Serum Uric Acid Is a Strong Predictor of Stroke in Patients With Non–Insulin-Dependent Diabetes Mellitus

Lehto, Seppo; Niskanen, Leo; Rönnemaa, Tapani; Laakso, Markku

doi:10.1161/01.str.29.3.635

Cited by 365 publications

(251 citation statements)

References 57 publications

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“…In diabetic subjects elevated serum UA levels are related with increased risk of future stroke [14,15]. A recent study showed that in type 2 diabetic subjects elevated plasma UA levels were associated with increased arterial stiffness, which is a well-recognised cardiovascular risk factor [16].…”

Section: Discussionmentioning

confidence: 99%

Predictors of In-Hospital Mortality after Acute Ischemic Stroke in Subjects with and without Diabetes Mellitus

Papazafiropoulou¹,

Sotiropoulos²,

Skliros³

et al. 2009

TOGMJ

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Abstract:Background: Diabetes mellitus is a well-established risk factor for ischemic stroke and is associated with increased in-hospital mortality. The aim of the present study was to determine the potential predictors of in-hospital mortality after an ischemic stroke in diabetic and nondiabetic subjects. Methods: 159 diabetic subjects (66 males / 93 females, mean age ± SD: 77.4 ± 6.4 years) and 159 non diabetic subjects (66 males / 93 females, mean age ± SD: 77.3 ± 5.2 years) hospitalized for ischemic stroke were studied. Demographic characteristics and laboratory tests on admission as well as outcome were recorded. Brain computed tomography scan was performed in all study subjects. Results: In-hospital death rates did not differ between the diabetic and the nondiabetic patients [36 (22.6%) vs. 27 (17.0%), respectively, P = 0.20]. In the diabetic study group multivariate analysis, after controlling for CRP, total cholesterol, LDL-C, urea and creatinine levels, demonstrated that death was related with WBC count (OR: 1.002, 95% CI: 1.001-1.004, P = 0.005), glucose levels (OR: 1.007, 95% CI: 1.002-1.012, P = 0.008), and UA levels (OR: 1.51, 95% CI: 1.003-2.260, P = 0.05). In the nondiabetic study group, after controlling for WBC count, CRP, total cholesterol and LDL-C levels, death was related only with glucose levels (OR: 1.016, 95% CI: 1.001-1.031, P = 0.03). Conclusions: WBC count and UA levels on hospital admission are independent predictors for in-hospital mortality in diabetic subjects with ischemic stroke. Plasma glucose levels are predictor for in-hospital mortality in both diabetic and nondiabetic subjects.

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Section: Discussionmentioning

confidence: 99%

Predictors of In-Hospital Mortality after Acute Ischemic Stroke in Subjects with and without Diabetes Mellitus

Papazafiropoulou¹,

Sotiropoulos²,

Skliros³

et al. 2009

TOGMJ

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show abstract

“…Although the role of uric acid as a risk factor for cardiovascular diseases and strokes has been widely debated over the years, recent studies have provided fresh evidence that high serum uric acid levels could be related to a higher incidence of hypertension, 55,56 cardiovascular diseases and strokes, especially in patients with preexisting hypertension, heart failure or diabetes mellitus. [57][58][59][60] Hypertensive patients, particularly with hyperuricaemia have a higher risk of experiencing cardiovascular or cerebrovascular disease than patients with normal uric acid levels. [57][58][59][60] Although the mechanism by which uric acid exerts its pathogenetic effect on cardiovascular and cerebrovascular complications is still unclear, high uric acid levels have been shown to induce inflammation, endothelial dysfunction, oxidative metabolism, and platelet adhesion and aggregation.…”

Section: Aii-mediated Effects Of Arbsmentioning

confidence: 99%

“…[57][58][59][60] Hypertensive patients, particularly with hyperuricaemia have a higher risk of experiencing cardiovascular or cerebrovascular disease than patients with normal uric acid levels. [57][58][59][60] Although the mechanism by which uric acid exerts its pathogenetic effect on cardiovascular and cerebrovascular complications is still unclear, high uric acid levels have been shown to induce inflammation, endothelial dysfunction, oxidative metabolism, and platelet adhesion and aggregation. [61][62][63][64][65] All these changes induced by high uric acid levels could conceivably lead to cardiovascular complications and stroke and therefore, drugs that lower uric acid levels have been shown to reverse these changes.…”

