Higher Serum Uric Acid Concentrations Research Articles

Serum uric acid concentration is associated with lower glomerular filtration rate in children undergoing kidney transplantation.

The relationship between serum concentration of uric acid (UA) and chronic kidney disease is complex due to many confounding variables. There is currently debate over whether hyperuricemia acts as a marker of kidney disease or as an independent risk factor. To test the impact of serum UA concentration on the estimated glomerular filtration rate (GFR) of children undergoing kidney transplantation. Prospective longitudinal study of children and adolescents after kidney transplantation. We analyzed clinical, anthropometric, and laboratory data at pre-transplant and 1, 3, and 6 months after transplant. We developed models of repeated measures analysis, using the generalized estimating equations technique for the outcome evolution of the estimated GFR at 1, 3 and 6 months. High serum UA concentration at 1 and 3 months was modeled as the main exposure variable. We included 103 transplant patients. In a model adjusted for time, recipient sex and age, the occurrence of acute rejection episodes, and the estimated glomerular filtration at baseline, the trajectory of GFR exhibited an inverse relationship with UA (β = -7.1, 95% CI: -11.5 to -2.6, p < .01). Serum UA increase was associated with lower graft function over time.

J-shaped association of serum uric acid concentrations with all-cause mortality in individuals with osteoarthritis: A prospective cohort study

ObjectiveThe purpose of this study was to explore the relationship between serum uric acid (SUA) concentrations and all-cause mortality in individuals with osteoarthritis (OA). MethodsAll participant data were retrieved from the National Health and Nutrition Examination Survey database. A total of 4671 participants (age range: 20 to 85 years old), including 2988 females and 1683 males, were included in this study. The determination of death outcome was based on the National Death Index (up to December 31, 2019). We explored the nonlinear relationship between SUA concentrations and all-cause mortality in OA patients by establishing a Cox proportional risk model and a two-segment Cox proportional risk model and ran an interaction test to identify the high-risk population for all-cause mortality. ResultsDuring 30,645 person-years of follow-up, the number of all-cause deaths for females and males was 736 and 516, respectively. After multivariate adjustment, we found a nonlinear relationship between SUA concentrations and all-cause mortality in both females and males with OA. In addition, we found a J-shaped relationship between SUA concentrations and all-cause mortality. The SUA concentration thresholds for all-cause mortality of females and males were stable at 5.6mg/dl and 6.2mg/dl, respectively. Compared with SUA concentrations below the inflection point, the all-cause mortality risk at higher SUA concentrations in females and males with OA increased by 20% (hazard ratio [HR]: 1.2, 95% confidence interval [CI]: 1.1 to 1.2) and 25% (HR: 1.2, 95% CI: 1.12 to 1.39), respectively. ConclusionsThere is a nonlinear relationship between SUA concentrations and all-cause mortality in the American OA population (J-shaped association). The all-cause mortality thresholds for SUA concentrations in females and males are 5.6mg/dl and 6.2mg/dl, respectively.

Serum uric acid is related to liver and kidney disease and 12-year mortality risk after myocardial infarction.

To study the associations of non-alcoholic fatty liver disease (NAFLD), chronic kidney disease (CKD), and serum uric acid (SUA) in patients with post-myocardial infarction (MI) patients, and the relationship of SUA with 12-year mortality risk. We included 3,396 patients (60-80 years old, 78% men) of the Alpha Omega Cohort. Multivariable prevalence ratios (PRs) were obtained for the association of NAFLD [fatty liver index (FLI), ≥77 (women) and ≥79 (men)] with CKD [estimated glomerular filtration rate (eGFR), <60 mL/min per 1.73 m2]. We calculated sensitivity and specificity of SUA to detect the (combined) presence and absence of NAFLD and CKD. Cause-specific mortality was monitored from enrolment (2002-2006) through December 2018. Hazard ratios (HRs) for all-cause and cardiovascular disease (CVD) mortality in SUA categories were obtained from multivariable Cox models. Median baseline FLI was 67 (men, 68; women, 64), and mean ± SD eGFR was 81 ± 20 mL/min per 1.73 m2 (17% with CKD). Sex-specific FLI was associated with higher CKD prevalence (PRtertile3 vs. tertile1, 1.94; 95% confidence interval: 1.57, 2.39). Baseline SUA was 0.36 ± 0.09 mmol/L. With increasing SUA concentrations, specificity for the presence of NAFLD, CKD, or both increased, and sensitivity decreased. During 12 (interquartile range, 9-14) years of follow-up, 1,592 patients died (713 from CVD). HRs ranged from 1.08 (0.88, 1.32) for SUA ≤0.25 mmol/L to 2.13 (1.75, 2.60) for SUA >0.50 mmol/L vs. SUA >0.30-0.35 mmol/L for all-cause mortality. For CVD mortality, HRs ranged from 1.05 (0.77, 1.44) to 2.43 (1.83, 3.25). NAFLD and CKD were strongly associated, which was reflected by higher SUA concentrations. SUA was a strong predictor of 12-year mortality risk after MI.

