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Kim J, Lee SY, Lee J, Yoon S, Kim EG, Lee E, Kim N, Lee S, Gym H, Park SI. Effects of uric acid on ischemic diseases, stratified by lipid levels: a drug-target, nonlinear Mendelian randomization study. Sci Rep 2024; 14:1338. [PMID: 38228698 PMCID: PMC10791707 DOI: 10.1038/s41598-024-51724-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 01/09/2024] [Indexed: 01/18/2024] Open
Abstract
Although uric acid-lowering agents such as xanthine oxidase inhibitors have potential cardioprotective effects, studies on their use in preventing cardiovascular diseases are lacking. We investigated the genetically proxied effects of reducing uric acid on ischemic cardiovascular diseases in a lipid-level-stratified population. We performed drug-target Mendelian randomization (MR) analyses using UK Biobank data to select genetic instruments within a uric acid-lowering gene, xanthine dehydrogenase (XDH), and construct genetic scores. For nonlinear MR analyses, individuals were stratified by lipid level. Outcomes included acute myocardial infarction (AMI), ischemic heart disease, cerebral infarction, transient cerebral ischemic attack, overall ischemic disease, and gout. We included 474,983 non-gout individuals with XDH-associated single-nucleotide polymorphisms. The XDH-variant-induced uric acid reduction was associated with reduced risk of gout (odds ratio [OR], 0.85; 95% confidence interval [CI], 0.78-0.93; P < 0.001), cerebral infarction (OR, 0.86; 95% CI, 0.75-0.98; P = 0.023), AMI (OR, 0.79; 95% CI, 0.66-0.94; P = 0.010) in individuals with triglycerides ≥ 188.00 mg/dL, and cerebral infarction in individuals with low-density lipoprotein cholesterol (LDL-C) ≤ 112.30 mg/dL (OR, 0.76; 95% CI, 0.61-0.96; P = 0.020) or LDL-C of 136.90-157.40 mg/dL (OR, 0.67; 95% CI, 0.49-0.92; P = 0.012). XDH-variant-induced uric acid reduction lowers the risk of gout, AMI for individuals with high triglycerides, and cerebral infarction except for individuals with high LDL-C, highlighting the potential heterogeneity in the protective effects of xanthine oxidase inhibitors for treating AMI and cerebral infarction depending on the lipid profiles.
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Affiliation(s)
- Jungeun Kim
- Basgenbio Inc., Seoul, Republic of Korea
- Department of Statistics and Actuarial Science, College of Natural Sciences, Soongsil University, Seoul, Republic of Korea
| | | | - Jihye Lee
- Basgenbio Inc., Seoul, Republic of Korea
| | - Sanghyuk Yoon
- Basgenbio Inc., Seoul, Republic of Korea
- Department of Epidemiology and Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea
| | | | | | - Nayoung Kim
- Basgenbio Inc., Seoul, Republic of Korea
- Department of Epidemiology and Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea
| | - Sol Lee
- Basgenbio Inc., Seoul, Republic of Korea
| | - Ho Gym
- Basgenbio Inc., Seoul, Republic of Korea
| | - Sang-In Park
- Department of Pharmacology, College of Medicine, Kangwon National University, 1 Gangwondaehak-gil, Chuncheon-si, Gangwon-do, 24341, Republic of Korea.
- Biomedical Research Institute, Kangwon National University Hospital, Chuncheon, Republic of Korea.
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Otani N, Hoshiyama E, Ouchi M, Takekawa H, Suzuki K. Uric acid and neurological disease: a narrative review. Front Neurol 2023; 14:1164756. [PMID: 37333005 PMCID: PMC10268604 DOI: 10.3389/fneur.2023.1164756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 05/05/2023] [Indexed: 06/20/2023] Open
Abstract
Hyperuricemia often accompanies hypertension, diabetes, dyslipidemia, metabolic syndrome, and chronic renal disease; it is also closely related to cardiovascular disease. Moreover, several epidemiological studies have linked hyperuricemia and ischemic stroke. However, uric acid may also have neuroprotective effects because of its antioxidant properties. An association between low uric acid levels and neurodegenerative diseases has been suggested, which may be attributed to diminished neuroprotective effects as a result of reduced uric acid. This review will focus on the relationship between uric acid and various neurological diseases including stroke, neuroimmune diseases, and neurodegenerative diseases. When considering both the risk and pathogenesis of neurological diseases, it is important to consider the conflicting dual nature of uric acid as both a vascular risk factor and a neuroprotective factor. This dual nature of uric acid is important because it may help to elucidate the biological role of uric acid in various neurological diseases and provide new insights into the etiology and treatment of these diseases.
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Affiliation(s)
- Naoyuki Otani
- Department of Cardiology, Dokkyo Medical University Nikkyo Medical Center, Mibu, Japan
| | - Eisei Hoshiyama
- Department of Neurology, Dokkyo Medical University, Mibu, Japan
| | - Motoshi Ouchi
- Department of Pharmacology and Toxicology, Dokkyo Medical University School of Medicine, Mibu, Japan
| | - Hidehiro Takekawa
- Department of Neurology, Dokkyo Medical University, Mibu, Japan
- Stroke Center, Dokkyo Medical University, Mibu, Japan
| | - Keisuke Suzuki
- Department of Neurology, Dokkyo Medical University, Mibu, Japan
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Global status and trends in gout research from 2012 to 2021: a bibliometric and visual analysis. Clin Rheumatol 2023; 42:1371-1388. [PMID: 36662336 PMCID: PMC9852810 DOI: 10.1007/s10067-023-06508-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 12/28/2022] [Accepted: 01/05/2023] [Indexed: 01/21/2023]
Abstract
BACKGROUND Gout is the most common inflammatory arthritis with an increasing prevalence and incidence across the globe. We aimed to provide a comprehensive and systematic knowledge map of gout research to determine its current status and trends over the past decade. METHODS Publications on gout research were obtained from the Web of Science Core Collection (WOSCC) database. Bibliometric R, VOSviewer, and Citespace were employed to analyze the eligible literature. RESULTS A total of 5535 publications concerning gout research between 2012 and 2021 were included. Most publications and citations both numerically came from China. The strongest international cooperation belonged to the USA. The University of Auckland was the most productive institution with a leading place in research collaboration. The prime funding agency was the National Natural Science Foundation of China. Most papers were published in Clinical Rheumatology. Annals of the Rheumatic Diseases achieved the highest number of citations, H-index and IF, which showed the most excellent comprehensive strength. The individual author with the most paper authorship was Dalbeth Nicola with 241 publications and 46 H-index. Keywords and co-citation analysis discovered that pathological mechanism remains the future hotspot in gout research. It may involve gout connection with gut microbiota, NLRP3 inflammasome, xanthine oxidase, and urate-transporter ABCG2. In addition, besides metabolic diseases, the relationship between gout and heart failure may need more attention. CONCLUSION This study clarified the current status and research frontier in gout over the past decade, which would provide valuable research references for later researchers. Key Points •We disclosed the current status and frontier directions of gout over the past 10 years worldwide. •We identified future hotspots of gout research, including gout connection with gut microbiota, NLRP3 inflammasome, xanthine oxidase, and urate-transporter ABCG2. •We discovered that the relationship between gout and heart status would be the research frontier.
