involving community-dwelling subjects aged ≥65 years and followed up for a mean 4.4 years. We included 1128 participants (aged 74.7 ± 7.1 years) without MetS at the baseline. Gender-specific SUA groups according to the standard deviation (SD) from the mean were considered, taking the incidence of MetS as the main outcome. The mean SUA level was significantly higher in men than in women (5.4 ± 1.2 vs. 4.5 ± 1.2 mg/dl; p < 0.0001). Over the 4.4-year follow-up, 496 individuals developed MetS. After adjusting for potential confounders, Cox's regression analysis revealed no relationship between higher baseline SUA concentrations and the incidence of MetS in men or in the sample as whole, while women with SUA levels more than 1 SD above the mean (≥5.7 mg/dl) carried a 58% higher risk (95%CI: 1.03-2.40; p = 0.03) of being newly diagnosed with MetS during the follow-up.

CONCLUSION

High SUA levels significantly and independently predicted MetS in older women, but not in men, over a 4.4-year follow-up.

Association Between Family History and Hypertension Among Chinese Elderly

This study aimed to evaluate the association between family history and prevalence of hypertension among Chinese community elderly, and also explore the gender difference. A population-based cross-sectional study was conducted in Miyun district of Beijing, in 2014. The family history information was obtained from each subject and was divided into 3 categories, no family history (FH0), 1 generation of first-degree relatives with hypertension (FH1), and 2 generations of first-degree relatives with hypertension (FH2). The prevalence of hypertension was 53.0%. Participants with positive family history had a significantly higher prevalence of hypertension (67.5%, 95% CI: 63.3-71.7) than those without (47.9%, 95% CI: 45.2-50.6), and even among participants without hypertension, the blood pressure levels were higher with positive FH. Multiple logistic regression analysis showed that a significantly linear-trend increase in hypertension according to family history of first degree relative numbers was observed in both genders (P for trend < 0.001). This study suggests that family history had not only a significant but also graded association with hypertension and with blood pressure levels, and this association exists even among those without hypertension.

Gender differences in the association between hyperuricemia and diabetic kidney disease in community elderly patients

AIMS

To investigate gender differences of the associations between hyperuricemia and diabetic kidney disease (DKD) in elderly patients with type 2 diabetes mellitus (T2DM) based on electronic health records (EHR).

METHODS

A total of 20,207 older diabetic patients (mean age 71±7years) were investigated based on the EHR from 2012 to 2013 in the Minhang District of Shanghai-China. The status of hyperuricemia, albuminuric DKD and the odds ratios of DKD relative to hyperuricemia were analyzed among 8541 men and 11,666 women.

RESULTS

The overall rate of hyperuricemia was 20.5% (males: 17.2%, females: 23.0%) and that of albuminuric DKD was 36.2% (males: 32.2%, female: 39.1%) in these diabetic patients. Hyperuricemia was independently associated with increased risk of reduced renal function and albuminuria (p<0.001) in both genders. After adjustment of traditional DKD risk factors, hyperuricemia had a stronger association with albuminuric DKD in males (OR 1.67, 95% CI: 1.48-1.88) than in females (OR 1.23, 95% CI: 1.12-1.35).

CONCLUSIONS

This study showed an independent association of hyperuricemia with albuminuric DKD that was stronger in elderly males for the first time in China based on EHR. The level of uric acid should be monitored and managed in older diabetic patients.

Dose-response Relationship of Serum Uric Acid with Metabolic Syndrome and Non-alcoholic Fatty Liver Disease Incidence: A Meta-analysis of Prospective Studies

Emerging evidence has shown that serum uric acid (SUA) elevation might cause metabolic derangements, including metabolic syndrome (MetS) and non-alcoholic fatty liver disease (NAFLD); however, magnitude of the risk has not been quantified. We searched PubMed, EMBASE, and ISI databases for relevant studies through 10 May 2015. Prospective studies reporting the risk of SUA elevation on the incidence of MetS/NAFLD were enrolled. Pooled HR of MetS was 1.55 (95%CI: 1.40-1.70) for the highest versus lowest SUA categories, and 1.05 (95%CI: 1.04-1.07) per incremental increased in SUA of 1 mg/dl. The pooled HR of MetS in younger women was higher than age-matched men and older women (1.17 vs. 1.05 and 1.04, respectively, P < 0.05). Individuals in the highest SUA category had a 40% greater risk of disease NAFLD occurrence. Dose-response increment of NAFLD events was 1.03 (95%CI: 1.02-1.05). A positive relationship with a linear trend for SUA elevation with MetS and NAFLD in different genders was examined by a dose-response meta-analysis (P < 0.001).SUA assay is useful in screening metabolic disorders for linear trend between its elevation and MetS/NAFLD incidence. SUA-lowering therapy is a potential strategy for preventing systemic/hepatic metabolic abnormalities.

Serum uric acid is associated with cardiac diastolic dysfunction among women with preserved ejection fraction

Serum uric acid (SUA) is associated with the severity and prognosis of systolic heart failure. We investigated the potential association between SUA and cardiac diastolic dysfunction among total of 744 cardiac patients (202 women and 542 men) who had preserved left ventricular ejection fraction. Presence of diastolic dysfunction was assessed by echocardiographic data, plasma B-type natriuretic peptide concentration, and left ventricular hypertrophy. Univariate analysis showed that the prevalence of diastolic dysfunction increased with increasing SUA value in women, but not in men. When sex-nonspecific SUA quartiles were used, multivariate logistic regression analysis, among female patients who were not taking uric acid lowering medication, showed that the third (SUA, 5.7-6.4 mg) and the fourth (SUA, ≥6.5 mg/dl) SUA quartiles were associated with diastolic dysfunction with an odds ratio of 3.25 (P < 0.05) and 8.06 (P < 0.001), respectively, when compared with the first SUA quartile (≤4.7 mg/dl). When sex-specific SUA quartiles were used among these population, multivariate logistic regression analysis showed that the fourth SUA quartile (≥5.7 mg/dl) was associated with diastolic dysfunction with an odds ratio of 5.34 (P < 0.05) when compared with the first SUA quartile (≤4.1 mg/dl). By contrast, the relationship between SUA and diastolic dysfunction was not significant in men, irrespective of which of the sex-nonspecific or sex-specific SUA quartiles were used. These data indicated that among cardiac patients with preserved ejection fraction, SUA was significantly associated with diastolic dysfunction in women but not in men.