Association between serum uric acid concentration and radiographic axial spondylarthritis: a cross-sectional study of 202 patients.

Association between serum uric acid concentration and radiographic axial spondylarthritis: a cross-sectional study of 202 patients.

Association between serum uric acid and female infertility: a cross-sectional study of National Health and Nutrition Examination Survey (NHANES) 2013–2018

BackgroundFemale infertility is a major problem for women of reproductive-age worldwide. Oxidative stress and inflammation are involved in processes related to female infertility. Serum uric acid levels, an indicator of oxidative stress and inflammation, have rarely been reported to be associated with female infertility. This study aimed to investigate the relationship between serum uric acid levels and female infertility.MethodsThis cross-sectional study included women aged 18–44 years from the National Health and Nutrition Examination Survey (NHANES) between 2013 and 2018. All data were extracted from NHANES questionnaires and laboratory measurements. Weighted univariable and multivariable logistic regression analyses were utilized to explore the relationship between serum uric acid and female infertility. Stratified analyses were performed based on body mass index (BMI, < 25 kg/m2 and ≥ 25 kg/m2) and age (≤ 30 years and > 30 years). The odds ratio (OR) with 95% confidence interval (CI) was used to report associations.ResultsA total of 2,884 women were included, of which 352 (13.30%) had infertility. Women with high serum uric acid concentrations were related to higher odds of infertility (OR = 1.20, 95%CI: 1.03–1.39) after adjusting for confounders. Compared with serum uric acid concentrations ≤ 3.72 mg/dL, women with uric acid concentrations of 4.43–5.13 mg/dL (OR = 1.65, 95%CI: 1.02–2.67) and > 5.13 mg/dL (OR = 1.86, 95%CI: 1.10–3.13) were related to higher odds of infertility. Stratified analyses showed that high serum uric acid concentrations were associated with higher odds of infertility in women with a BMI < 25 kg/m2 (OR = 1.41, 95%CI: 1.04–1.93), but not in women with a BMI ≥ 25 kg/m2 (P = 0.056). In addition, high serum uric acid concentrations were associated with higher odds of infertility in women aged > 30 years (OR = 1.23, 95%CI: 1.04–1.45), but not in women aged ≤ 30 years (P = 0.556).ConclusionWomen with high serum uric acid concentrations were associated with higher odds of infertility, and this association may vary by BMI and age.

Distribution of serum uric acid concentration and its association with lipid profiles: a single-center retrospective study in children aged 3 to 12 years with adenoid and tonsillar hypertrophy

BackgroundPresently, there is no consensus regarding the optimal serum uric acid (SUA) concentration for pediatric patients. Adenoid and tonsillar hypertrophy is considered to be closely associated with pediatric metabolic syndrome and cardiovascular risk and is a common condition in children admitted to the hospital. Therefore, we aimed to evaluate the relationship between SUA and dyslipidemia and propose a reference range for SUA concentration that is associated with a healthy lipid profile in hospitalized children with adenoid and tonsillar hypertrophy.MethodsPreoperative data from 4922 children admitted for elective adenoidectomy and/or tonsillectomy surgery due to adenoid and tonsillar hypertrophy were collected. SUA concentrations were scaled to standard deviation (SD), and SUA deviations were expressed as SD from the mean SUA of children without dyslipidemia.ResultsThe mean SUA concentration of the participants was 4.27 ± 1.01 mg/dL, and the prevalence of hyperuricemia was 1.6% when it was defined using an SUA of ≥ 7.0 mg/dL. Participants with dyslipidemia (856, 17.4%) had a higher prevalence of hyperuricemia (3.4% vs. 1.2%, P < 0.001) and higher SUA concentrations (4.51 ± 1.15 vs. 4.22 ± 0.97 mg/dL, P < 0.001) than those with ortholiposis. The circulating lipid status of participants with SUAs < 1 SD below the mean value for the participants with ortholiposis (range 1.80–3.28 mg/dL) was more normal. Each 1-SD increase in SUA was associated with a 27% increase in the risk of dyslipidemia (OR = 1.270, 95% CI, 1.185–1.361). Adjustment for a number of potential confounders reduced the strength of the relationship, but this remained significant (OR = 1.125, 95% CI, 1.042–1.215). The higher risk of dyslipidemia was maintained for participants with SUAs > 1 SD above the mean value of the participants with ortholiposis.ConclusionsSUA was independently associated with dyslipidemia in children with adenoid and tonsillar hypertrophy, and an SUA < 1 SD below the mean value for patients with ortholiposis was associated with a healthy lipid profile.

