Serum uric acid and cardiovascular disease: Recent developments, and where do they leave us?

Baker, Joshua F.; Krishnan, Eswar; Chen, Lan; Schumacher, H. Ralph

doi:10.1016/j.amjmed.2005.03.043

Cited by 326 publications

(250 citation statements)

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“…1 Although extensive epidemiological data suggest that serum uric acid (SUA) is a relevant marker for cardiovascular disease in different clinical settings including hypertension, it remains debatable whether SUA is an independent risk factor for adverse cardiovascular outcome. [2][3][4][5] Several pathophysiological mechanisms linking SUA to adverse cardiovascular outcome have been proposed, including proliferation of vascular smooth muscle cells, 6 prothrombotic effects mediated by platelet activation, 7 impaired nitric oxide generation and endothelial dysfunction, 8 activation of local renin-angiotensin-aldosterone system 9 and stimulation of inflammatory pathways. 10 Inflammation seems to have a pivotal role in the pathogenesis of hypertension and hypertensive target organ damage.…”

Section: Introductionmentioning

confidence: 99%

The diverse associations of uric acid with low-grade inflammation, adiponectin and arterial stiffness in never-treated hypertensives

et al. 2010

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The data regarding the role of serum uric acid (SUA) along with subclinical inflammation in the context of hypertensive vascular damage are rather scarce and controversial. Towards this end, we assess the links between SUA, high-sensitivity CRP (hs-CRP), adiponectin and carotid to femoral pulse wave velocity (c-f PWV) in 292 subjects with never-treated stage I-II essential hypertension. On the basis of the median SUA levels (0.31 mmol l À1 ), the study population was divided into subjects with low (n ¼ 149) and high (n ¼ 143) SUA values. By multiple regression analysis, it was revealed that SUA was independently associated with log hs-CRP (R 2 ¼ 0.098; P ¼ 0.02), log adiponectin (R 2 ¼ 0.102; P ¼ 0.03), waist circumference (R 2 ¼ 0.049; P ¼ 0.04), 24-h systolic blood pressure (SBP) (R 2 ¼ 0.179; P ¼ 0.001) and estimated glomerular filtration rate (R 2 ¼ 0.156; b (s.e.) ¼ À0.169 (0.023); P ¼ 0.02). In addition, c-f PWV was independently associated with age (R 2 ¼ 0.116; Po0.0001), waist circumference (R 2 ¼ 0.088; Po0.0001), 24-h SBP (R 2 ¼ 0.167; P ¼ 0.001), log adiponectin (R 2 ¼ 0.07; P ¼ 0.006) and log hs-CRP (R 2 ¼ 0.06; P ¼ 0.034). In conclusion, SUA levels are independently associated with hs-CRP and adiponectin levels but not with c-f PWV in essential hypertensive patients. Increased SUA levels are accompanied by a state of pronounced inflammatory activation and hypoadiponectinemia that significantly impairs the arterial stiffness accelerating the vascular ageing process in this setting.

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Section: Introductionmentioning

confidence: 99%

The diverse associations of uric acid with low-grade inflammation, adiponectin and arterial stiffness in never-treated hypertensives

et al. 2010

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“…1,2 Many more have asymptomatic hyperuricemia, a risk factor for gout and for higher cardiovascular risk. 3 Hypertension is also very common, affecting Ϸ1 in every 4 adults. 4 Among those with prehypertension, those in the highest uric acid quartile were at Ͼ2 times greater risk for microalbuminuria than those in the lowest quartile, but this relationship was not found among normotensive subjects.…”