Section: Aii-mediated Effects Of Arbsmentioning

confidence: 99%

Possible pathophysiologic mechanisms supporting the superior stroke protection of angiotensin receptor blockers compared to angiotensin-converting enzyme inhibitors: clinical and experimental evidence

Chrysant

2005

J Hum Hypertens

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Stroke is a major cause of death and disability and its incidence increases linearly with age and the level of systolic and diastolic blood pressure. Stroke, besides being a cause of long-term disability for the affected person, also imposes a significant burden on society and healthcare costs. Although good blood pressure control is very critical for stroke prevention, angiotensin receptor blockers (ARBs) may be superior to angiotensin-converting enzyme inhibitors (ACEIs) for the same degree of blood pressure control. This hypothesis has clinical and experimental support. ARBs prevent stroke incidence by blocking the angiotensin II (AII), AT 1 receptors preventing brain ischaemia and allowing AII to stimulate the unoccupied AT 2 receptors, which improve brain ischaemia. ACEIs, by reducing AII generation, are less effective in preventing stroke. This hypothesis provides evidence that AII plays an important role in the prevention of stroke. Certain ARBs like losartan, and telmisartan, irbesartan and candesartan possess additional properties which may play a role in stroke prevention, which is independent of AII. These include antiplatelet aggregating, hypouricemic, antidiabetic and atrial antifibrillatory effects. However, the most critical factor in stroke prevention is good blood pressure control irrespective of drug used.

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“…12 This is a matter of concern as SUA levels 44 mg/dl have been associated with atherogenesis and stroke in individuals at risk for diabetes or CVD. 21,22 American Indians also have higher rates of albuminuria and of CKD (ie, estimated glomerular filtration rate (eGFR) o60 ml/(min/1.73 m 2 )) than the general US population due primarily to an excess of diabetes and diabetic nephropathy. 23,24 Furthermore, the prevalence of end-stage renal disease (ESRD) and diabetic-ESRD are much higher (two and four times, respectively) in American Indians than in the general US population.…”

Section: Introductionmentioning

confidence: 99%

Replication of the effect of SLC2A9 genetic variation on serum uric acid levels in American Indians

et al. 2013

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Increased serum uric acid (SUA) or hyperuricemia, a risk factor for gout, renal and cardiovascular diseases, is caused by either increased production or decreased excretion of uric acid or a mix of both. The solute carrier protein 2 family, member 9 (SLC2A9) gene encodes a transporter that mediates urate flux across the renal proximal tubule. Genome-wide association studies have consistently shown the association of single-nucleotide polymorphisms in this gene with SUA in majority populations. American Indian participants of the Strong Heart Family Study, belonging to multigenerational families, have high prevalence of hyperuricemia. We conducted measured genotype analyses, based on variance components decomposition method and accounting for family relationships, to assess whether the association between SUA and SLC2A9 gene polymorphisms generalized to American Indians (n ¼ 3604) of this study. Seven polymorphisms were selected for genotyping based on their association with SUA levels in other populations. A strong association was found between SLC2A9 gene polymorphisms and SUA in all centers combined (P-values: 1.3 Â 10 À31 -5.1 Â 10 À23 ) and also when stratified by recruitment center; P-values: 1.2 Â 10 À14 -1.0 Â 10 À5 . These polymorphisms were also associated with the estimated glomerular filtration rate and serum creatinine but not albumin-creatinine ratio. In summary, the association of polymorphisms in the uric acid transporter gene with SUA levels extends to a new population of American Indians.

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Serum Uric Acid Is a Strong Predictor of Stroke in Patients With Non–Insulin-Dependent Diabetes Mellitus

Cited by 365 publications

References 57 publications

Predictors of In-Hospital Mortality after Acute Ischemic Stroke in Subjects with and without Diabetes Mellitus

Predictors of In-Hospital Mortality after Acute Ischemic Stroke in Subjects with and without Diabetes Mellitus

Possible pathophysiologic mechanisms supporting the superior stroke protection of angiotensin receptor blockers compared to angiotensin-converting enzyme inhibitors: clinical and experimental evidence

Replication of the effect of SLC2A9 genetic variation on serum uric acid levels in American Indians

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