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Rahimi N, Modabberi S, Faghir-Ghanesefat H, Shayan M, Farzad Maroufi S, Asgari Dafe E, Reza Dehpour A. The Possible Role of Nitric Oxide signaling and NMDA Receptors in Allopurinol effect on Maximal Electroshock- and Pentylenetetrazol-Induced Seizures in Mice. Neurosci Lett 2022; 778:136620. [PMID: 35395326 DOI: 10.1016/j.neulet.2022.136620] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/16/2022] [Accepted: 04/03/2022] [Indexed: 11/26/2022]
Abstract
Allopurinol, a uric-acid-lowering medication, has shown its efficacy in several studies suggesting that allopurinol can be prescribed as adjunctive cure meant for intractable epilepsy. The exact mechanism of allopurinol is still unknown. This study evaluates allopurinol's effect on seizure threshold, seizure incidence, and mortality rate in mice models. Moreover, the possible involvement of nitric oxide (NO) pathway and N-methyl-D-aspartate (NMDA) receptors are investigated. To evaluate the effect of allopurinol on seizure, we used the pentylenetetrazole (PTZ)-induced seizure along with maximal electroshock (MES)-induced seizure. To assess the underlying mechanism behind the allopurinol activity, we used nitric oxide synthase (NOS) substrate (L-arginine), NOS inhibitors (L-NAME, aminoguanidine, 7-nitroindazole), and NMDA receptor antagonist (MK-801). Intraperitoneal allopurinol administration at a dose of 50 mg/kg in mice showed a significant (p<0.001) anti-convulsant activity in the PTZ-induced seizure. Even though pre-treatment with L-Arginine (60 mg/kg) potentiates allopurinol's anti-convulsant effect in the PTZ-induced seizure, pre-treatment with L-NAME (10 mg/kg), aminoguanidine (100 mg/kg), and 7-nitroindazole (30 mg/kg) reversed the anti-convulsant effect of allopurinol in the PTZ-induced seizure. In addition, pre-treatment with MK-801 also decreased the anti-convulsant effect of allopurinol in the PTZ-induced seizure. While allopurinol at a dose of 50 mg/kg and 100 mg/kg did not induce protection against seizure incidence in the MES-induced seizure, it revealed a remarkable effect in reducing the mortality rate in the MES-induced seizure. Allopurinol increases the seizure threshold in PTZ-induced seizure and enhances the survival rate in MES-induced seizure. Allopurinol exerts its anti-convulsant effect, possibly through targeting NO pathway and NMDA receptors.
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Affiliation(s)
- Nastaran Rahimi
- Experimental Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Sepideh Modabberi
- Experimental Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Hedyeh Faghir-Ghanesefat
- Experimental Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Shayan
- Experimental Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Farzad Maroufi
- Experimental Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Elaheh Asgari Dafe
- Experimental Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Reza Dehpour
- Experimental Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
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Association between circulating cystatin C and hyperuricemia: a cross-sectional study. Clin Rheumatol 2022; 41:2143-2151. [PMID: 35355151 DOI: 10.1007/s10067-022-06139-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 03/16/2022] [Accepted: 03/19/2022] [Indexed: 11/03/2022]
Abstract
INTRODUCTION/OBJECTIVES Circulating cystatin C has reportedly been related to cardiovascular disease, diabetes, and metabolic syndrome, apart from its traditional role in estimating the glomerular filtration rate. However, whether circulating cystatin C is related to hyperuricemia remains unclear. METHOD We included 2406 men and 1273 women who attended their annual health checkups in this study. Anthropometric and biochemical parameters were measured. Hyperuricemia was diagnosed as fasting serum uric acid > 420 µmol/L in men and women. RESULTS A total of 695 (18.9%) participants were diagnosed with hyperuricemia. Hyperuricemic patients had significantly higher serum cystatin C levels than healthy controls (0.91 (0.83-1.02) versus 0.82 (0.72-0.92) mg/L, P < 0.001). Serum cystatin C levels were positively related to the prevalence of hyperuricemia, which was 5.18%, 14.76%, 22.66%, and 31.24% in participants with serum cystatin C levels in the first, second, third, and fourth quartiles, respectively (P < 0.001 for trend). In stepwise multivariate logistic regression analysis, participants with serum cystatin C in the fourth quartile had a more than twofold increased risk of hyperuricemia (OR 2.262, 95% CI 1.495-3.422; P < 0.001) compared with those with serum cystatin C in the first quartile. In subgroup analyses, the fourth quartile of cystatin C was related to increased risks of hyperuricemia in both non-obese and obese participants (OR 4.405, 95% CI 1.472-13.184, P = 0.008; OR 1.891, 95% CI 1.228-2.911, P = 0.004, respectively), in non-metabolic syndrome participants (OR 3.043, 95% CI 1.692-5.473; P < 0.001) but not in metabolic syndrome participants (OR 1.689, 95% CI 0.937-3.045; P = 0.081), and in non-non-alcoholic fatty liver disease (non-NAFLD) (OR 2.128, 95% CI 1.424-3.180; P < 0.001, respectively) and young and middle-aged participants (OR 2.235, 95% CI 1.492-3.348, P < 0.001) but not in NAFLD and elderly participants. CONCLUSIONS This study revealed a positive association of circulating cystatin C with hyperuricemia. Key Points • Serum cystatin C is associated with an increased risk of hyperuricemia. • Serum cystatin C is a useful biomarker in distinguishing patients at high risk of having hyperuricemia.
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Allopurinol to reduce cardiovascular morbidity and mortality: A systematic review and meta-analysis. PLoS One 2021; 16:e0260844. [PMID: 34855873 PMCID: PMC8638940 DOI: 10.1371/journal.pone.0260844] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 11/17/2021] [Indexed: 12/02/2022] Open
Abstract
Aims To compare the effectiveness of allopurinol with no treatment or placebo for the prevention of cardiovascular events in hyperuricemic patients. Methods and results Pubmed, Web of Science and Cochrane library were searched from inception until July 2020. Randomized controlled trials (RCT) and observational studies in hyperuricemic patients without significant renal disease and treated with allopurinol, versus placebo or no treatment were included. Outcome measures were cardiovascular mortality, myocardial infarction, stroke, or a combined endpoint (CM/MI/S). For RCT’s a random effects meta-analysis was performed. For observational studies a narrative synthesis was performed. Of the original 1995 references we ultimately included 26 RCT’s and 21 observational studies. We found a significantly reduced risk of combined endpoint (Risk Ratio 0.65 [95% CI] [0.46 to 0.91]; p = 0.012) and myocardial infarction (RR 0.47 [0.27 to 0.80]; p = 0.01) in the allopurinol group compared to controls. We found no significant effect of allopurinol on stroke or cardiovascular mortality. Of the 15 observational studies with sufficient quality, allopurinol was associated with reduced cardiovascular mortality in 1 out of 3 studies that reported this outcome, myocardial infarction in 6 out of 8, stroke in 4 out of 7, and combined end-point in 2 out of 2. Cardiovascular benefit was only observed when allopurinol therapy was prolonged for more than 6 months and when an appropriate allopurinol dose was administered (300 mg or more/day) or sufficient reduction of serum urate concentration was achieved (<0.36 mmol/l). Conclusions Data from RCT’s and observational studies indicate that allopurinol treatment reduces cardiovascular risk in patients with hyperuricemia. However, the quality of evidence from RCTs is low to moderate. To establish whether allopurinol lowers the risk of cardiovascular events a well-designed and adequately powered randomized, placebo-controlled trial is needed in high-risk patients with hyperuricemia. Systematic review registration PROSPERO registration CRD42018089744
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Padda J, Khalid K, Padda S, Boddeti NL, Malhi BS, Nepal R, Cooper AC, Jean-Charles G. Hyperuricemia and Its Association With Ischemic Stroke. Cureus 2021; 13:e18172. [PMID: 34703698 PMCID: PMC8530529 DOI: 10.7759/cureus.18172] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2021] [Indexed: 12/29/2022] Open
Abstract
Elevated serum uric acid (SUA) levels have been associated with an increased risk of cardiovascular (CV) disease and acute ischemic stroke (AIS) as well as many other medical conditions. AIS is a CV complication that is the second most common cause of mortality worldwide. It results from reduced blood flow to the brain by means of thrombosis, embolism, or systemic hypoperfusion. Studies have demonstrated an association between SUA levels and CV events, with a significant dose-response relationship between elevated SUA levels and stroke risk. Since the relationship between SUA levels and AIS risk has been established, studies are also being conducted in order to evaluate whether antihyperuricemic drugs can lower this risk. Allopurinol use in hyperuricemic patients has been shown to decrease the risk of major CV events, which include AIS. This narrative review aims to investigate the role of SUA as an independent risk factor for AIS along with the proposed biological mechanisms by thoroughly appraising research findings from relevant full-text articles and abstracts indexed in PubMed and the Cochrane Library. In this literature, we will be discussing hyperuricemia, AIS, the association between the two, and the use of antihyperuricemic medications on stroke prognosis. This review will also shed new light on studies that have begun to provide insight into the predictive role of hyperuricemia in AIS.
