Effect Of Serum Uric Acid Research Articles

Effect of Uric Acid on the Development of Chronic Kidney Disease: The Korean Multi-Rural Communities Cohort Study.

ObjectivesSeveral studies have investigated the effects of serum uric acid (SUA) levels on chronic kidney disease (CKD), with discrepant results. The effect of SUA levels on CKD development was studied in the Korean rural population.MethodsA total of 9695 participants aged ≥40 years were recruited from 3 rural communities in Korea between 2005 and 2009. Of those participants, 5577 who participated in the follow-up and did not have cerebrovascular disease, myocardial infarction, cancer, or CKD at baseline were studied. The participants, of whom 2133 were men and 3444 were women, were grouped into 5 categories according to their quintile of SUA levels. An estimated glomerular filtration rate of <60 mL/min/1.73 m2 at the time of follow-up was considered to indicate newly developed CKD. The effects of SUA levels on CKD development after adjusting for potential confounders were assessed using Cox proportional hazard models.ResultsAmong the 5577 participants, 9.4 and 11.0% of men and women developed CKD. The hazard ratio (HR) of CKD was higher in the highest quintile of SUA levels than in the third quintile in men (adjusted HR, 1.60; 95% confidence interval [CI], 1.02 to 2.51) and women (adjusted HR, 1.56; 95% CI, 1.14 to 2.15). Furthermore, CKD development was also more common in the lowest quintile of SUA levels than in the third quintile in men (adjusted HR, 1.83; 95% CI, 1.15 to 2.90). The effect of SUA was consistent in younger, obese, and hypertensive men.ConclusionsBoth high and low SUA levels were risk factors for CKD development in rural Korean men, while only high levels were a risk factor in their women counterparts.

Arterial Stiffness Mediated the Association Between Serum Uric Acid and Blood Pressure

Background: Elevated serum uric acid concentration and arterial stiffness are both risk factors for hypertension. Serum uric acid is also associated with arterial stiffness. Whether serum uric acid affects blood pressure through arterial stiffening is yet unsolved, with very limited observational studies. Methods: Participants were selected from Kailuan Study (2008-2016), who were free of cardiovascular diseases and anti-hypertensive drugs. Arterial stiffness was measured by brachial-ankle pulse wave velocity. Parameters of blood pressure included systolic and diastolic blood pressure, mean artery pressure, and pulse pressure. Study Group I consisted of participants with baseline uric acid, brachial-ankle pulse wave velocity at next follow-up visit (~2 years), and blood pressure at a third follow-up (~4 years); Study Group II consisted of participants with complete data in a single visit. Correlations were tested by multivariate linear regressions. Role of arterial stiffness in connecting uric acid to blood pressure was tested by mediation analyses. Findings: In Study Group I, correlations were found between serum uric acid and arterial stiffness (R2=0.299, P<0.001), serum uric acid and blood pressure (R2=0.191, P<0.001), and arterial stiffness and blood pressure (R2=0.288, P<0.001). In mediation analyses, the total, direct, and indirect effect of serum uric acid on systolic blood pressure were 0.0118 (P<0.001), 0.0103 (P<0.001), and 0.0015 (P<0.001), respectively. The percentage of mediation effect was 12.8%. Similar results persisted with diverse BP outcomes, and in Study Group II. Interpretation: Arterial stiffness mediated the association between serum uric acid and blood pressure. Funding Statement: Authors report no funding. Conflict of Interest: Authors report no conflict of interest. Ethics Approval Statement: The study was approved by Ethics Committees of Kailuan General Hospital, in accordance with the Declaration of Helsinki

Impact of serum uric acid on incident hypertension in a worksite population of Japanese men.

