Association of Serum Uric Acid and Cardiovascular Disease in Healthy Adults

Kivity, Shaye; Kopel, Eran; Maor, Elad; Abu-Bachar, Fadi; Segev, Shlomo; Sidi, Yechezkel; Olchovsky, David

doi:10.1016/j.amjcard.2012.12.034

Cited by 106 publications

(66 citation statements)

References 22 publications

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“…This provides evidence for a stratified treatment regimen of exogenous UA. Kivity et al 2013 reported UA levels had stronger association with cardiovascular disease in women than in men, indicating the necessity of stratifying by gender in investigations of cardio-cerebrovascular risk factors. Moreover, UA levels are higher in men.…”

Section: Discussionmentioning

confidence: 93%

Prognostic Significance of Uric Acid Levels in Ischemic Stroke Patients

Zhang

Huang

et al. 2015

Neurotox Res

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The importance and function of serum uric acid (UA) levels in patients with cardiovascular disease or stroke are unclear. We sought to evaluate the appropriate UA levels for stroke patients and the association between endogenous UA levels and clinical outcomes in acute ischemic stroke (AIS) patients, particularly regarding the possible interaction between gender and UA levels with respect to AIS prognosis. We examined 303 patients who had an onset of ischemic stroke within 48 h. Of those, 101 patients received thrombolytic treatment. Serum UA (μmol/L) levels were measured the second morning after admission. Patient prognosis was evaluated 90 days after clinical onset by modified Rankin Scale. Patients were divided into four groups according to serum UA quartiles. A binary multivariate logistic regression model was used to assess clinical relevance in regard to functional outcome and endogenous UA levels. Analysis of subgroups by gender and normal glomerular filtration rate were also been done. Poor functional outcome was associated with older age, history of atrial fibrillation, or higher baseline National Institutes of Health Stroke Scale scores. After adjustment for potential confounders, patients with higher UA levels (>380 μmol/L) or lower UA levels (≤250 μmol/L) were 2-3 times more likely to have a poor outcome (OR 2.95, 95% CI 1.14-7.61; OR 2.78, 95% CI 1.02-7.58, respectively) compared to the baseline group (UA level 316-380 μmol/L). The same results were observed in thrombolyzed patients. Patients with high and low UA levels were 9-18 times more likely to having poor outcomes compared to the baseline group (UA level: 316-380 μmol/L; OR 18.50, 95% CI: 2.041-167.67; OR 9.66, 95% CI 1.42-65.88, respectively). In men, patients with high UA levels were 6 times more likely to have poor outcomes compared to the baseline group (UA level: 279-334 μmol/L; OR 6.10, 95% CI 1.62-22.93). However, female patients with UA level 271-337 μmol/L were seven times more likely to perform badly compared to the baseline group (UA level >337 μmol/L, OR 7.06, 95% CI 1.00-49.81). Serum UA levels in an appropriate range were associated with better outcome in patients with AIS but may be harmful when too high or too low. The association of UA levels with AIS prognosis differed in male and female patients, which highlights the necessity of stratifying by gender in investigations of cerebrovascular risk factors.

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Section: Discussionmentioning

confidence: 93%

Prognostic Significance of Uric Acid Levels in Ischemic Stroke Patients

Zhang

Huang

et al. 2015

Neurotox Res

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“…Regarding all-cause mortality and cardiovascular mortality, most studies find that serum UA is an independent predictor of cardiovascular end points, especially in patients with CAD, 17,30,[33][34][35] but some studies reported the opposite. 29,36,37 Possible explanations for diverging results could be sex-specific effects, 38 an interaction with kidney function, 39 or the possibility that UA might turn pro-oxidant under certain conditions (e.g., CAD). 40 In the LURIC study, the UA concentration is associated with CVD and SCD after multivariate adjustment.…”

Section: Discussionmentioning

confidence: 99%

Uric Acid and Cardiovascular Events

Kleber

Delgado

Grammer

et al. 2015

Journal of the American Society of Nephrology

246

156

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Obesity and diets rich in uric acid-raising components appear to account for the increased prevalence of hyperuricemia in Westernized populations. Prevalence rates of hypertension, diabetes mellitus, CKD, and cardiovascular disease are also increasing. We used Mendelian randomization to examine whether uric acid is an independent and causal cardiovascular risk factor. Serum uric acid was measured in 3315 patients of the Ludwigshafen Risk and Cardiovascular Health Study. We calculated a weighted genetic risk score (GRS) for uric acid concentration based on eight uric acid-regulating single nucleotide polymorphisms. Causal odds ratios and causal hazard ratios (HRs) were calculated using a two-stage regression estimate with the GRS as the instrumental variable to examine associations with cardiometabolic phenotypes (cross-sectional) and mortality (prospectively) by logistic regression and Cox regression, respectively. Our GRS was not consistently associated with any biochemical marker except for uric acid, arguing against pleiotropy. Uric acid was associated with a range of prevalent diseases, including coronary artery disease. Uric acid and the GRS were both associated with cardiovascular death and sudden cardiac death. In a multivariate model adjusted for factors including medication, causal HRs corresponding to each 1-mg/dl increase in genetically predicted uric acid concentration were significant for cardiovascular death (HR, 1.77; 95% confidence interval, 1.12 to 2.81) and sudden cardiac death (HR, 2.41; 95% confidence interval, 1.16 to 5.00). These results suggest that high uric acid is causally related to adverse cardiovascular outcomes, especially sudden cardiac death.

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“…The full methods employed by this program were previously published. [18][19][20] The Institutional Ethics Committee of Sheba Medical Center approved the study.…”

Section: Study Populationmentioning

confidence: 99%