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Affiliation(s)
- Jaskamal Padda
- Internal Medicine, Jersey City (JC) Medical Center, Orlando, USA
| | - Khizer Khalid
- Internal Medicine, Jersey City (JC) Medical Center, Orlando, USA
| | - Sandeep Padda
- Internal Medicine, Jersey City (JC) Medical Center, Orlando, USA
| | | | | | - Rohini Nepal
- Internal Medicine, Jersey City (JC) Medical Center, Orlando, USA
| | | | - Gutteridge Jean-Charles
- Internal Medicine, Jersey City (JC) Medical Center, Orlando, USA.,Internal Medicine, Advent Health & Orlando Health Hospital, Orlando, USA
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Suissa S, Suissa K, Hudson M. Allopurinol and cardiovascular events: Time-related biases in observational studies. Arthritis Care Res (Hoboken) 2021; 74:858-865. [PMID: 34057310 DOI: 10.1002/acr.24713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/05/2021] [Accepted: 05/20/2021] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Several observational studies reported that allopurinol, an effective treatment for gout, was associated with important reductions in cardiovascular events, with calls for large randomized trials, though some results were conflicting. We assessed the extent of time-related biases in these observational studies. METHODS We searched the literature for all observational studies reporting on allopurinol and cardiovascular events, focusing on two time-related biases. Time-related confounding bias results from studies using cohorts of patients all exposed to allopurinol, with comparisons based on episodes of allopurinol discontinuation, where confounding factors are not updated over follow-up time. Immortal time bias arises from the exposure misclassification of periods of cohort follow-up during which the outcome under study cannot occur. RESULTS We identified 12 studies, of which eight were affected by time-related confounding bias or immortal time bias, while the remaining four studies avoided these biases. The studies affected by time-related confounding bias resulted in significant reductions in the incidence of cardiovascular events with allopurinol use (pooled hazard ratio 0.88; 95% CI: 0.85-0.92), as did the studies affected by immortal time bias (pooled hazard ratio 0.79; 95% CI: 0.72-0.87). The four studies that avoided these biases resulted in a pooled hazard ratio of 1.07 (95% CI: 0.91-1.25). CONCLUSIONS Observational studies reporting significantly reduced incidence of cardiovascular events with allopurinol use were affected by time-related biases. Overall, studies that avoided these biases did not find a protective effect. The ALL-HEART randomised trial will provide important and accurate evidence on the potential effectiveness of allopurinol on cardiovascular outcomes.
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Affiliation(s)
- Samy Suissa
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Canada.,Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada.,Department of Medicine, McGill University, Montréal, Canada
| | - Karine Suissa
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA,, USA
| | - Marie Hudson
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Canada.,Department of Medicine, McGill University, Montréal, Canada.,Division of Rheumatology, Jewish General Hospital, Montreal, Canada
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Hyperuricemia in Kidney Disease: A Major Risk Factor for Cardiovascular Events, Vascular Calcification, and Renal Damage. Semin Nephrol 2020; 40:574-585. [PMID: 33678312 DOI: 10.1016/j.semnephrol.2020.12.004] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Kidney disease, especially when it is associated with a reduction in estimated glomerular filtration rate, can be associated with an increase in serum urate (uric acid), suggesting that hyperuricemia in subjects with kidney disease may be a strictly secondary phenomenon. Mendelian randomization studies that evaluate genetic scores regulating serum urate also generally have not found evidence that serum urate is a causal risk factor in chronic kidney disease. Nevertheless, this is countered by a large number of epidemiologic, experimental, and clinical studies that have suggested a potentially important role for uric acid in kidney disease and cardiovascular disease. Here, we review the topic in detail. Overall, the studies strongly suggest that hyperuricemia does have an important pathogenic role that likely is driven by intracellular urate levels. An exception may be the role of extracellular uric acid in atherosclerosis and vascular calcification. One of the more striking findings on reviewing the literature is that the primary benefit of lowering serum urate in subjects with CKD is not by slowing the progression of renal disease, but rather by reducing the incidence of cardiovascular events and mortality. We recommend large-scale clinical trials to determine if there is a benefit in lowering serum urate in hyperuricemic subjects in acute and chronic kidney disease and in the reduction of cardiovascular morbidity and mortality in subjects with end-stage chronic kidney disease.
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Borghi C, Agabiti-Rosei E, Johnson RJ, Kielstein JT, Lurbe E, Mancia G, Redon J, Stack AG, Tsioufis KP. Hyperuricaemia and gout in cardiovascular, metabolic and kidney disease. Eur J Intern Med 2020; 80:1-11. [PMID: 32739239 DOI: 10.1016/j.ejim.2020.07.006] [Citation(s) in RCA: 129] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 06/16/2020] [Accepted: 07/07/2020] [Indexed: 02/07/2023]
Abstract
During the last century, there has been an increasing prevalence of hyperuricaemia noted in many populations. While uric acid is usually discussed in the context of gout, hyperuricaemia is also associated with hypertension, chronic kidney disease, hypertriglyceridaemia, obesity, atherosclerotic heart disease, metabolic syndrome, and type 2 diabetes. Here we review the connection between hyperuricaemia and cardiovascular, kidney and metabolic diseases. Contrary to the popular view that uric acid is an inert metabolite of purine metabolism, recent studies suggest serum uric acid may have a variety of pro-inflammatory, pro-oxidative and vasoconstrictive actions that may contribute to cardiometabolic diseases. Hyperuricaemia is a predictive factor for the development of hypertension, metabolic syndrome, type 2 diabetes, coronary artery disease, left ventricular hypertrophy, atrial fibrillation, myocardial infarction, stroke, heart failure and chronic kidney disease. Treatment with uric acid-lowering therapies has also been found to improve outcomes in patients with hypertension and kidney disease, in some but not all studies. In conclusion, uric acid is emerging as a potentially treatable risk factor for cardiometabolic diseases, and more clinical trials investigating the potential benefit of lowering serum uric acid are recommended in individuals with hyperuricaemia with and without deposition and concomitant hypertension, metabolic syndrome or chronic kidney disease.
