Uric Acid Level as a Risk Factor for Cardiovascular and All-Cause Mortality in Middle-aged Men

Niskanen, Leo; Laaksonen, David E.; Nyyssönen, Kristiina; Alfthan, Georg; Lakka, Hanna‐Maaria; Lakka, Timo A.; Salonen, Jukka T.

doi:10.1001/archinte.164.14.1546

Cited by 602 publications

(306 citation statements)

References 49 publications

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“…It has also been indicated that in 4 seasons of the annual training cycle (adopted from Bompa, 1999), the match season in which the training moved towards anaerobic, the relaxing activity of this enzyme was high, and this is consistent with the findings of the present study because HIIT activities in which the major energy system is anaerobic can increase this enzyme and as a result, improve the salvage pathway purine nucleotides (26). One of the considerable findings of the present study is the significant increase in hypoxanthine, which indicates breakdown of ATP, and also lower serum uric acid, which is an indicator of inflammation and injury, suggesting that although uric acid is the final product of purine in humans, in this study it not only did not increase, but also decreased (27). An overall look at the research may suggest that exercise stress caused excretion of purine nucleotide and high energy metabolism.…”

Section: Discussionsupporting

confidence: 41%

The Effects of a Short-Term High-Intensity Interval Training (HIIT) on the Levels of Serum Hypoxanthine-Guanine Phosphoribosyltransferase (HGPRT) Enzyme and Some Variables of Purine Nucleotide Cycle

Ghanbari–Niaki

Gatabi

Fathi

et al. 2016

Ann Mil Health Sci Res

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Background: The enzyme HGPRT 5-phosphoribosyl converts to hypoxanthine or guanine to build up IMP or GMP as an ATP and GTP precursor in the purine nucleotides salvage pathway. This enzyme is most active in the liver, blood cells, nervous system, and skeletal muscles. In fact, the normal activity of this enzyme is involved in the salvage of 90% of free nucleotides and thereby contributes to the economy of purine in cells. Minor decrease or defect of this enzyme results in the increased xanthine, uric acid, and oxygen free radicals. Reports suggest the relationship between this enzyme and the level of physical preparation, antioxidant capacity, and low blood uric acid levels in active individuals. However, the effect of different types of exercise, especially high-intensity intermittent exercise on this enzyme is not clear.

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Section: Discussionsupporting

confidence: 41%

The Effects of a Short-Term High-Intensity Interval Training (HIIT) on the Levels of Serum Hypoxanthine-Guanine Phosphoribosyltransferase (HGPRT) Enzyme and Some Variables of Purine Nucleotide Cycle

Ghanbari–Niaki

Gatabi

Fathi

et al. 2016

Ann Mil Health Sci Res

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“…Our study did not aim to assess the relationship between the change of SUA and mortality risks. A single measurement of SUA to predict outcomes was a simplified and practical approach, similar to what was done by previous researchers 5, 6, 7, 8, 10, 11. Information on diuretics and urate‐lowering agents was lacking in our study.…”

Section: Discussionmentioning

confidence: 97%

“…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. Earlier studies indicate that hyperuricemia is associated with increased risks of death from any causes and CVD‐related mortality in older adults 8, 9, 10, 11.…”

mentioning

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

135

103

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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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“…Elevated SUA levels have been shown to be associated with atherosclerosis [3] and risk factors for CAD such as hypertension [4], obesity [5], diabetes [6], metabolic syndrome [7,8] and chronic renal failure [9,10,11]. Several studies in healthy subjects [12,13,14] and CAD patients [15,16,17,18,19,20,21] have shown that elevated SUA levels independently predict worse cardiovascular outcomes, while the Framingham study [22] and others [23,24,25] failed to support these findings. Although it is well known that SUA levels are partially influenced by renal function [26], the relationship between the cardiovascular risk associated with hyperuricemia and renal dysfunction has not been previously investigated.…”

Section: Introductionmentioning

confidence: 99%

Serum Uric Acid for Risk Stratification of Patients with Coronary Artery Disease

et al. 2009

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Objectives: In patients with coronary artery disease (CAD), elevated serum uric acid (SUA) levels may predict worse cardiovascular outcomes. It is known that SUA levels are influenced by renal function. We aimed to assess the predictive value of SUA while taking into account patients’ renal function. Methods: The primary end point (PEP) risk, including fatal or nonfatal myocardial infarction (MI) or sudden death, was assessed by SUA quintiles before and after adjustment for the estimated glomerular filtration rate (eGFR) in 2,796 nondiabetic CAD patients enrolled in the Bezafibrate Infarction Prevention study. Results: The PEP risk increased from the lowest (11.8%) to highest SUA quintile (18.0%), p < 0.005, respectively. After adjustment for age, sex, smoking, prior MI, metabolic syndrome variables, NYHA classes II–IV, heart rate and treatment with bezafibrate, diuretics, angiotensin-converting enzyme inhibitors, β-blockers, calcium channel blockers and antiplatelets, the highest SUA quintile exhibited the highest PEP risk [hazard ratio (HR): 1.47 (95% CI: 1.06–2.04)]. Patients in the highest – compared with those in the lowest – quintiles continued to demonstrate an increased PEP risk [HR: 1.46 (95% CI: 1.04–2.06)], even after additional adjustment for the eGFR. Conclusion: In nondiabetic patients with CAD, elevated SUA levels are associated with an increased risk of cardiac events, independent of renal function.

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Uric Acid Level as a Risk Factor for Cardiovascular and All-Cause Mortality in Middle-aged Men

Cited by 602 publications

References 49 publications

The Effects of a Short-Term High-Intensity Interval Training (HIIT) on the Levels of Serum Hypoxanthine-Guanine Phosphoribosyltransferase (HGPRT) Enzyme and Some Variables of Purine Nucleotide Cycle

The Effects of a Short-Term High-Intensity Interval Training (HIIT) on the Levels of Serum Hypoxanthine-Guanine Phosphoribosyltransferase (HGPRT) Enzyme and Some Variables of Purine Nucleotide Cycle

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

Serum Uric Acid for Risk Stratification of Patients with Coronary Artery Disease

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