Moni­toring of exposure to toxins in raptors in Albania

Raptors are large carnivorous birds, most well known for their scavenging nature. This study evaluates the level of exposure to toxins in raptors and vultures in Albania to assess whether existing legislation and regulations are effectively protecting vultures and other wildlife in Albania. During 2014-2018, at the Wildlife Animals Laboratory, Agriculture University of Tirana, Albania, 35 birds (Circaetus gallicus, Gyps fulvus, Gypaetus barbatus) were tested for exposure to toxins. The results indicated elevated blood lead levels in 65.7% of sampled raptors, while in 17.1% there was evidence of exposure to the non-steroidal anti-inflammatory drug (NSAID) diclofenac, based on visceral gout and the presence of cases with high serum uric acid concentration. Other injuries were found in 17.1% of raptors, with the most frequent being physical damage, traumatic injuries, or fractures caused by farmers, shooting, electric burn injuries from electrocution, injuries from collisions, etc. The results suggest that lead poisoning in raptors could be one of the main reasons for the observed declines in vulture populations in Albania. Furthermore, the apparent evidence for exposure to NSAIDs is concerning and requires further investigation.

The effect of serum uric acid concentration on the severity of chronic congestive heart failure

This study aimed to investigate the adverse effects of serum uric acid concentration on the severity of chronic congestive heart failure. One hundred patients with chronic congestive heart failure (several risk factors include hypertension, smoking, and diabetes mellitus) were enrolled in this study (51 females and 49 males). Participants were admitted to Alsader Medical City in Al-Najaf from August 2018 to March 2019. Detailed medical history and complete clinical examination were performed for all patients. The patients' ages ranged from 13-90 years, with a mean of 62.1±15.8 years, and the median was 65 years. No statistically significant age difference was observed between males and females (P-value=0.687). Increased serum uric acid had a directly negative effect on the severity of chronic congestive heart failure and hypertension. High serum uric acid concentration was associated with increased severity of chronic congestive heart failure class NYHA III and NYHA IV and a decrement in ejection fraction of the left ventricle.

Association between Serum Uric Acid and Hypertension in a Large Cross-Section Study in a Chinese Population.

Background: The association of serum uric acid (SUA) with hypertension has been well established in Caucasian populations. However, its association with hypertension in Chinese remained to be clarified. Methods: Consecutive patients, homogeneous in Chinese Han ethnicity, aged ≥18 years, abstracted from the database, admitted from 1 January 2010 to 31 December 2013, were included for potential analysis. The patients were grouped according to the presence or absence of hypertension. Unconditional logistic regression was performed to estimate the association between SUA and hypertension. Its possible interactions with risk factors on hypertension were also explored. Results: A total of 9587 patients were finally analyzed in the current study, where 5692 were with hypertension and 3895 were without hypertension. Per 100 μmol/L higher SUA concentration was associated with multivariable-adjusted odds ratios (95% CI) of 1.25 (1.08–1.22) in males, 1.10 (1.01–1.20) in females, and 1.19 (1.13–1.24) in total. On a categorical scale, when compared with the first quintile, the multivariable-adjusted odds ratios (95% CI) were 1.40 (1.20–1.64) for the 2nd quintile, 1.48 (1.27–1.74) for the 3rd quintile, 1.55 (1.32–1.82) for the 4th quintile, and 1.92 (1.63–2.26) for the 5th quintile, with a p for trend < 0.01. Conclusions: SUA is associated with hypertension in a dose-response manner among the Chinese hospitalized population. Management of SUA could help to the prevention and control of hypertension.

Relationship between bisphenol A, bisphenol S, and bisphenol F and serum uric acid concentrations among school-aged children.

BackgroundHyperuricemia has a suspected relationship with hypertension, metabolic syndrome, kidney disease, and cardiovascular disease. Endocrine disruptors may affect uric acid metabolism; however, few epidemiologic studies have been performed in children regarding newly developed bisphenol A (BPA) substitutes. We evaluated the associations between BPA, bisphenol S (BPS), and bisphenol F (BPF) exposure and serum uric acid concentrations in 6-year-old Korean children.MethodsFrom the Environment and Development of Children cohort study, six-year-old children (N = 489; 251 boys) who underwent an examination during 2015–2017 were included. Anthropometry, questionnaires, and biological samples were evaluated. BPA, BPS, and BPF levels were measured from spot urine samples, and log-transformed or categorized into groups for analysis. We constructed linear regression models adjusting for age, sex, urinary creatinine levels, body mass index z-scores, and estimated glomerular filtration rates.ResultsMean serum uric level was 4.2 mg dL-1 (0.8 SD) without sex-differences. Among the three bisphenols, higher BPS exposure was associated with increased serum uric acid concentrations (P-value for trend = 0.002). When BPS levels were categorized into three groups (non-detection < 0.02 μg L-1 vs. medium BPS; 0.02–0.05 μg L-1 vs. high BPS ≥ 0.05 μg L-1), the high BPS group showed higher serum uric acid concentrations (by 0.26 mg dL-1, P = 0.003) than the non-detection group after adjusting for covariates, which was significant in boys but not girls.DiscussionsUrinary BPS levels was positively associated with serum uric acid concentrations in 6-year-old children, and the association was more pronounced in boys. Considering the increasing use of BPS and concerning effect of hyperuricemia on health outcomes, their positive relationship should be investigated further.