Higher levels of serum uric acid are associated with an increased risk of cardiovascular diseases, which may be confounded by comorbidities. We investigated the effects of serum uric acid on the risk of hypertension in Japanese men at a worksite. We evaluated a total of 2335 Japanese male workers without hypertension who ranged in age from 18 to 64 years at a worksite in 2009. These men were followed for 6 years from 2009 to 2015. During the follow-up period, 380 individuals developed hypertension. The odds ratio for the incident hypertension was estimated according to quartiles of serum uric acid levels of 5.1 or less, 5.2-5.8, 5.9-6.6, and at least 6.7 mg/dl. The multivariable-adjusted risk of incident hypertension was significantly higher in the highest serum uric acid quartile than in the lowest: odds ratio 1.00 (reference) for the lowest quartile, 1.34 (0.91-1.97) for the second quartile, 1.42 (0.97-2.06) for the third quartile, and 1.65 (1.14-2.40) for the highest quartile. In stratified analyses, the association between serum uric acid and incident hypertension was significant in the patients of aged below 45 years and without comorbidities, namely diabetes and low levels of high-density lipoprotein-cholesterol. Serum uric acid levels were associated with the future incidence of hypertension, and the association was observed in the younger individuals, those without diabetes, and those with preserved high-density lipoprotein cholesterol levels in a worksite population of Japanese men.

Raised serum uric acid is associated with higher bone mineral density in a cross-sectional study of a healthy Indian population.

PurposeOxidative stress has been implicated as a fundamental mechanism in the decline of bone mass. Reactive oxygen species are reported to suppress osteoblast generation and differentiation and enhance osteoclast development and activity. Increasing evidence suggests favorable effect of serum uric acid (UA) on bone metabolism due to its antioxidant properties. Therefore, we investigated the association between serum UA levels and bone mineral density (BMD) in healthy adult Indian subjects.Materials and methodsWe reviewed the medical records of 524 subjects who had undergone preventive health check-ups in a tertiary care hospital that included UA and BMD measurements at femur neck, total femur, and lumbar spine. Subjects concomitantly taking drugs or having a medical condition that would affect the bone metabolism or UA levels were excluded.ResultsThe final analysis included 310 subjects (mean age: 47.2±12.2 years; females: 43.5%; males: 56.5%). Study population was categorized into two groups based on the group median value for UA (ie, 5.4 mg/dL). BMD was significantly higher at all skeletal sites in subjects with UA >5.4 mg/dL compared to subjects with UA ≤5.4 mg/dL (p<0.001). On correlation analysis, UA was positively associated with BMD at all skeletal sites (r=0.211–0.277; p<0.05). The correlation remained significant after controlling for age (p<0.05) and lifestyle factors (smoking, alcohol use, physical activity, and diet; p<0.05) independently. UA significantly (p<0.001) accounted for 4.5%–7.7% of the variance in BMD (r2=0.045–0.077) in unadjusted model and 1.6%–3.2% of the variance (p<0.05) when adjusted for age and body mass index combined at lumbar spine and right femur neck, respectively.ConclusionWe conclude that raised UA levels are associated with higher BMD at all skeletal sites and UA may have a protective role in bone metabolism owing to its antioxidant effect.

Sex-specific Relationship of Serum Uric Acid with All-cause Mortality in Adults with Normal Kidney Function: An Observational Study.

To explain the clinical effect of serum uric acid (SUA) levels as a risk factor for mortality, considering exclusion of kidney function. Participants aged over 40 years who underwent health checkups were recruited. Individuals with estimated glomerular filtrations rates < 60 ml/min/1.73 m2 and who received laboratory study and colonoscopy on the same day were excluded. SUA levels were higher in men than in women (5.7 ± 1.2 mg/dl for men and 4.2 ± 0.9 mg/dl for women, p < 0.001). During 12.3 ± 3.6 years of followup, 1402 deaths occurred among 27,490 participants. About 6.9% of men and 3.1% of women died. The overall mortality rate had a U-shaped association with SUA levels, a U-shaped association in men, and no association in women. There was a significant interaction of sex for the SUA-mortality association (p for interaction = 0.049); therefore, survival analysis was conducted by sex. In men, the lower SUA group had a higher mortality rate after adjustment (SUA ≤ 4.0 mg/dl, adjusted HR 1.413, 95% CI 1.158-1.724, p = 0.001) compared with the reference group (SUA 4.1-6.0 mg/dl). A higher SUA contributed to an insignificant increased mortality in men (> 8.0 mg/dl, adjusted HR 1.140, 95% CI 0.794-1.636, p = 0.479). Women failed to show any significant association between SUA and mortality. This study provided novel evidence that SUA-mortality association differed by sex. We demonstrated that a lower SUA was an independent risk factor for all-cause mortality in men with normal kidney function.

