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

Abstract

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.

Results of an Observational Cohort Study of Hyperuricemia as a Predictor of Poor Physical Performance in the Elderly

“…At the baseline, people with hyperuricemia had an increased frequency of several medical conditions (including obesity, diabetes mellitus, CVD, and hypertension) than those with normal SUA levels, although lower prevalence of osteoporotic fractures in both sexes. All these findings are in general agreement with the current literature regarding the topic of hyperuricemia and comorbidities . At baseline, people with hyperuricemia scored significantly worse than those with normal SUA levels in all the physical performance tests, except for handgrip strength.…”

“…SUA levels were measured using a colorimetric enzymatic method with an intra‐ and interassay coefficient of variation <10%. Hyperuricemia was defined as SUA levels ≥7 mg/dl in men and ≥6 mg/dl in women .…”

“…Although different thresholds can be used, the upper limit of the reference range for men is usually set at 7 mg/dl and for women 6 mg/dl . The tendency to develop hyperuricemia increases with age, particularly due to a decrease in the excretion of uric acid, predisposing older adults as more likely to have hyperuricemia . Hyperuricemia could depend on several factors, including age, sex, obesity, metabolic and cardiovascular diseases (CVDs), dietary habits (particularly heavy alcohol drinking), and cancer .…”

“…While these studies attempting to disentangle the relationship between SUA and physical performance are important, both studies were conducted among Asians, limiting generalizability. Perhaps more importantly, both studies only considered handgrip strength as a proxy of physical performance and did not include a sufficient number of older people, in which, as mentioned, the prevalence of hyperuricemia seems to be higher than among other ages . One more recent large study among 5,819 older Americans suggested that hyperuricemia is associated with worse leg but not arm performance .…”

Gender-specific association between uric acid level and chronic kidney disease in the elderly health checkup population in China

“…Age-related increase in SUA levels was found among women, in contrast, SUA level did not vary significantly among man [22]. A survey based on individuals elder than 65 years suggested the prevalence of hyperuricemia increased of only 6% in men from 65 to over 90 years, but doubled in women (from 15.3% in those having 65 years to 34.4% in the 90s) [23]. In the present study, we found the prevalence of hyperuricemia was 22.2% in the elder population, with 25.2% in male and 17.0% in female.…”