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Affiliation(s)
- Claudio Borghi
- Department of Medical and Surgical Sciences, Ospedale Malpighi, University of Bologna, Via Albertoni 15, 40138 Bologna, Italy.
| | - Enrico Agabiti-Rosei
- Department of Clinical and Experimental Sciences, University of Brescia Division of Medicine, Viale Europa, 11 - 25123 Brescia, Italy
| | - Richard J Johnson
- Department of Medicine, University of Colorado Anschutz Medical Campus, 12700 East 19th Ave Aurora, Colorado, United States
| | - Jan T Kielstein
- Medical Clinic V: Nephrology, Rheumatology and Blood Purification, Academic Teaching Hospital Braunschweig, Salzdahlumer Straße 90, 38126, Braunschweig, Germany
| | - Empar Lurbe
- Pediatric Department, General Hospital of Valencia and CIBERObn, Av. Menéndez Pelayo 4, 46010 Valencia, Spain
| | - Giuseppe Mancia
- University of Milano-Bicocca, Piazza dell'AteneoNuovo, 1, 20126 Milan and Policlinico di Monza, Monza, Italy
| | - Josep Redon
- Hospital Clinic of Valencia, INCLIVA University of Valencia and CIBERObn, Av. Menéndez Pelayo 4, 46010 Valencia, Spain
| | - Austin G Stack
- Department of Nephrology, University Hospital Limerick, Graduate Entry Medical School, University of Limerick, Castletroy, Co. Limerick, V94 T9PX, Ireland
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Rosas G, Gaffo A, Rahn EJ, Saag KG. Cardiovascular safety risks associated with gout treatments. Expert Opin Drug Saf 2020; 19:1143-1154. [PMID: 32731769 DOI: 10.1080/14740338.2020.1804551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Uric acid is the final byproduct of purine metabolism. The loss of the enzyme that hydrolyzes uric acid to allantoin was lost, leading to a decrease in uric acid excretion and its further accumulation. The buildup of uric acid leads to damage in different organ systems, including the cardiovascular system. With the increasing burden of cardiovascular disease worldwide, a growing body of evidence has addressed the relationship between urate, cardiovascular outcomes, and gout medication cardiovascular safety. Areas covered: We discuss the most common gout therapies used for the reduction of serum urate and management of gout flares in different observational and clinical trials and their effects on different aspects of cardiovascular disease. We selected the most representative clinical studies that evaluated cardiovascular outcomes with each gout therapy as well as recommendation given by the most representative guidelines from Rheumatology societies for the management of gout. EXPERT OPINION The treatment of gout reduces joint damage and it can also lessen CV morbidity. Allopurinol shows CV safety profile when compared to other ULTs. Evidence supporting CV safety with the use of colchicine and IL-1 agents is promising and research needs to be conducted to further assess this outcome.
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Affiliation(s)
- Giovanna Rosas
- Department of Medicine, University of Alabama at Birmingham , Birmingham, AL, USA
| | - Angelo Gaffo
- Department of Medicine, University of Alabama at Birmingham , Birmingham, AL, USA
| | - Elizabeth J Rahn
- Department of Medicine, University of Alabama at Birmingham , Birmingham, AL, USA
| | - Kenneth G Saag
- Department of Medicine, University of Alabama at Birmingham , Birmingham, AL, USA
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Hu G, Li J, Wang Q, Wang C, Wang Y, Gong T, Liu D. J-shaped relationship between serum uric acid levels and the risk of ischemic stroke in high-risk individuals: A hospital-based observational study. Clin Neurol Neurosurg 2020; 195:105906. [PMID: 32447150 DOI: 10.1016/j.clineuro.2020.105906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 04/25/2020] [Accepted: 05/07/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The relationship between serum uric acid (SUA) and the risk of ischemic stroke (IS) has been fully elucidated in previous studies. Therefore, we further investigated the relationship between SUA levels and the risk of IS. PATIENTS AND METHODS 2195 patients at the Beijing Hospital, between February 2012 and May 2018, were enrolled in our hospital-based cross-sectional study. The patients were divided into an IS group and a (non-IS) control group, based on their medical records. SUA level was measured using the enzymatic uricase method. Univariate and multivariable logistic regression models were used for the analysis. RESULTS A total of 300 patients with IS [176 men; age (mean ± SD): 71.38 ± 10.66 years] and 1895 control patients [1060 men; age (mean ± SD): 66.12 ± 12.04 years] were enrolled in this study. IS patients had higher concentrations of SUA, compared with control group patients [6.11 ± 1.92 vs. 5.77 ± 1.62 (mg/dL)]; P = 0.004). We observed a J-shaped association between SUA levels and the risk of IS. Both the univariate and multivariate logistic regression analyses found a significantly elevated risk of IS in the bottom and upper SUA levels both in quartiles and deciles, compared with the intermediate SUA levels. CONCLUSION These results indicate a J-shaped, independent association between SUA levels and the risk of IS in high-risk individuals.
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Affiliation(s)
- Gaifeng Hu
- Beijing Hospital, National Center of Gerontology, No. 1 DaHua Road, Dong Dan, Beijing 100730, China; Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, No. 9 Dongdansantiao, Dongcheng District, Beijing 100730, China
| | - Juan Li
- Beijing Hospital, National Center of Gerontology, No. 1 DaHua Road, Dong Dan, Beijing 100730, China; Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, No. 9 Dongdansantiao, Dongcheng District, Beijing 100730, China
| | - Quan Wang
- Beijing Hospital, National Center of Gerontology, No. 1 DaHua Road, Dong Dan, Beijing 100730, China; Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, No. 9 Dongdansantiao, Dongcheng District, Beijing 100730, China
| | - Cui Wang
- Beijing Hospital, National Center of Gerontology, No. 1 DaHua Road, Dong Dan, Beijing 100730, China; Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, No. 9 Dongdansantiao, Dongcheng District, Beijing 100730, China
| | - Yang Wang
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, No. 9 Dongdansantiao, Dongcheng District, Beijing 100730, China; Medical Research & Biometrics Center, Fuwai Hospital, National Center for Cardiovascular Diseases, China
| | - Tao Gong
- Beijing Hospital, National Center of Gerontology, No. 1 DaHua Road, Dong Dan, Beijing 100730, China
| | - Deping Liu
- Beijing Hospital, National Center of Gerontology, No. 1 DaHua Road, Dong Dan, Beijing 100730, China; Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, No. 9 Dongdansantiao, Dongcheng District, Beijing 100730, China.
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Valsaraj R, Singh AK, Gangopadhyay KK, Ghoshdastidar B, Goyal G, Batin M, Mukherjee D, Sengupta U, Chatterjee S, Sengupta N. Management of asymptomatic hyperuricemia: Integrated Diabetes & Endocrine Academy (IDEA) consensus statement. Diabetes Metab Syndr 2020; 14:93-100. [PMID: 31991299 DOI: 10.1016/j.dsx.2020.01.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 01/13/2020] [Accepted: 01/14/2020] [Indexed: 02/07/2023]
Abstract
AIM The definition and management of asymptomatic hyperuricemia has been an area of controversy for many decades. Debate persists regarding the benefit of treating all cases of asymptomatic hyperuricemia and hence, unsurprisingly there are no clear clinical practice guidelines from our country. PARTICIPANTS Ten members consisting of eminent physicians, endocrinologists, nephrologist and a rheumatologist were selected by the Integrated Diabetes & Endocrine Academy (IDEA) for a closed meeting with the aim to come to a consensus. EVIDENCE A literature search was performed using PubMed and Cochrane library following which published articles in indexed peer review journals were selected. CONSENSUS PROCESS Each participant voiced their opinion after reviewing the available data and a consensus was reached after three meetings by voting. CONCLUSION Recommendations were made on important areas such as definition, investigation and management of asymptomatic hyperuricemia.
