Uric Acid and Cardiovascular Risk

Feig, Daniel I.; Kang, Duk Hee; Johnson, Richard J.

doi:10.1056/nejmra0800885

Cited by 2,087 publications

(1,755 citation statements)

References 133 publications

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“…12 This is in contrast to the literature that classify the black population as a high-risk group regarding hyperuricemia 4,8,13 or that the African population and Caucasian population have similar UA levels. 14 The role of UA in the development of CVD and its concomitant associations with components of the metabolic syndrome is receiving growing attention.…”

Section: Introductionmentioning

confidence: 92%

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Uric acid and the cardiovascular profile of African and Caucasian men

2010

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The African population is considered a high-risk group for the development of hypertension, and identifying risk factors are therefore essential in preventive actions against cardiovascular disease (CVD). Elevated levels of uric acid (UA) are often associated with CVD. Our first aim was to establish possible ethnic differences in UA levels between African and Caucasian men. Our second aim was to determine any associations between UA levels and cardio-metabolic variables, and also how these correlates differ between the two groups. African (N ¼ 87) and Caucasian (N ¼ 121) men participated in this cross-sectional study. Our results have shown that African men had significantly lower (353±87.7 vs 401 ± 98.2; Po0.01) UA levels compared with Caucasian men. Waist circumference and triglycerides correlated strongly with UA in both ethnic groups. This was confirmed with a forward stepwise multiple regression analysis. After adjustment for confounders, the correlation between UA and triglycerides remained significant only in the Caucasians (r ¼ 0.29; P ¼ 0.02), whereas only the African men showed an independent correlation between UA and total peripheral resistance (TPR) (r ¼ 0.23; P ¼ 0.04). TPR increased significantly across UA tertiles only in the African men (P ¼ 0.01 vs P ¼ 0.96).In conclusion, despite their lower UA levels, Africans showed an independent relationship between UA and vascular resistance, indicating a possible explanation for their high prevalence of hypertension.

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Section: Introductionmentioning

confidence: 92%

“…Many studies argue that the association between UA and cardiovascular dysfunction is co-incidental, and based on the presence of the individual components of the metabolic syndrome. 8 These components include hypertension, obesity, dyslipidemia and hyperinsulinemia/insulin resistance.…”

Section: Introductionmentioning

confidence: 99%

Uric acid and the cardiovascular profile of African and Caucasian men

2010

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“…XOIs might reduce free radical production, leading to improved left ventricular (LV) function and reverse LV remodeling and renal function 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12. There is a substantial literature suggesting that serum UA concentrations are associated with worse cardiovascular outcomes 13, 14, 15. However, UA is excreted by the kidney and therefore a marker of renal function which is also strongly associated with cardiovascular outcome.…”

Section: Introductionmentioning

confidence: 99%

Xanthine oxidase inhibition for the treatment of cardiovascular disease: an updated systematic review and meta‐analysis

et al. 2016

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BackgroundPrevious studies have shown that xanthine oxidase inhibitors (XOI) might improve outcome for patients with cardiovascular disease. However, more evidence is required.Methods and resultsWe published a meta‐analysis of trials conducted before 2014 examining the effects of XOI on mortality in patients with cardiovascular disease. At least two further trials (N = 323 patients) have since been published. Accordingly, we repeated our analysis after a further search for randomized controlled trials of XOI in PubMed/MEDLINE, EMBASE, and Cochrane Databases. We identified eight relevant trials with 1031 patients. The average age of the patients was 61 years and 68% were men (one study did not report gender). There were 57 deaths in these eight trials, 26 in those assigned to XOI, and 31 in those assigned to the control. The updated meta‐analysis could not confirm a reduction in mortality for patients assigned to XOI compared with placebo (odds ratio 0.84) but 95% confidence intervals were wide (0.48–1.47).ConclusionsThis updated meta‐analysis does not suggest that XOI exert a large reduction in mortality but also cannot exclude the possibility of substantial harm or benefit.

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“…Cardiovascular disease (CVD) is the leading cause of death in the older population, and the prevalence and incidence of CVD increases exponentially with advancing age 2. Uric acid, the final product of purine degradation in humans, mediates proinflammatory endothelial dysfunction and is associated with greater risks for CVD events 3, 4. Although a wealth of research has reported that an elevated serum uric acid (SUA) level >7 mg/dL independently predicts all‐cause and CVD‐related mortality in middle‐aged adults,5, 6, 7 studies linking hyperuricemia to mortality risks in the elderly population are conflicting and inconclusive 8, 9, 10, 11, 12, 13, 14.…”

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confidence: 99%

U‐Shaped Association Between Serum Uric Acid Levels With Cardiovascular and All‐Cause Mortality in the Elderly: The Role of Malnourishment

Tseng

Chen

et al. 2018

JAHA

134

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BackgroundThe link between elevated serum uric acid (SUA) levels and cardiovascular disease (CVD)–related mortality in the elderly population remains inconclusive. Nutritional status influences both SUA and CVD outcomes. Therefore, we investigated whether SUA‐predicted mortality and the effect‐modifying roles of malnourishment in older people.Methods and ResultsA longitudinal Taiwanese cohort including 127 771 adults 65 years and older participating in the Taipei City Elderly Health Examination Program from 2001 to 2010 were stratified by 1‐mg/dL increment of SUA. Low SUA (<4 mg/dL) strata was categorized by malnourishment status defined as Geriatric Nutritional Risk Index <98, serum albumin <38 g/L, or body mass index <22 kg/m2. Study outcomes were all‐cause and CVD‐related mortality. Cox models were used to estimate hazard ratios (HRs) of mortality, after adjusting for 20 demographic and comorbid covariates. Over a median follow‐up of 5.8 years, there were 16 439 all‐cause and 3877 CVD‐related deaths. Compared with the reference SUA strata of 4 to <5 mg/dL, all‐cause mortality was significantly higher at SUA <4 mg/dL (HR, 1.16; 95% confidence interval, 1.07–1.25) and ≥8 mg/dL (HR, 1.13; confidence interval, 1.06–1.21), with progressively elevated risks at both extremes. Similarly, increasingly higher CVD‐related mortality was found at the SUA level <4 mg/dL (HR, 1.19; confidence interval, 1.00–1.40) and ≥7 mg/dL (HR, 1.17; confidence interval, 1.04–1.32). Remarkably, among the low SUA (<4 mg/dL) strata, only malnourished participants had greater all‐cause and CVD‐related mortality. This modifying effect of malnourishment remained consistent across subgroups.Conclusions SUA ≥8 or <4 mg/dL independently predicts higher all‐cause and CVD‐related mortality in the elderly, particularly in those with malnourishment.

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Uric Acid and Cardiovascular Risk

Cited by 2,087 publications

References 133 publications

Uric acid and the cardiovascular profile of African and Caucasian men

Uric acid and the cardiovascular profile of African and Caucasian men

Xanthine oxidase inhibition for the treatment of cardiovascular disease: an updated systematic review and meta‐analysis

U‐Shaped Association Between Serum Uric Acid Levels With Cardiovascular and All‐Cause Mortality in the Elderly: The Role of Malnourishment

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