Direct and Indirect Effects of Serum Uric Acid on Blood Sugar Levels in Patients with Prediabetes: A Mediation Analysis.

Purpose To estimate both direct and indirect effects (through obesity) of serum uric acid (SUA) on blood sugar in prediabetes patients. Methods Prediabetes patients who came to the outpatient clinic of the Department of Family Medicine, Ramathibodi Hospital, were included in this cross-sectional study. Mediation analysis was applied to determine direct and indirect effects of SUA on glycemic parameters (fasting plasma glucose (FPG) and HbA1c) through waist circumference (WC). A mediation effect was estimated using the product-of-coefficient method with a bootstrap analysis of 1000 replications. Results 1043 patients were eligible for this study. Every 1 mg/dl increase in SUA was associated with an increase in WC and then was significantly associated with an increase in FPG by 0.082 mg/dl (95% CI: 0.010, 0.154). SUA was directly associated with FPG with a coefficient of 0.413 (95% CI: 0.049, 0.776). For HbA1c, every one mg/dl increase in SUA was associated with an increase in HbA1c level through WC by 0.006 (95% CI: 0.003, 0.010). However, SUA was not directly associated with HbA1c. Conclusions We found that an increase in SUA was directly and indirectly associated with increased FPG but the effect of SUA on HbA1c was shown when it was mediated through WC.

Interactive effect of serum uric acid and total bilirubin for cardiovascular disease in Chinese patients with type 2 diabetes.

Serum uric acid (SUA) at high levels and bilirubin at low levels were potent antioxidant but it was uncertain that whether SUA and total bilirubin (TBIL) had additive interaction for the risk of CVD in type 2 diabetes mellitus (T2DM). We conducted a cross-sectional survey of 6713 inpatients with T2DM and admitted to 81 tertiary care hospitals. CVD was defined as having either prior coronary heart disease or stroke or peripheral arterial disease. Binary logistic regression was used to estimate odds ratios of SUA and TBIL for CVD. The effect size of additive interaction was estimated by three measures, i.e., relative excess risk due to interaction, attributable proportion due to interaction and synergy index. Among 6713 patients with T2DM, 561 (8.36%) suffered from CVD. Using ≥283 umol/L (median) to define high SUA and <11.5 umol/L (n = 2290 or 34.11%) to define low TBIL, copresence of both factors (n = 621 or 9.25%) was associated with 5.18-fold (95% CI, 4.00–6.72) risk of CVD with significant additive interactions in multivariable analysis as compared to absence of both risk factors. The copresence of both high SUA and low TBIL was associated with a large increased risk of CVD in high-risk Chinese patients with type 2 diabetes.

Serum Uric Acid Relation for Hearing Threshold Shift.

Objectives The effects of serum uric acid (UA) level on a variety of diseases were found from experimental and observational studies via oxidative stress and anti-oxidants. However, research on the association of UA and hearing thresholds is relatively sparse. We investigated this issue in the U.S. general population to evaluate the relationship of serum UA levels and pure tone threshold of hearing.Methods Forty four thousand eighty four eligible participants aged 20 to 69 years who have serum UA data and received Audiometry Examination Component were enrolled from the National Health and Nutrition Examination Survey 1999–2004. Hearing thresholds (dB) as a pure tone average at low frequencies (0.5, 1, 2 kHz) and at high frequencies (3, 4, 6, and 8 kHz) were computed. Multivariate linear regression models and tertile-based analysis with an extended-model approach for covariates adjustment were used to assess the correlation between serum UA level and hearing thresholds.Results In the adjusted mode of tertile-based analysis, the regression coefficients elucidated as the change of log-transformed mean hearing thresholds upon comparing participants in the highest tertile of serum UA to those in the lowest tertile were –0.067 (P=0.023) in high frequency and –0.058 (P=0.054) in low frequency. After adjusting for multiple pertinent covariates, inverse association between tertiles of serum UA and hearing thresholds remained essentially unchanged. The negative trends between serum UA and hearing thresholds were statistically significant (P for trends <0.05) in tertile-based multiple linear regressions.Conclusion Individuals with elevated UA levels independently were found to be inversely associated with hearing thresholds for pure tone audiometry in a nationally representative sample of U.S. adults.