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Affiliation(s)
- Rahul Valsaraj
- Department of Endocrinology, Nilratan Sircar Medical College and Hospital, Kolkata, West Bengal, India.
| | | | | | - Biswajit Ghoshdastidar
- Division of Internal Medicine, Woodlands Multispeciality Hospital, Kolkata, West Bengal, India.
| | - Ghanshyam Goyal
- Department of Diabetology, ILS Hospitals, Kolkata, West Bengal, India; Department of Diabetes, S V S Marwari Hospital, Kolkata, West Bengal, India.
| | - Masood Batin
- Medicine and Diabeto-cardiology, Mission of Mercy Hospital, GD Hospital and Diabetes Institute and Islamia Hospital, Kolkata, West Bengal, India.
| | - Dibyendu Mukherjee
- Medicine & Chief of Rheumatology Clinic, K.P.C Medical College, Kolkata, West Bengal, India.
| | - Upal Sengupta
- Nephrology, Fortis Hospitals, Kolkata, India, West Bengal, India.
| | - Sanjay Chatterjee
- Nutrition & Diabetes, Department of Diabetes & Endocrinology, Apollo Gleneagles Hospitals, Kolkata, West Bengal, India.
| | - Nilanjan Sengupta
- Department of Endocrinology, Nilratan Sircar Medical College and Hospital, Kolkata, West Bengal, India.
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Cardiovascular Disease in Gout and the Protective Effect of Treatments Including Urate-Lowering Therapy. Drugs 2019; 79:531-541. [PMID: 30868398 DOI: 10.1007/s40265-019-01081-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Cardiovascular disease affects more than 90 million Americans. Recent studies support an increased cardiovascular disease risk in inflammatory conditions, such as gout. Increased serum urate levels, or hyperuricemia, are a precursor to gout. Data from meta-analyses have shown hyperuricemia to be linked to hypertension and coronary heart disease. Similarly, gout has been associated with an increased risk of myocardial infarction, cerebrovascular accidents, and death from cardiovascular disease in randomized clinical trials. Urate-lowering therapy reduces serum urate and may decrease systemic inflammation, generation of oxidative species, and reverses endothelial dysfunction through hyperuricemia-dependent or hyperuricemia-independent pathways. Cardioprotective benefits of allopurinol, a first-line agent for the treatment of gout, have been demonstrated to potentially prevent myocardial infarction, stroke, atrial fibrillation, and other cardiovascular diseases in observational studies in select populations. Randomized controlled trials (RCTs) have also examined the role of newer urate-lowering therapies, such as febuxostat and lesinurad, and their risk of cardiovascular-specific mortality in comparison to allopurinol. A large post-marketing study of febuxostat vs. allopurinol showed higher all-cause and cardiovascular-specific mortality in the febuxostat group than in the allopurinol group; a major study limitation was that large numbers of patients were lost to follow-up or discontinued treatment. RCTs are required to assess the comparative effectiveness of urate-lowering therapies, validate findings of observational studies, and to determine which subgroup populations of gout are most likely to benefit from appropriate long-term urate-lowering therapy. This review examines the data for increased cardiovascular disease in gout and potential underlying mechanisms (including hyperuricemia, inflammation, endothelial dysfunction, oxidative stress) and the effect of urate-lowering therapy on cardiovascular disease.
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Garcia-Gil M, Comas-Cufí M, Ramos R, Martí R, Alves-Cabratosa L, Parramon D, Prieto-Alhambra D, Baena-Díez JM, Salvador-González B, Elosua R, Dégano IR, Marrugat J, Grau M. Effectiveness of Statins as Primary Prevention in People With Gout: A Population-Based Cohort Study. J Cardiovasc Pharmacol Ther 2019; 24:542-550. [PMID: 31248268 DOI: 10.1177/1074248419857071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Cardiovascular guidelines do not give firm recommendations on statin therapy in patients with gout because evidence is lacking. AIM To analyze the effectiveness of statin therapy in primary prevention of coronary heart disease (CHD), ischemic stroke (IS), and all-cause mortality in a population with gout. METHODS A retrospective cohort study (July 2006 to December 2017) based on Information System for the Development of Research in Primary Care (SIDIAPQ), a research-quality database of electronic medical records, included primary care patients (aged 35-85 years) without previous cardiovascular disease (CVD). Participants were categorized as nonusers or new users of statins (defined as receiving statins for the first time during the study period). Index date was first statin invoicing for new users and randomly assigned to nonusers. The groups were compared for the incidence of CHD, IS, and all-cause mortality, using Cox proportional hazards modeling adjusted for propensity score. RESULTS Between July 2006 and December 2008, 8018 individuals were included; 736 (9.1%) were new users of statins. Median follow-up was 9.8 years. Crude incidence of CHD was 8.16 (95% confidence interval [CI]: 6.25-10.65) and 6.56 (95% CI: 5.85-7.36) events per 1000 person-years in new users and nonusers, respectively. Hazard ratios were 0.84 (95% CI: 0.60-1.19) for CHD, 0.68 (0.44-1.05) for IS, and 0.87 (0.67-1.12) for all-cause mortality. Hazard for diabetes was 1.27 (0.99-1.63). CONCLUSIONS Statin therapy was not associated with a clinically significant decrease in CHD. Despite higher risk of CVD in gout populations compared to general population, patients with gout from a primary prevention population with a low-to-intermediate incidence of CHD should be evaluated according to their cardiovascular risk assessment, lifestyle recommendations, and preferences, in line with recent European League Against Rheumatism recommendations.
