Association between Uric Acid and Carotid Atherosclerosis in Elderly Persons

Kawamoto, Ryuichi; Tomita, Hitomi; Oka, Yuichiro; Kodama, Akihiro; Ohtsuka, Naoko; Kamitani, Atsushi

doi:10.2169/internalmedicine.44.787

Cited by 34 publications

(29 citation statements)

References 36 publications

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“…Some prior studies, with both negative and positive associations reported, have either failed to adjust for low-dose aspirin use or for renal insufficiency (both of which can increase SUA and risk for CVD 36,37 ), have not used current standard definitions for hypertension, and/or have adjusted for the presence of hypertension and use of antihypertensive agents, which may cause problems of collinearity [1][2][3]5,8,10,21,23,24 . Finally, as any effect of SUA is likely to be small given the multifactorial nature of CVD, studies with relatively small numbers of events may not be able to demonstrate an association, particularly when populations studied are at low risk for the outcome under study [8][9][10] .…”

Section: Discussionmentioning

confidence: 99%

“…If hyperuricemia is indeed an independent risk factor for CVD, it might motivate a change in traditional treatment recommendations. [20][21][22][23][24][25][26] . Such conflicting results may in part be related to differences in analytic approaches and/or effectiveness of controlling for potential confounding.…”

Section: Nih Public Accessmentioning

confidence: 99%

“…This association was consistent regardless of the presence or absence of conditions that may be associated with both uric acid and carotid atherosclerosis. While the uricosuric effects of estrogen 35 and the lower likelihood of preclinical atherosclerotic disease in premenopausal women may account for lack of association noted among women, hyperuricemia appeared to be associated with a higher prevalence of carotid plaques among postmenopausal women (women ≥ age 55 yrs).To date, a few studies have specifically evaluated the association of SUA and carotid atherosclerosis, with some reporting higher SUA levels to be associated with carotid atherosclerosis 20,22,23,26 , consistent with our findings, while others found no association 21,24,25 . Prior epidemiologic studies of hyperuricemia and adverse clinical cardiovascular outcomes have also been conflicting.…”

mentioning

confidence: 99%

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Serum Uric Acid Is Associated with Carotid Plaques: The National Heart, Lung, and Blood Institute Family Heart Study

Neogi

Ellison

Hunt³

et al. 2009

J Rheumatol

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Objective-To examine the association of serum uric acid (SUA) with a marker of preclinical cardiovascular disease (CVD), carotid atherosclerotic plaques (PLQ), where early evidence of risk may be evident, focusing on individuals without CV risk factors.Methods-The National Heart, Lung, and Blood Institute Family Heart Study is a multicenter study designed to assess risk factors for heart disease. PLQ were assessed with carotid ultrasound. We conducted sex-specific logistic regression to assess the association of SUA with presence of PLQ, including analyses among persons without risk factors related to both CVD and hyperuricemia.Results-In total, 4866 participants had both SUA and carotid ultrasound assessed (54% women, mean age 52 yrs, mean body mass index 27.6). The association of SUA with PLQ increased with increasing SUA levels, demonstrating a dose-response relation for men [OR 1.0, 1.29, 1.61, 1.75, for SUA categories < 5 (reference), 5 to < 6, 6 to < 6.8, ≥ 6.8 mg/dl, respectively; p = 0.002]. Similar associations were found in men without CV risk factors. We found no relation of SUA with PLQ in women. Studies examining the relation of hyperuricemia with cardiovascular disease (CVD) have had conflicting results. While many have found an independent association of higher serum uric acid (SUA) concentrations with increased risk of adverse cardiovascular outcomes 1-7 , others have not [8][9][10] . Biological mechanisms linking hyperuricemia to CVD risk exist, but direct effects of uric acid on the vasculature remain controversial 11,12 . Moreover, some have argued that the positive association between SUA and CVD may be due to the concurrent cardiovascular comorbidities seen in many persons with hyperuricemia, including diabetes, dyslipidemia, hypertension, and obesity [13][14][15] . Conclusion-In NIH Public AccessClarifying the relation of SUA to CVD risk has clinical implications and public health importance. First, there has been a secular increase in the incidence and prevalence of gout and hyperuricemia 16,17 . Second, asymptomatic hyperuricemia is presently not an indication for urate-lowering therapy. If hyperuricemia is indeed an independent risk factor for CVD, it might motivate a change in traditional treatment recommendations. [20][21][22][23][24][25][26] . Such conflicting results may in part be related to differences in analytic approaches and/or effectiveness of controlling for potential confounding.Further, prior studies have not examined SUA's effects in individuals who are free from comorbidities, which themselves can both increase SUA and increase risk for preclinical CVD. If SUA were associated with preclinical CVD in persons without any such comorbidities, it would constitute stronger evidence for SUA's association with CVD than has been presented in previous studies.We evaluated the association of SUA with carotid plaques in a large multicenter study, the National Heart, Lung, and Blood Institute (NHLBI) Family Heart Study, and further assessed these associations for the modifyi...