Effects of Serum Uric Acid on Estimated GFR in Cardiac Surgery Patients: A Pilot Study

Background: The aim of the study was to investigate the effects of serum uric acid (SUA) on acute kidney injury (AKI) in patients undergoing cardiac surgery. Methods: Prospectively collected data from a previous study were analyzed to investigate the relationship between SUA and AKI as assessed by neutrophil gelatinase-associated lipocalin (NGAL), serum creatinine (SCr) and kinetic estimated glomerular filtration rate (KeGFR). Results: Patients undergoing cardiovascular surgery (n = 37) were included. SUA was measured at postoperative 1 h. Statistically significant correlations were present between SUA and NGAL measured at postoperative 1 h (r = 0.39, p = 0.008), 6 h (r = 0.31, p = 0.029) and 24 h (r = 0.31, p < 0.001), respectively. Significant correlations were also noted between SUA and SCr measured on postoperative day 1 (r = 0.41, p = 0.006), day 2 (r = 0.29, p = 0.042) and day 3 (r = 0.42, p = 0.009). Negative correlations were demonstrated between SUA and day 1 (r = -0.44, p = 0.007), day 2 (r = -0.43, p = 0.007), day 3 (r = -0.44, p = 0.006 and day 4 KeGFR (r = -0.35, p = 0.035). The inverse relationship of SUA and KeGFR was also demonstrated with a different method (Jelliffe) of measurement. Conclusions: A reduction in glomerular filtration rate (GFR) can lead to a rise in SUA. However, in this study, we are able to show that SUA at 1 h (maximal dilution time) effectively predicts subsequent changes in urinary NGAL, SCr, KeGFR, and the development of AKI. Thus, these findings suggest that uric acid precedes and predicts acute changes in renal function and cannot be ascribed to a simple relationship in which a reduced GFR raises SUA.

No causal effect of serum urate on bone-related outcomes among a population of postmenopausal women and elderly men of Chinese Han ethnicity--a Mendelian randomization study.

We conducted a Mendelian randomization analysis to assess the effect of serum uric acid on bone-related outcomes using a weighted urate transporter genetic risk score as the instrumental variable. The results showed no significance. Our study identified no evidence of a causal role between uric acid and bone-related outcomes. Observational studies have associated elevated levels of serum uric acid (SUA) with increasing bone mineral density (BMD) and a lowered prevalence of osteoporotic fractures (OFs) in postmenopausal women and elderly men. However, due to unmeasured confounding variables, these observational studies have not provided insight into the causal relationship between SUA and bone-related outcomes. Our aim was to evaluate the effect of SUA on bone-related outcomes using Mendelian randomization. We recruited 1322 Chinese Han individuals (214 elderly men and 1108 postmenopausal women) from the Shanghai area in China. Mendelian randomization using a two-stage least-squares regression method was conducted with SUA as the exposure variable, a weighted urate transporter genetic risk score as the instrumental variable, and all-site BMD, bone turnover markers, and levels of 25-hydroxyvitamin D3 [25(OH)D], serum calcium (Ca), serum phosphorus (P), and parathyroid hormone (PTH) as outcome variables. Strong associations between SUA and bone-related outcomes were observed in an ordinary observational analysis (lumbar spine: beta = 0.122, p < 0.0001; hip: beta = 0.104, p < 0.0001; femoral neck: beta = 0.108, p < 0.0001). However, the Mendelian randomization analysis showed no evidence for a causal association of SUA with BMD (lumbar spine: beta = 0.385, p = 0.257; hip: beta = 0.191, p = 0.499; femoral neck: beta = 0.194, p = 0.533). Similar results were found between SUA and other bone-related phenotypes. Our study identified no evidence of a causal role between SUA and bone-related outcomes, although strong associations in an observational analysis were observed in a population of postmenopausal women and elderly men.

