Abstract
INTRODUCTIONSmoking status based solely on self-reporting is unreliable and might be inaccurate, particularly among women. This study investigated the association between urinary cotinine-verified smoking status and hyperuricemia in a nationwide Korean population.METHODSThis study included 5329 participants aged ≥19 years with information on smoking status, urine cotinine levels and serum uric acid. We determined smoking status according to self-reports and urinary cotinine levels. Multivariate linear regression analysis was used to measure the association between smoking exposure and serum uric acid levels. The effects of smoking on hyperuricemia were evaluated by multivariate logistic regression analysis.RESULTSBiochemically verified active and passive smokers comprised 22% (38.7% of men and 8.8% of women) and 12.3% (11.9% of men and 12.6% of women) of the study population, respectively. While reclassification rate of active smokers was 1.4% in men, 31.8% of cotinine-verified female active smokers were self-reported never smokers. Higher uric acid levels were observed with increased tobacco exposure among women (p-trend=0.007) but not among men. After adjusting for confounders, the risk of hyperuricemia increased with tobacco exposure only in women (p-trend=0.016).CONCLUSIONSCotinine-verified smoking status was associated with increased serum uric acid and hyperuricemia in a dose-response manner only in women. This study might provide evidence to support the importance of smoking cessation in women with gout and further studies are necessary to elucidate the underlying mechanism of the observed association.
Highlights
Smoking status based solely on self-reporting is unreliable and might be inaccurate, among women
Growing evidence indicates that hyperuricemia is a pre-existing condition for gout and a risk factor for diabetes[3], hypertension[4], chronic kidney disease[5], premature death from cardiovascular disease[6], and overall mortality[7]; the increasing prevalence of hyperuricemia, especially in women, is drawing increasing attention in public health owing to its implications for chronic diseases[8]
Higher serum uric acid and urinary cotinine levels were observed in the active smoking group (p
Summary
Smoking status based solely on self-reporting is unreliable and might be inaccurate, among women. Hyperuricemia is a prerequisite condition for gout and results from decreased uric acid excretion or increased uric acid production due to increased cell turnover, high-purine diet, or deficiency of enzymes related to purine metabolism[1,2]. Several genetically-susceptible loci including solute carrier family 2 member 9 (SLC2A9), ATP-binding cassette subfamily G member 2 (ABCG2), glucokinase regulator (GCKR) etc., are associated with uric acid excretion in kidney and individuals having risk allele of these loci showed elevated serum uric acid levels and increased risk of gout[9,10]. A study using Framingham Heart Study cohort data reported that cigarette smoking had protective effects against elevated uric acid levels[15] and a longitudinal study from Japan observed a decreased risk of hyperuricemia among smokers[16]
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