Uric acid and cardiovascular disease risk reclassification: Findings from NHANES III

Zalawadiya, Sandip; Veeranna, Vikas; Mallikethi-Reddy, Sagar; Bavishi, Chirag; Lunagaria, Abhishekh; Kottam, Anupama; Afonso, Luís

doi:10.1177/2047487313519346

Cited by 83 publications

(79 citation statements)

References 27 publications

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“…After screening the title or abstract, 1028 studies were excluded, and the remaining 59 were further identified by reading the full-text. According to the predefined inclusion criteria, 14 studies [21–34] enrolling 341 389 participants were included in the meta-analysis. Based on the reference lists of the included studies, we retrieved six potential studies, but none met our inclusion criteria.…”

Section: Resultsmentioning

confidence: 99%

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Hyperuricemia and coronary heart disease mortality: a meta-analysis of prospective cohort studies

Zuo

Jiang

et al. 2016

BMC Cardiovasc Disord

137

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BackgroundHyperuricemia may be associated with an increased risk of coronary heart disease (CHD) mortality; however, the results from prospective studies are conflicting. The objective of this study was to assess the association between hyperuricemia and risk of CHD mortality by performing a meta-analysis.MethodsPubmed and Embase were searched for relevant prospective cohort studies published until July 2015. Studies were included only if they reported data on CHD mortality related to hyperuricemia in a general population. The pooled adjusted relative risk (RR) was calculated using a random-effects model.ResultsA total of 14 studies involving 341 389 adults were identified. Hyperuricemia was associated with an increased risk of CHD mortality (RR: 1.14; 95 % CI: 1.06–1.23) and all-cause mortality (RR: 1.20; 95 % CI: 1.13–1.28). For each increase of 1 mg/dl of serum uric acid (SUA), the overall risks of CHD and all-cause mortality increased by 20 and 9 %, respectively. According to the gender subgroup analyses, hyperuricemia increased the risk of CHD mortality in women (RR: 1.47; 95 % CI: 1.21–1.73) compared to men (RR: 1.10; 95 % CI: 1.00–1.19). The risk of all-cause mortality was greater in women.ConclusionsHyperuricemia may modestly increase the risk of CHD and all-cause mortality. Future research is needed to determine whether urate–lowering therapy has beneficial effects for reducing CHD mortality.Electronic supplementary materialThe online version of this article (doi:10.1186/s12872-016-0379-z) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

“…Of the 14 included studies, four were performed in the United States [21, 22, 29, 34], five in Europe [24, 26, 30, 31, 33] and five in Asia [22, 25, 27, 28, 32]. All except one [24] were written in English.…”

Section: Resultsmentioning

confidence: 99%

Hyperuricemia and coronary heart disease mortality: a meta-analysis of prospective cohort studies

Zuo

Jiang

et al. 2016

BMC Cardiovasc Disord

137

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“…22,23 A recent publication based on NHANES III data demonstrated modest evidence of a J-shaped relationship between uric acid level and CVD mortality in a population limited to those without a history of diabetes or CVD. 24 Investigators have suggested that this inverted association may be due to the protective role of uric acid as an antioxidant. 21,23 It has also been suggested that low uric acid levels may reflect persons with poor nutritional status or wasting, although in the present study persons with lower uric acid have more optimal levels of measured health characteristics compared with persons with higher uric acid levels.…”

Section: Discussionmentioning

confidence: 99%

Uric Acid Levels, Kidney Function, and Cardiovascular Mortality in US Adults: National Health and Nutrition Examination Survey (NHANES) 1988-1994 and 1999-2002