P3‐098: Serum uric acid, cerebrospinal fluid marker of Alzheimer's disease and cognition

Lower level of serum uric acid has detrimental effect on the risk of dementia and cognitive impairment in the elderly. However, underlying mechanism for the effect of uric acid has not been elucidated. We investigated the association between serum uric acid and cerebrospinal fluid (CSF) level of biomarkers including beta amyloid (Aβ), tau, total tau (t-tau), and phospho-tau (p-tau) using the database of the Alzheimer's Disease Neuroimaging Initiative (ADNI). According to serum uric acid level, subjects were subgrouped into tertiles. Mixed-effect models were used to evaluate the effect of serum uric acid on CSF biomarkers and longitudinal cognitive decline. Compared to the middle uric acid tertile group, the lowest tertile group and the highest tertile group had lower CSF Aβ levels and higher tau and p-tau levels, although statistical significance was reached only in the lower tertile group. Both the lowest tertile and the highest tertile groups had significantly higher CSF t-tau levels compared to the middle tertile group. Serum uric acid showed detrimental effects on longitudinal MMSE decline: in subjects with baseline MCI, the lower tertile group had faster MMSE decline compared to the middle tertile group (beta = -1.13, p = 0.002), while the higher tertile group tended to have (beta = -0.62, p = 0.072); in subjects with baseline dementia, both the lower tertile group (beta = -2.84, p = 0.002) and the higher tertile group (beta = -2.45, p = 0.010) had faster MMSE decline compared to the middle tertile group; but in subjects with baseline normal cognition, the rate of decline was comparable in the lower tertile (beta = 0.16, p = 0.533) and the higher tertile (beta = 0.07, p =0.724) groups compared to the middle tertile group. Our study showed that serum uric acid is associated with CSF biomarkers of AD regardless of baseline diagnosis and also associated with faster cognitive decline in MCI and dementia patients. Both deficient and excessive serum uric acid showed detrimental effects. These findings may provide explanations for the association between serum uric acid and risk of dementia in the elderly.

Joint effects of serum uric acid and body mass index on risk of prehypertension in Chinese population

BackgroundThere are few data available on the association between serum uric acid (UA) and prehypertension when hypertension prevention efforts may be applicable. MethodsWe performed a cross-sectional study to evaluate risk of prehypertension and its association with serum UA and other confounding factors. Levels of serum UA, blood pressure, body mass index (BMI) and some related factors were detected. ResultsParticipants with prehypertension had higher levels of serum UA and BMI. Compared to those with normotension, the multivariate-adjusted odds ratios [ORs, 95% confidence interval (CI)] for men with prehypertension were 1.33 (95% CI, 1.08–3.91) of serum UA and 1.21 (95% CI, 1.17–1.29) of BMI. In women, the ORs were 1.96 (95% CI, 1.21–3.46) and 1.28 (95% CI, 1.14–2.46), respectively. Increasing serum UA and BMI were associated with increased risk of prehypertension. Compared with the lowest quartiles, the highest serum UA and BMI quartiles entailed >4.4 times greater risk of prehypertension. In sex-specific analysis, OR was 2.41 (95% CI, 1.55–3.75) for men and 7.37 (95% CI, 4.16–13.0) for women. ConclusionsBoth high serum UA and high BMI are associated with risk of prehypertension. Individuals with higher serum UA and BMI simultaneously have a higher risk for prehypertension, especially for women.

Effect of serum uric acid on the positive predictive value of dobutamine stress echocardiography.