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Affiliation(s)
- Maria Garcia-Gil
- 1 Institut Universitari d'Investigació en Atenció Primària Jordi Gol ( IDIAJGol), Catalonia, Spain.,2 ISV Research Group, Research Unit in Primary Care, Catalonia, Spain
| | - Marc Comas-Cufí
- 1 Institut Universitari d'Investigació en Atenció Primària Jordi Gol ( IDIAJGol), Catalonia, Spain.,2 ISV Research Group, Research Unit in Primary Care, Catalonia, Spain
| | - Rafel Ramos
- 1 Institut Universitari d'Investigació en Atenció Primària Jordi Gol ( IDIAJGol), Catalonia, Spain.,2 ISV Research Group, Research Unit in Primary Care, Catalonia, Spain.,3 Primary Care, Primary Care Services, Girona, Catalan Institute of Health (ICS), Catalonia, Spain.,4 Department of Medical Sciences, School of Medicine, University of Girona, Girona, Spain
| | - Ruth Martí
- 1 Institut Universitari d'Investigació en Atenció Primària Jordi Gol ( IDIAJGol), Catalonia, Spain.,2 ISV Research Group, Research Unit in Primary Care, Catalonia, Spain.,5 Biomedical Research Institute, Girona (IdIBGi), ICS, Catalonia, Spain
| | - Lia Alves-Cabratosa
- 1 Institut Universitari d'Investigació en Atenció Primària Jordi Gol ( IDIAJGol), Catalonia, Spain.,2 ISV Research Group, Research Unit in Primary Care, Catalonia, Spain
| | - Dídac Parramon
- 1 Institut Universitari d'Investigació en Atenció Primària Jordi Gol ( IDIAJGol), Catalonia, Spain.,2 ISV Research Group, Research Unit in Primary Care, Catalonia, Spain
| | - Daniel Prieto-Alhambra
- 6 Musculoskeletal Pharmaco- and Device Epidemiology, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom.,7 GREMPAL (Grup de Recerca en Malalties Prevalents de l'Aparell Locomotor) Research Group, IDIAJGol and CIBERFes, Universitat Autònoma de Barcelona and Instituto Carlos III, Barcelona, Spain
| | - Jose Miguel Baena-Díez
- 8 REgistre Gironí del Cor Research Group (REGICOR) and Cardiovascular, Epidemiology and Genetics Research Group (EGEC), Hospital del Mar Medical Research Institute (IMIM), Barcelona, Catalonia, Spain.,9 Institut Universitari d'Investigació en Atenció Primària Jordi Gol ( IDIAJGol), Catalunya, Spain.,10 MACAP Renal Research Group, Research Unit in Primary Care, Barcelona, Spain.,11 La Marina Primary Care Centre, Catalan Institute of Health (ICS), Barcelona, Spain
| | - Betlem Salvador-González
- 8 REgistre Gironí del Cor Research Group (REGICOR) and Cardiovascular, Epidemiology and Genetics Research Group (EGEC), Hospital del Mar Medical Research Institute (IMIM), Barcelona, Catalonia, Spain.,12 Florida Sud Primary Care Centre, Primary Care Services, Costa Ponent, Catalan Institute of Health, Catalunya, Spain
| | - Roberto Elosua
- 8 REgistre Gironí del Cor Research Group (REGICOR) and Cardiovascular, Epidemiology and Genetics Research Group (EGEC), Hospital del Mar Medical Research Institute (IMIM), Barcelona, Catalonia, Spain.,13 CIBER Cardiovascular Diseases (CIBERCV), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Irene R Dégano
- 8 REgistre Gironí del Cor Research Group (REGICOR) and Cardiovascular, Epidemiology and Genetics Research Group (EGEC), Hospital del Mar Medical Research Institute (IMIM), Barcelona, Catalonia, Spain.,13 CIBER Cardiovascular Diseases (CIBERCV), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Jaume Marrugat
- 8 REgistre Gironí del Cor Research Group (REGICOR) and Cardiovascular, Epidemiology and Genetics Research Group (EGEC), Hospital del Mar Medical Research Institute (IMIM), Barcelona, Catalonia, Spain.,13 CIBER Cardiovascular Diseases (CIBERCV), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - María Grau
- 8 REgistre Gironí del Cor Research Group (REGICOR) and Cardiovascular, Epidemiology and Genetics Research Group (EGEC), Hospital del Mar Medical Research Institute (IMIM), Barcelona, Catalonia, Spain.,13 CIBER Cardiovascular Diseases (CIBERCV), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.,14 Universitat de Barcelona, Catalonia, Spain
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Scicchitano P, Cortese F, Gesualdo M, De Palo M, Massari F, Giordano P, Ciccone MM. The role of endothelial dysfunction and oxidative stress in cerebrovascular diseases. Free Radic Res 2019; 53:579-595. [PMID: 31106620 DOI: 10.1080/10715762.2019.1620939] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Pietro Scicchitano
- Department of Cardiology, Hospital “F. Perinei”, Altamura, Italy
- Section of Cardiovascular Diseases, Department of Emergency and Organ Transplantation, School of Medicine, University of Bari, Bari, Italy
| | - Francesca Cortese
- Section of Cardiovascular Diseases, Department of Emergency and Organ Transplantation, School of Medicine, University of Bari, Bari, Italy
| | | | - Micaela De Palo
- Department of Cardiac Surgery, Mater Dei Hospital, Bari, Italy
| | | | - Paola Giordano
- Department of Biomedical Sciences and Human Oncology – Paediatric Unit, Policlinico Hospital, Bari, Italy
| | - Marco Matteo Ciccone
- Section of Cardiovascular Diseases, Department of Emergency and Organ Transplantation, School of Medicine, University of Bari, Bari, Italy
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Gaita L, Timar R, Lupascu N, Roman D, Albai A, Potre O, Timar B. The Impact Of Hyperuricemia On Cardiometabolic Risk Factors In Patients With Diabetes Mellitus: A Cross-Sectional Study. Diabetes Metab Syndr Obes 2019; 12:2003-2010. [PMID: 31632111 PMCID: PMC6781154 DOI: 10.2147/dmso.s222570] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 09/03/2019] [Indexed: 12/22/2022] Open
Abstract
PURPOSE Hyperuricemia (HUA) is linked to a variety of non-communicable diseases such as atherosclerotic cardiovascular disease (ASCVD), chronic kidney disease (CKD) and hypertension, with evidence showing its role in the development of diabetes mellitus (DM). Our study's main aim was to explore the associations of HUA with other traditional risk factors in Romanian patients with DM and to assess the impact of the increase of serum UA on DM complications and HbA1c. PATIENTS AND METHODS In this cross-sectional, non-interventional study, we enrolled, according to a population-based, consecutive-case principle, 133 patients previously diagnosed with DM. HbA1c, uric acid, lipid profile, urinary albumin/creatinine ratio, glomerular filtration rate, TSH and FT4 measurements were performed, while the diagnosis of retinopathy and of diabetic neuropathy was established using standardized methods. RESULTS An increased uric acid level was associated with a significant increase in the risk for development of stroke (OR=1.526; p=0.004). A weak, positive and statistically significant correlation can also be observed between the BMI and the presence of hyperuricemia (r=0.131; p=0.034), and between the triglyceride levels and hyperuricemia (r= 0.173; p=0.004). Glomerular filtration rate was correlated to hyperuricemia in a strong and negative manner, having an important statistical significance (r=-0.818; p=0.003). In our study, UA levels and HbA1c were negatively correlated, without reaching statistical significance. CONCLUSION Serum UA is strongly correlated with the BMI, triglyceride level and GFR in Romanian patients with DM and HUA is significantly associated with a higher risk of stroke in these individuals.
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Affiliation(s)
- Laura Gaita
- Second Department of Internal Medicine, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Romulus Timar
- Second Department of Internal Medicine, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
- Department of Diabetes and Metabolic Diseases, “Pius Brinzeu” Emergency Hospital, Timisoara, Romania
- Correspondence: Romulus Timar Second Department of Internal Medicine, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu, Timisoara300041, RomaniaTel +4 0748 331 294 Email
| | - Nicoleta Lupascu
- Second Department of Internal Medicine, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Deiana Roman
- Second Department of Internal Medicine, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Alin Albai
- Second Department of Internal Medicine, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
- Department of Diabetes and Metabolic Diseases, “Pius Brinzeu” Emergency Hospital, Timisoara, Romania
| | - Ovidiu Potre
- First Department of Internal Medicine, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
- Department of Hematology, Municipal Emergency Hospital, Timisoara, Romania
| | - Bogdan Timar
- Department of Diabetes and Metabolic Diseases, “Pius Brinzeu” Emergency Hospital, Timisoara, Romania
- Department of Functional Sciences, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
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Lai SW, Lin CL, Liao KF. Case-control study examining the association between allopurinol use and ischemic cerebrovascular disease. J Investig Med 2018; 67:48-51. [PMID: 30042112 DOI: 10.1136/jim-2018-000774] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2019] [Indexed: 12/25/2022]
Abstract
Few studies focus on the relationship between allopurinol and ischemic cerebrovascular disease. The goal of the study was to investigate the association of long-term therapy of allopurinol with the first-time attack of ischemic cerebrovascular disease in Taiwan. We performed a case-control study using the database of the Taiwan National Health Insurance Program. The case group included 14,937 subjects aged 20-84 years with the first-time attack of ischemic cerebrovascular disease from 2000 to 2013. The control group included 14,937 sex-matched and age-matched subjects aged 20-84 years without any type of cerebrovascular disease. Ever use of allopurinol was defined as subjects who had at least a prescription for allopurinol before the index date. The OR and the 95% CI for ischemic cerebrovascular disease associated with allopurinol use were measured by the multivariable logistic regression model. The adjusted OR of ischemic cerebrovascular disease was 0.992 (95% CI 0.989 to 0.996) for subjects with increasing cumulative duration of allopurinol use for every 1 month, compared with never use. In a further analysis, the adjusted OR of ischemic cerebrovascular disease was 0.74 (95% CI 0.57 to 0.96) for cumulative duration of allopurinol use >3 years, compared with never use. Our findings suggest that lone-term therapy of allopurinol >3 years is associated with decreased risk of the first-time attack of ischemic cerebrovascular disease, compared with no allopurinol therapy.