Odden

Amadu

Smit

et al. 2014

American Journal of Kidney Diseases

127

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Background Chronic kidney disease (CKD) and hyperuricemia often coexist, and both conditions are increasing in prevalence in the United States. However, their shared role in cardiovascular risk remains highly debated. Study Design Cross-sectional and longitudinal. Setting & Participants Participants in the National Health and Nutrition Examination Survey (NHANES) from 1988 to 2002 (n = 10,956); data were linked to mortality data from the National Death Index through December 31st, 2006. Predictors Serum uric acid concentration, categorized as the sex-specific lowest (<25th), middle (25th–<75th), and highest (≥75th) percentiles; and kidney function assessed by estimated glomerular filtration rate (eGFR) based on the CKD-EPI (CKD Epidemiology Collaboration) creatinine–cystatin C equation, and urinary albumin-creatinine ratio (ACR) Outcomes Cardiovascular death and all-cause mortality. Results Uric acid levels were correlated with eGFRcr-cys (r = −0.29; p<0.001), and were only slightly correlated with ACR (r = 0.04; p<0.001). There were 2,203 deaths up until December 31st, 2006, of which 981 were due to cardiovascular causes. Overall, there was a U-shaped association between uric acid levels and cardiovascular mortality in both women and men, although the lowest risk of cardiovascular mortality occurred at a lower level of uric acid for women compared with men. There was an association between the highest quartile of uric acid and cardiovascular mortality even after adjustment for potential confounders (HR, 1.48; 95% CI, 1.13–1.96), although this association was attenuated after adjustment for ACR and eGFRcr-cys (HR, 1.25; 95% CI, 0.89–1.75). The pattern of association between uric acid levels and all-cause mortality was similar. Limitations GFR not measured; mediating events were not observed. Conclusions High uric acid is associated with cardiovascular and all-cause mortality, although this relationship was no longer statistically significant after accounting for kidney function.

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“…9,32 Some studies have suggested that hyperuricemia is also an independent predictor for cardiovascular disease, 10,11 whereas others have not. 33 Researchers have suggested that hyperuricemia might elevate cardiovascular disease risk indirectly by increasing the risk of hypertension. 34 Several studies suggest that hyperuricemia is a stronger predictor of future disease in women, who have lower serum uric acid concentrations than men.…”

Section: Discussionmentioning

confidence: 99%

Uric Acid: A Missing Link Between Hypertensive Pregnancy Disorders and Future Cardiovascular Disease?

Weissgerber

Milić

Turner

et al. 2015

Mayo Clinic Proceedings

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Objective To determine whether women who had a hypertensive pregnancy disorder (HPD) have elevated uric acid concentrations decades after pregnancy, when compared to women who had normotensive pregnancies. Patients and Methods The Genetic Epidemiology Network of Arteriopathy study measured uric acid concentrations in Hispanic (30%), non-Hispanic white (28%), and non-Hispanic black (42%) women (60 ± 10 years of age). This cross-sectional study was conducted between July 1, 2000 and December 31, 2004. Hispanic participants were recruited from families with high rates of diabetes, whereas non-Hispanic participants were recruited from families with high rates of hypertension. This analysis compared uric acid concentrations in women with a history of normotensive (n=1,846) or hypertensive (n=408) pregnancies by logistic regression. Results Women who had a HPD had higher uric acid concentrations (Median: 5.7 vs. 5.3 mg/dL, P<.001) and were more likely to have uric acid concentrations above 5.5 mg/dl (54.4% vs. 42.4%, P=.001) than women who had normotensive pregnancies. These differences persisted after adjusting for traditional cardiovascular risk factors, co-morbidities and other factors that affect uric acid concentrations. A family-based subgroup analysis comparing uric acid concentrations in women who had a HPD (n=308) and their parous sisters who had normotensive pregnancies (n=250) gave similar results (Median uric acid concentrations: 5.7 vs. 5.2 mg/dl, P=0.02; Proportion of women with uric acid >5.5 mg/dl: 54.0% vs. 40.3%, P<.001). Conclusion Decades after pregnancy, women who had a HPD have higher uric acid concentrations. This effect does not appear to be explained by a familial predisposition to elevated uric acid concentrations.

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Uric acid and cardiovascular disease risk reclassification: Findings from NHANES III

Abstract: sUA was not an independent predictor of both CVD and CHD mortality. Ethnicity did not influence the association of sUA with CVD mortality. Furthermore, sUA did not add to risk assessment beyond traditional CVD risk factors.

Cited by 83 publications

References 27 publications

Hyperuricemia and coronary heart disease mortality: a meta-analysis of prospective cohort studies

Hyperuricemia and coronary heart disease mortality: a meta-analysis of prospective cohort studies

Uric Acid Levels, Kidney Function, and Cardiovascular Mortality in US Adults: National Health and Nutrition Examination Survey (NHANES) 1988-1994 and 1999-2002

Uric Acid: A Missing Link Between Hypertensive Pregnancy Disorders and Future Cardiovascular Disease?

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