There is controversial data regarding the relationship between uric acid (UA) and coronary artery disease and cardiovascular events. Despite the deleterious effects of hyperuricemia on endothelial function, the effect of UA on myocardial ischemia has not been previously studied. We aimed to investigate the relationship between UA and myocardial ischemia that was identified using dobutamine stress echocardiography (DSE). In this retrospective study, the laboratory and DSE reports of 548 patients were reviewed. The patients were divided into two groups based on the presence of ischemia and further subdivided into three groups according to the extent of ischemia (none, ischemia in 1-3 segments, ischemia in >3 segments). Serum UA levels were compared. Determinants of ischemia were assessed using a regression model. UA was increased in patients with ischemia and was correlated with the number of ischemic segments (p < 0.001). A cutoff value of UA > 5 mg/dl had 63.9 % sensitivity, 62.0 % specificity, 42.5 % positive predictive value (PPV), and 79.6 % negative predictive value for ischemia. When the positive DSE exams were further sorted according to the UA cutoff, the PPV of DSE increased from 80.2 to 94.0 %. Uric acid (odds ratio 1.51; 95 % CI 1.14-1.99), diabetes mellitus, HDL and glomerular filtration rate were found to be independent determinants of myocardial ischemia in DSE. Increased UA is associated with both the presence and extent of DSE-identified myocardial ischemia. A UA cutoff may be a good method to improve the PPV of DSE.

SAT0517 Prognostic Value of Long-Term Cumulative Uric Acid Level on Cardiovascular Diseases in Gout Patients with Treatment

BackgroundThe role of serum uric acid as an independent risk factor for cardiovascular disease (CVD) remains unclear, although hyperuricemia is associated with CVD such as ischemic heart diseases (IHD), cerebrovascular...

Effect of Serum Uric Acid in Augmentation of Insulin Secretion and Improvement of HbA1c in Diabetic Patients: Proposed Statistical Regression Models for Uric Acid, HbA1c and Insulin

Currently serum uric acid is not considered a metabolic biomarker in diabetes. The purpose of the current study was to find the significant associations, correlations and to develop regression models between uric acid, HbA1c, and serum insulin among diabetic patients. The study enrolled type-1 and type-2 diabetic patients for 30 months. For HbA1c and uric acid, patients were divided into two groups: HbA1c＜7% or HbA1c≥7%, UA＜6.5 mg/dl or UA≥6.5mg/dl, respectively. For measurement of insulin levels, patients on diet/metformin only were selected. Data for 1205 patients were analyzed which included 754 (62.6%) males, 451 (37.4%) females, 92 (7.6%) type-1, and 1113 (92.4%) type-2diabetic subjects. For the group HbA1c＜7%, uric acid levels were higher (mean 5.8±4.7) as compared to HbA1c＞7% (mean 4.8±1.5); for the group UA＜6.5 mg/dl, serum insulin levels were lower (mean 39±15.7) as compared to the group with UA≥6.5 mg/dl (mean 73.4±20.5). Uric acid was significantly and inversely correlated with HbA1c (r=-0.13, p-value＜0.0001) and positively correlated with serum insulin (r=0.293, p-value=0.005). Regression models for uric acid and HbA1c was found to be HbA1c=10.235+(-0.094×uric acid); p-value＜0.000 and for uric acid with insulin was observed to be Serum insulin=-9.650+(11.595×uric acid); p-value 0.005. Higher levels of uric acid are associated with lower HbA1c both in type-1 and type-2 diabetic patients. Uric acid is involved in the augmentation of insulin secretion in type-2 subjects.

GW24-e0502 Effect of serum uric acid as a risk factor for developing chronic renal insufficiency in a general population in Beijing

ObjectivesHigh serum uric acid (SUA) levels have been suggested to be associated with chronic kidney disease (CKD) risk factors, such as hypertension and diabetes. However, it is unclear whether SUA...

Synergistic effects of serum uric acid and cardiometabolic risk factors on early stage atherosclerosis: the cardiometabolic risk in Chinese study.