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Affiliation(s)
- Shih-Wei Lai
- College of Medicine, China Medical University, Taichung, Taiwan.,Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Cheng-Li Lin
- College of Medicine, China Medical University, Taichung, Taiwan.,Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Kuan-Fu Liao
- College of Medicine, Tzu Chi University, Hualien, Taiwan.,Division of Hepatogastroenterology, Department of Internal Medicine, Taichung Tzu Chi General Hospital, Taichung, Taiwan
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Grainger R, Taylor WJ. Allopurinol and peripheral vascular disease: enough observational data to warrant interventional studies: Allopurinol and the prevention of vascular disease. Rheumatology (Oxford) 2018; 57:408-409. [PMID: 28968915 DOI: 10.1093/rheumatology/kex354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2017] [Indexed: 11/14/2022] Open
Affiliation(s)
- Rebecca Grainger
- Rehabilitation Teaching and Research Unit, University of Otago Wellington, Wellington, New Zealand
| | - William J Taylor
- Rehabilitation Teaching and Research Unit, University of Otago Wellington, Wellington, New Zealand
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Singh JA, Cleveland J. Allopurinol and the risk of incident peripheral arterial disease in the elderly: a US Medicare claims data study. Rheumatology (Oxford) 2018; 57:451-461. [PMID: 29106674 DOI: 10.1093/rheumatology/kex232] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Indexed: 12/14/2022] Open
Abstract
Objective The aim was to examine whether allopurinol use is independently associated with a reduction in the risk of incident peripheral arterial disease (PAD) in the US elderly. Methods We used the 5% random Medicare sample from 2006 to 2012 to examine the association of allopurinol use and duration of use with the risk or hazard of incident PAD in a retrospective cohort study using a new user design. Multivariable Cox regression models adjusted for demographics, co-morbidity, cardiac medications and cardiac conditions. Hazard ratios (HRs) and 95% CIs were calculated. Results We identified 26 985 episodes of incident allopurinol use in 25 282 beneficiaries; 3167 allopurinol use episodes (12%) ended in incident PAD. In multivariable-adjusted analyses, allopurinol use was associated with an HR of 0.88 (95% CI: 0.81, 0.95) for incident PAD, as was female gender, HR 0.84 (95% CI: 0.78, 0.90). In a separate multivariable-adjusted model, compared with no allopurinol use, longer durations of allopurinol use were associated with lower HR of PAD: 181 days to 2 years, 0.88 (95% CI: 0.79, 0.97); and >2 years, 0.75 (95% CI: 0.63, 0.89). Other factors significantly associated with a higher HR of PAD were age 75 to < 85 and ⩾85 years, higher Charlson index score and black race. Sensitivity analyses that adjusted for cardiac conditions and medications confirmed these findings, with minimal to no attenuation of HRs. Conclusion New allopurinol use was independently associated with a lower risk of PAD in the elderly. Longer allopurinol use durations seemed more protective. Mechanisms of the protective effect need to be investigated in future studies.
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Affiliation(s)
- Jasvinder A Singh
- Medicine Service, VA Medical Center, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Medicine at School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.,Division of Epidemiology at School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - John Cleveland
- Department of Medicine at School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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Desai RJ, Franklin JM, Spoendlin-Allen J, Solomon DH, Danaei G, Kim SC. An evaluation of longitudinal changes in serum uric acid levels and associated risk of cardio-metabolic events and renal function decline in gout. PLoS One 2018; 13:e0193622. [PMID: 29489919 PMCID: PMC5831471 DOI: 10.1371/journal.pone.0193622] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 02/14/2018] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE Gout patients have a high burden of co-morbid conditions including diabetes mellitus (DM), chronic kidney disease (CKD), and cardiovascular disease (CVD). We sought to evaluate the association between changes in serum uric acid (SUA) levels over time and the risk of incident DM, CVD, and renal function decline in gout patients. METHODS An observational cohort study was conducted among enrollees of private health insurance programs in the US between 2004 and 2015. Gout patients were included on the index date of a SUA measurement ≥6.8 mg/dl. The exposure of interest was cumulative change in SUA levels from baseline. Hazard ratios (HR) and 95% confidence intervals (CI) for incident DM, incident CVD, and renal function decline (≥30% reduction in glomerular filtration rate) were derived using marginal structural models with stabilized inverse probability weights accounting for baseline confounders (age, gender, co-morbidities, co-medications) and time-varying confounders (serum creatinine, blood urea nitrogen, glycated hemoglobin). RESULTS Among 26,341 patients with gout, the average age was 62, 75% were men, and the median baseline SUA was 8.6 mg/dl (interquartile range 7.7 to 9.5). The incidence rates/100 person-years (95% CI) were 1.63 (1.51-1.75) for DM, 0.77 (0.70-0.84) for CVD, and 4.32 (4.14-4.49) for renal function decline. The adjusted HR (95% CI) per 3 mg/dl reduction in SUA, corresponding on average to achieving the target level of <6 mg/dl in this population, was 1.04 (0.92-1.17) for DM, 1.07 (0.89-1.29) for CVD, and 0.85 (0.78-0.92) for renal function decline. CONCLUSIONS Reduction in SUA in patients with gout may be associated with a reduced risk of renal function decline, but not with DM or CVD.