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Section: Discussionmentioning

confidence: 99%

Section: Nih Public Accessmentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Serum Uric Acid Is Associated with Carotid Plaques: The National Heart, Lung, and Blood Institute Family Heart Study

Neogi

Ellison

Hunt³

et al. 2009

J Rheumatol

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“…1 Several large studies have provided conflicting results regarding the clinical significance of elevated SUA levels in cardiovascular or cerebrovascular disease. Some concluded that SUA is an independent risk factor for cardiovascular disease (CVD), [2][3][4][5][6] with an apparently stronger association in women than in men, 7,8 in the elderly 9 and in patients with essential hypertension, 10 congestive heart failure 11,12 and type 2 diabetes mellitus. 13,14 In contrast, the Framingham Heart Study concluded that an association with CVD merely reflects the link between SUA and other risk factors, including hypertension, renal disease, elevated lipoprotein levels and the use of diuretics.…”

mentioning

confidence: 99%

Serum Uric Acid as an Independent Predictor of Early Death After Acute Stroke

Karagiannis

Mikhailidis²,

Τζιόμαλος

et al. 2007

Circ J

117

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“…It has been shown that UA is positively associated with an increase in systolic blood pressure (SBP) 14,15 and may be a risk factor or marker for ultrasonographically determined carotid atherosclerosis. 16 However, to date, there is little information about the relative impact of the prenatal environment on UA levels and development of the cardiovascular disease. The purpose of this study was to investigate if alterations in serum UA are present in young children with LBW and to determine whether there is a relationship between UA concentration, vascular function, and SBP levels.…”

mentioning

confidence: 99%

Effects of Low Birth Weight in 8- to 13-Year-Old Children

et al. 2006

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Abstract-Low birth weight has been associated with an increased incidence of adult cardiovascular disease. Endothelial dysfunction and high levels of serum uric acid are associated with hypertension. In this study, we have determined whether uric acid is related to blood pressure and vascular function in children with low birth weight. We evaluated vascular function using high-resolution ultrasound, blood pressure, and uric acid levels in 78 children (35 girls, 43 boys, aged 8 to 13 years). Increasing levels of uric acid and systolic blood pressure were observed in children with low birth weight. Birth weight was inversely associated with both systolic blood pressure and uric acid; on the other hand, uric acid levels were directly correlated with systolic blood pressure in children of the entire cohort. Low birth weight was associated with reduced flow-mediated dilation (rϭ0.427, PϽ0.001). Because the children with low birth weight had elevated uric acid as well as higher systolic blood pressure levels, we evaluated the correlation between these variables. In the low birth weight group, multiple regression analysis revealed that uric acid (␤ϭϪ2.886; SEϭ1.393; Pϭ0.040) had a graded inverse relationship with flow-mediated dilation, which was not affected in a model adjusting for race and gender. We conclude that children with a history of low birth weight show impaired endothelial function and increased blood pressure and uric acid levels. These findings may be early expressions of vascular compromise, contributing to susceptibility to disease in adult life. (Hypertension. 2006;48:45-50.)

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Association between Uric Acid and Carotid Atherosclerosis in Elderly Persons

Cited by 34 publications

References 36 publications

Serum Uric Acid Is Associated with Carotid Plaques: The National Heart, Lung, and Blood Institute Family Heart Study

Serum Uric Acid Is Associated with Carotid Plaques: The National Heart, Lung, and Blood Institute Family Heart Study

Serum Uric Acid as an Independent Predictor of Early Death After Acute Stroke

Effects of Low Birth Weight in 8- to 13-Year-Old Children

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