ObjectiveTo comprehensively examine the associations of serum uric acid (SUA) with central and peripheral arterial stiffness in Chinese adults, and particularly assess the interactions between SUA and other cardiometabolic risk factors.MethodsThe study included 3,772 Chinese men and women with carotid radial pulse wave velocity (crPWV), carotid femoral PWV (cfPWV), carotid artery dorsalis pedis PWV (cdPWV) and SUA measured.ResultsAfter adjustment for age, sex, and BMI, the levels of SUA were significantly associated with increasing trend of cfPWV, crPWV and cdPWV (P for trend <0.0001). Further adjustment for heart rate (HR), blood pressure (BP) and lipids attenuated the associations with crPWV and cdPWV to be non-significant (P = 0.1, P = 0.099 respectively), but the association between SUV and cfPWV remained significant (P = 0.004). We found significant interactions between SUA and HR or BP in relation to cfPWV (P for interaction = 0.03, 0.003 respectively). The associations between SUA and cfPWV were more evident among individuals with higher HR or normal BP than those with lower HR or hypertension.ConclusionsSUA was associated with elevated aortic arterial stiffness in Chinese adults, independent of conventional cardiovascular risk factors. BP and HR might modify the deleterious effects of SUA.

Abstract 3287: Effects Of Serum Uric Acid On Outcomes Following Acute Stroke

Objective: Emerging data show that increased serum uric acid (UA) concentration is an independent risk factor for cardiovascular disease, chronic kidney disease, and stroke. Clinicians and researchers do not regularly monitor serum UA following stroke; therefore, we examined whether serum UA was correlated with neurological outcome after stroke. Patients and Methods: Consecutive acute stroke patients (n=1688; 348 hemorrhagic stroke, 1239 ischemic stroke, 101 TIA; median age 70; 1080 males) participated in this study and provided written informed consent to participate. All patients were admitted within 7 days of stroke onset to a regional brain attack center in Japan between January 2005 and December 2010. Patients who showed prehospital modified Rankin scale (mRS) scores of 0-1 were asked about daily lifestyle using the mRS at 3 months after stroke. We measured serum UA, estimated glomerular filtration rate (eGFR) calculated from serum creatinine, and recorded the age and sex of each patient. Patients whose mRS score at 3 months after stroke onset was 2-5 or who died after the stroke were classified into the “poor-outcome” group; patients with a mRS score of 0-1 were classified into the “fair-outcome” group. Logistic regression analysis was used to calculate the odds ratio of poor outcomes; the 95% CI for association between eGFR or UA and poor outcome were examined after adjusting for age greater than 75 years; sex; past history of stroke and/or TIA; current smoking and/or drinking status; hypertension; hypercholesterolemia; and diabetes mellitus. Results: The poor-outcome group included 704 patients, and had a higher proportion of females, patients with hypertension and/or hypercholesterolemia, and age over 75 years than did the fair-outcome group (984 patients). No intergroup differences were observed between the poor outcome and fair outcome groups for eGFR (69.4 ± 22.8 vs. 71.0 ± 19.4 ml/min, respectively, p=0.127) or UA (5.49 ± 1.70 vs. 5.44 ± 1.50 mg/dl, p=0.488). However, after adjusting for the above factors, an increase in eGFR of 1 ml/min was not correlated with poor neurological outcomes (odds ratio=1.004, 95% CI: 0.998-1.009), but an increase in serum UA by 1 mg/dl was positively correlated with poor outcome (odds ratio = 1.088, 95% CI: 1.007-1.176, p=0.033). Conclusion: After adjusting for confounders and variables, low serum UA upon hospital admission was positively correlated with fair neurological outcome 3 months after acute stroke, indicating that UA may contribute slightly to functional impairment associated with stroke.