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Affiliation(s)
- Rishi J. Desai
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital & Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
| | - Jessica M. Franklin
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital & Harvard Medical School, Boston, Massachusetts, United States of America
| | - Julia Spoendlin-Allen
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital & Harvard Medical School, Boston, Massachusetts, United States of America
| | - Daniel H. Solomon
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital & Harvard Medical School, Boston, Massachusetts, United States of America
- Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Goodarz Danaei
- Department of Global Health and Population, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Seoyoung C. Kim
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital & Harvard Medical School, Boston, Massachusetts, United States of America
- Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
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Bredemeier M, Lopes LM, Eisenreich MA, Hickmann S, Bongiorno GK, d’Avila R, Morsch ALB, da Silva Stein F, Campos GGD. Xanthine oxidase inhibitors for prevention of cardiovascular events: a systematic review and meta-analysis of randomized controlled trials. BMC Cardiovasc Disord 2018; 18:24. [PMID: 29415653 PMCID: PMC5804046 DOI: 10.1186/s12872-018-0757-9] [Citation(s) in RCA: 112] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 01/23/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Xanthine oxidase inhibitors (XOI), classified as purine-like (allopurinol and oxypurinol) and non-purine (febuxostat and topiroxostat) XOI, present antioxidant properties by reducing the production of reactive oxygen species derived from purine metabolism. Oxidative stress is an important factor related to endothelial dysfunction and ischemia-reperfusion injury, and may be implicated in the pathogenesis of heart failure, hypertension, and ischemic heart disease. However, there is contradictory evidence regarding the possible cardiovascular (CV) protective effect exerted by XOI. Our objective is to compare the incidence of major adverse cardiovascular events (MACE), mortality, total (TCE) and specific CV events in randomized controlled trials (RCTs) testing XOI against placebo or no treatment. METHODS PubMed, EMBASE, Web of Science, Cochrane Central, Lilacs databases were searched from inception to Dec 30 2016, along with hand searching. RCTs including exclusively adult individuals, lasting ≥ 4 weeks, with no language restriction, were eligible. Independent paired researchers selected studies and extracted data. Considering the expected rarity of events, Peto and DerSimonian/Laird odds ratios (OR), the latter in case of heterogeneity, were used for analysis. Random-effects meta-regression was used to explore heterogeneity. RESULTS The analysis of MACE included 81 articles (10,684 patients, 6434 patient-years). XOI did not significantly reduce risk of MACE (ORP = 0.71, 95% CI 0.46-1.09) and death (0.89, 0.59-1.33), but reduced risk of TCE (0.60, 0.44-0.82; serious TCE: 0.64, 0.46 to 0.89), and hypertension (0.54, 0.37 to 0.80). There was protection for MACE in patients with previous ischemic events (0.42, 0.23-0.76). Allopurinol protected for myocardial infarction (0.38, 0.17-0.83), hypertension (0.32, 0.18-0.58), TCE (0.48, 0.31 to 0.75, I2 = 55%) and serious TCE (0.56, 0.36 to 0.86, I2 = 44%). Meta-regression associated increasing dose of allopurinol with higher risk of TCE and serious TCE (P < 0.05). Accordingly, lower doses (≤ 300 mg/day) of allopurinol reduced the risk of TCE, unlike higher doses. Non-purine-like XOI did not significantly reduce or increase the risk of adverse CV events, but confidence intervals were wide. Quality of evidence was generally low to moderate. CONCLUSIONS Purine-like XOI may reduce the incidence of adverse CV outcomes. However, higher doses of allopurinol (> 300 mg/day) may be associated with loss of CV protection.
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Affiliation(s)
- Markus Bredemeier
- Rheumatology Service at Hospital Nossa Senhora da Conceição, Grupo Hospitalar Conceição, Porto Alegre, RS Brazil
- Serviço de Reumatologia do Hospital Nossa Senhora da Conceição, Avenida Francisco Trein, 596, sala 2048, Porto Alegre, RS 91350-200 Brazil
| | - Lediane Moreira Lopes
- Rheumatology Service at Hospital Nossa Senhora da Conceição, Grupo Hospitalar Conceição, Porto Alegre, RS Brazil
| | - Matheus Augusto Eisenreich
- Rheumatology Service at Hospital Nossa Senhora da Conceição, Grupo Hospitalar Conceição, Porto Alegre, RS Brazil
| | - Sheila Hickmann
- Rheumatology Service at Hospital Nossa Senhora da Conceição, Grupo Hospitalar Conceição, Porto Alegre, RS Brazil
| | - Guilherme Kopik Bongiorno
- Rheumatology Service at Hospital Nossa Senhora da Conceição, Grupo Hospitalar Conceição, Porto Alegre, RS Brazil
| | - Rui d’Avila
- Rheumatology Service at Hospital Nossa Senhora da Conceição, Grupo Hospitalar Conceição, Porto Alegre, RS Brazil
| | | | - Fernando da Silva Stein
- Rheumatology Service at Hospital Nossa Senhora da Conceição, Grupo Hospitalar Conceição, Porto Alegre, RS Brazil
| | - Guilherme Gomes Dias Campos
- Rheumatology Service at Hospital Nossa Senhora da Conceição, Grupo Hospitalar Conceição, Porto Alegre, RS Brazil
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Singh JA, Cleveland J. Allopurinol and the risk of ventricular arrhythmias in the elderly: a study using US Medicare data. BMC Med 2017; 15:59. [PMID: 28327188 PMCID: PMC5361697 DOI: 10.1186/s12916-017-0816-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 02/10/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND There are no published human studies investigating whether the use of allopurinol, the most commonly used medication for the treatment of hyperuricemia in gout, the most common type of inflammatory arthritis in adults, has any beneficial effects on ventricular electrophysiology. The objective of our study was to assess whether allopurinol use is associated with a reduction in the risk of ventricular arrhythmias (VA). METHODS We used the 5% random sample of Medicare beneficiaries from 2006-2012 to examine new allopurinol use and the risk of incident VA. Multivariable Cox regression analyses were adjusted for demographics (age, race, sex), comorbidity, cardiac medications, and conditions associated with VA. We calculated hazard ratios (HR) and 95% confidence intervals (CI). RESULTS Of the 28,755 episodes of new allopurinol use, 2538 were associated with incident VA (8.8%). Among patients with incident VA, 54% were male, 78% were White, 75% had gout as the underlying diagnosis, and the mean Charlson-Romano comorbidity score was 4.8. The crude incidence of VA per 1,000,000 person-days declined as the duration of allopurinol use increased: 1-180 days, 151; 181 days to 2 years, 105; and > 2 years, 85. In multivariable-adjusted analyses, compared to non-use, allopurinol use was associated with lower HR of VA of 0.82 (95% CI, 0.76-0.90). Compared to allopurinol non-use, longer allopurinol use durations were significantly associated with lower multivariable-adjusted HR for VA: 1-180 days, 0.96 (95% CI, 0.85-1.08); 181 days to 2 years, 0.76 (95% CI, 0.68-0.85); and > 2 years, 0.72 (95% CI, 0.60-0.87). Multiple sensitivity analyses adjusting for cardiac conditions, anti-arrhythmic drugs and alternate definitions confirmed our findings with minimal/no attenuation of estimates. CONCLUSION Allopurinol use and use duration of more than 6 months were independently associated with a lower risk of VA. Future studies need to assess the pathophysiology of this potential benefit.
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Affiliation(s)
- Jasvinder A Singh
- Medicine Service, Birmingham VA Medical Center, Birmingham, AL, USA. .,Department of Medicine at School of Medicine, and Division of Epidemiology at School of Public Health, University of Alabama at Birmingham (UAB), Birmingham, AL, USA. .,Department of Orthopedic Surgery, Mayo Clinic College of Medicine, Rochester, MN, USA. .,University of Alabama at Birmingham, Faculty Office Tower 805B, 510 20th Street S, Birmingham, AL, 35294, USA.
| | - John Cleveland
- Department of Medicine at School of Medicine, and Division of Epidemiology at School of Public Health, University of Alabama at Birmingham (UAB), Birmingham, AL, USA.,University of Alabama at Birmingham, Faculty Office Tower 805B, 510 20th Street S, Birmingham, AL, 35294, USA
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Singh JA, Uhlig T. Chasing crystals out of the body: will treat to serum urate target for gout help us get there? Ann Rheum Dis 2016; 76:629-631. [PMID: 28031165 DOI: 10.1136/annrheumdis-2016-210436] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 11/12/2016] [Accepted: 12/03/2016] [Indexed: 11/04/2022]
Affiliation(s)
- Jasvinder A Singh
- Birmingham VA Medical Center, Birmingham, Alabama, USA.,Department of Medicine, School of Medicine, University of Alabama, Birmingham, Alabama, USA.,Division of Epidemiology at the School of Public Health, University of Alabama, Birmingham, Alabama, USA
| | - Till Uhlig
- National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
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