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confidence: 99%

Hyperuricemia and Incidence of Hypertension Among Men Without Metabolic Syndrome

et al. 2007

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Abstract-The aim of this project was to study the risk of developing hypertension over a 6-year follow-up in normotensive men with baseline hyperuricemia (serum uric acid Ͼ7.0 mg/dL) but without diabetes/glucose intolerance or metabolic syndrome. We analyzed the data on men without metabolic syndrome or hypertension at baseline from the Multiple Risk Factor Intervention Trial. These men (nϭ3073; age: 35 to 57 years) were followed for an average of 6 years by annual examinations. Follow-up blood pressure among those with baseline was consistently higher than among those with normal serum uric acid concentration. We used Cox regression models for adjustment for the effects of serum creatinine, body mass index, age, blood pressure, proteinuria, serum cholesterol and triglycerides, alcohol and tobacco use, risk factor interventions, and use of diuretics. In these models, normotensive men with baseline hyperuricemia had an 80% excess risk for incident hypertension (hazard ratio: 1.81; 95% CI: 1.59 to 2.07) compared with those who did not. Each unit increase in serum uric acid was associated with a 9% increase in the risk for incident hypertension (hazard ratio: 1.09; 95% CI: 1.02 to 1.17). We conclude that the hyperuricemia-hypertension risk relationship is present among normotensive middle-aged men without diabetes/glucose intolerance or metabolic syndrome. in Ϸ3.9 million ambulatory care visits annually. 1,2 Many more have asymptomatic hyperuricemia, a risk factor for gout and for higher cardiovascular risk. 3 Hypertension is also very common, affecting Ϸ1 in every 4 adults. 4 Among those with prehypertension, those in the highest uric acid quartile were at Ͼ2 times greater risk for microalbuminuria than those in the lowest quartile, but this relationship was not found among normotensive subjects. 5 Animal and human studies have repeatedly shown a statistically independent association between serum uric acid and risk for hypertension. 6 -13 In a recent review, Johnson et al 8 have marshaled evidence that fulfills all of the Bradford Hill criteria for causality. 14 However, the issue of causality has been challenged. Skeptics cite studies that point to the strong coincidence of other cardiovascular risk factors, such as metabolic syndrome as a whole and its individual components as potential confounders. [15][16][17] Furthermore, many studies have linked a single baseline measurement of serum uric acid to onset of hypertension many years later: a limitation considering the fact that hyperuricemia, not necessarily a "trait," like serum cholesterol, can fluctuate up and down over time in response to common environmental changes such as diet, medications, and so forth.One way to overcome the above limitations would be to assemble a cohort of subjects who are at risk for hypertension but not hypertensive (thereby affording statistical power to detect small risk differences) and free of renal disease, diabetes, and metabolic syndrome. These individuals should then be followed over time with several repeated measures of ...

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“…Serum uric acid is considered as a useful biomarker for mortality in high-risk patients with acute coronary syndromes and heart failure and in patients with hypertension 33 . Despite emerging results on uric acid and its association with incident renal and cardiovascular outcomes, the beneficial role of reducing uric acid levels on cardiovascular risk, as well as on the progression of kidney diseases, is not established yet 34 .…”

Section: Protective (Antioxidant) Functions Of Uric Acidmentioning

confidence: 99%

“…Hyperuricemia has been found to be associated with obesity and insulin resistance, and consequently with type 2 diabetes 75,77,78 .…”

Section: Uric Acid and Type 2 Diabetesmentioning

confidence: 99%

Ürik Asidin Antioksidan ve Pro-Oksidan Özellikleri ile İlgili Kavram ve Tartışmalarının Derlemesi

Kumar¹,

Aruna²,

Naidu³

et al. 2015

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Uric acid, the end product of purine catabolism in humans and is known for its crystal deposition at higher concentrations (>7 mg/dl) in gout. Less is known about its antioxidant property and the beneficial effects in various diseases. It is thought that high concentration of uric acid in humans is an evolutionary advantage and it is also hypothesized that high concentration of uric acid is to compensate the antioxidant capacity of ascorbic acid which is lost in humans during the course of evolution. In the extracelluar environment, uric acid can scavenge free radicals like hydroxyl radical, singlet oxygen and peroxynitrite radical therefore, it is considered as a powerful antioxidant. On the other hand uric acid depending upon the chemical milieu, changing its property and at times it acts as pro oxidant and is associated with the pathobiochemistry in developing various diseases like hypertension, cardio vascular diseases, ischemia reperfusion injury, diabetes mellitus, non alcoholic fatty liver disorders etc. In this review, we tried to summarize the evolutionary advantages of hyperuricaemia, effects of both antioxidant property and pro-oxidant nature of uric acid in various disease conditions.

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Serum uric acid and cardiovascular disease: Recent developments, and where do they leave us?

Cited by 326 publications

References 93 publications

The diverse associations of uric acid with low-grade inflammation, adiponectin and arterial stiffness in never-treated hypertensives

The diverse associations of uric acid with low-grade inflammation, adiponectin and arterial stiffness in never-treated hypertensives

Hyperuricemia and Incidence of Hypertension Among Men Without Metabolic Syndrome

Ürik Asidin Antioksidan ve Pro-Oksidan Özellikleri ile İlgili Kavram ve Tartışmalarının Derlemesi

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