905 SERUM URIC ACID AS AN INDEPENDENT RISK FACTOR FOR ERECTILE DYSFUNCTION

You have accessJournal of UrologySexual Function/Dysfunction/Andrology: Basic Research1 Apr 2011905 SERUM URIC ACID AS AN INDEPENDENT RISK FACTOR FOR ERECTILE DYSFUNCTION Gholamreza Pourmand, Sepehr Salem, Abdolrasoul Mehrsai, and Farzad Allameh Gholamreza PourmandGholamreza Pourmand Tehran, Iran More articles by this author , Sepehr SalemSepehr Salem Tehran, Iran More articles by this author , Abdolrasoul MehrsaiAbdolrasoul Mehrsai Tehran, Iran More articles by this author , and Farzad AllamehFarzad Allameh Tehran, Iran More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.796AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Serum uric acid is now beginning to be considered as a risk predictor for cardiovascular diseases. However, little is known about the effect of hyperuricemia on the risk of developing other vascular disorders, especially erectile dysfunction (ED). Our aim was to evaluate whether serum uric acid is a predicting factor for ED while adjusting for other common risk factors. METHODS During study period, 251 patients with newly diagnosed and documented ED and 252 age-matched participants without ED were enrolled in this prospective case-control study at our referral center. Serum uric acid concentration and the distribution of potential ED risk factors (age, smoking, lipid profile, hypertension, obesity and diabetes mellitus) were evaluated. Serum uric acid levels were categorized into tertiles. The 5-item International Index of Erectile Function (IIEF-5) was used to evaluate the presence and the severity of ED. The uni- and multivariate logistic regression analysis were performed to assess the effect of serum uric acid on ED severity; calculating odds ratio (OR) and 95% confidence interval (CI). Adjustments were made for potential confounding factors including obesity, hypertension, diabetes, dyslipidemia and smoking. RESULTS The mean serum uric acid in ED positive and negative groups were 6.12±1.55 mg/dl and 4.97±1.09 mg/dl, respectively (P<0.001). While analyzing unadjusted variables, a statistically significant difference was found for all variables and also serum uric acid between ED positive and negative groups. In the logistic regression analysis, the adjusted OR for diabetes, hypertension, low high-density lipoprotein, and smoking demonstrated a significant confounding effect. After adjustment for major confounders, a significant trend of increasing risk was found for serum uric acid concentration (OR: 5.95, 95% CI: 2.96–11.97; P<0.001, comparing the highest with the lowest tertiles). An increase of 1 mg/dl in serum uric acid level was associated with approximately 2-fold increase in risk of ED (OR: 2.07; 95% CI: 1.63–2.64). CONCLUSIONS This study suggests that serum uric acid could be considered as a surrogate marker which can predict the occurrence of ED. Furthermore, hyperuricemia could be regarded as an independent risk factor in addition to the established ones. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e363 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Gholamreza Pourmand Tehran, Iran More articles by this author Sepehr Salem Tehran, Iran More articles by this author Abdolrasoul Mehrsai Tehran, Iran More articles by this author Farzad Allameh Tehran, Iran More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Uric Acid as a Predictor of All-Cause Mortality in Heart Failure: A Meta-Analysis

Serum uric acid (SUA) is a product of xanthine oxidase (XO). Apoptosis and tissue hypoxia lead to increased purine catabolism, which, in turn, increases XO activity and subsequently SUA levels. The purpose of this study was to perform a meta-analysis to evaluate the evidence supporting SUA as a predictor of all-cause mortality in patients with heart failure (HF) and to determine the SUA cut-off for the increase in risk. A search of the MEDLINE database (1966 to March 2009) supplemented by manual searches of bibliographies of key relevant articles was performed. The authors selected all cohort studies in which SUA was measured and mortality was reported in patients with HF. The pooled relative risk (RR) with the corresponding 95% confidence interval (CI) for all-cause mortality using the fixed-effects method was calculated. The effects of SUA on all-cause mortality at different SUA cut-offs using meta-regression was evaluated. The search strategy yielded 358 studies, of which only 6 met our eligibility criteria. The studies, however, comprised 1456 evaluable patients with HF, with a median ejection fraction of 32% (range, 26%-40%). The RR of all-cause mortality was 2.13 (95% CI, 1.78-2.55) for SUA>6.5 mg/dL compared with <6.5 mg/dL SUA level. There was a linear association (P<.01) between SUA and mortality after 7 mg/dL. Uric acid is an important prognostic marker for all-cause mortality in HF. SUA levels >7 mg/dL are associated with higher all-cause mortality.