Serum uric acid is positively associated with systolic and diastolic blood pressure in young adults

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Science and Technology Department of the Brazilian Ministry of Health. Introduction Uric acid is the final product of purine metabolism, and its increase can be related to excessive production or decreased renal excretion. Serum uric acid (SUA) has been positively and independently associated with inflammatory markers, insulin resistance, and cardiometabolic diseases in observational studies, but causal roles remain unclear.1,2 Purpose The aim of this study is to assess the associations of SUA with systolic blood pressure (SBP) and diastolic blood pressure (DBP) in 22-year-old individuals from a 1993 birth cohort in Brazil. Methods During 1993, all live born babies in the city were invited to take part in a prospective study and sub-samples of this cohort were followed-up since then. At the 22-year follow-up, interviews and clinical measurements were performed and non-fasting blood samples were drawn from the participants. SBP and DBP were obtained calculating the mean of two measurements (at the beginning and the end of the interview) using a blood pressure monitoring device. SUA was evaluated by enzymatic-colorimetric assay. The co-variables taken into consideration were cardiometabolic risk factors (body mass index, glucose, and total cholesterol) and behavioral risk factors (excessive alcohol consumption, physical inactivity, and smoking). Sex-stratified linear regressions have been performed and p &amp;lt; 0.05 was considered statistically significant. Results The sample was composed of 1660 (47.7%) men and 1822 (53.7%) women of approximately 22 years old. Mean (±SD) SUA (mg/dL) was higher in men (5.2 ± 1.2 vs. 3.9 ± 1.1). The same was observed for SBP (mmHg) [131.6 ± 12.3 vs. 116.9 ± 11.0] and DBP (mmHg) [73.8 ± 8.6 vs. 72.4 ± 8.7]. The adjusted linear regression coefficient (95%CI) between SUA and SBP was 0.014 (0.009; 0.019) for men and 0.015 (0.010; 0.019) for women; both with p &amp;lt; 0.001. The adjusted linear regression coefficient (95%CI) between SUA and DBP was 0.03 (0.023; 0.037) for men and 0.021 (0.015; 0.027) for women; both with p &amp;lt; 0.001. Higher tertiles of SBP and DBP were independently associated with higher SUA concentrations in men and women (p &amp;lt; 0.001) (Table). Conclusions In our study, SUA was positively associated with SBP and DBP in men and women independent of potential confounders. This finding reinforces that uric acid is associated with cardiovascular risk factors since early adult age. Abstract Figure.

Selected matrix metalloproteinases activity and hypertension-mediated organ damage in relation to uric acid serum level.

BackgroundAtherosclerosis is as a systemic inflammatory disease associated with the activation of many mediators, including matrix metalloproteinases (MMPs), and may be amplified by abnormal high serum uric acid (UA) concentration (hyperuricemia, HU). The aim of the study was to determine the relationship between serum UA concentration and activity of MMPs and their correlation with the hypertension-mediated organ damage (HMOD) intensity.MethodsOne hundred and nine patients untreated with antihypertensive, hypolipemic or urate-lowering drugs with diagnosed stage 1–2 essential hypertension were included in this study. In all participants blood pressure (BP) was measured, carotid-femoral pulse wave velocity (PWV), intima–media thickness (IMT), echocardiography and blood tests including UA, lipids and serum concentrations of MMPs (1, 2, 3, 9) were observed. The participants were divided into hyper- and normuricemic groups.ResultsUric acid concentration in the whole study group positively correlated with some HMOD parameters (IMT, PWV, left ventricular mass index, left atrial dimension). Among the studied metalloproteinases only MMP-3 activity positively correlated with serum UA concentration independently of age, body mass index and serum lipids (R2 = 0.11, p = 0.048). Multivariate regression analysis showed positive association between IMT and BP, UA concentration and MMP-3 activity, independently of waist circumference and serum lipids (R2 = 0.328, p < 0.002). Patients with HU were characterized by higher activity of MMP-3 than those without (19.41 [14.45; 21.74] vs. 13.98 [9.52; 18.97] ng/mL, p = 0.016).ConclusionsThe present results may support the thesis that UA and the increased by UA activity of MMPs may take part in the development of HMOD, especially IMT.

Hyperuricemia as a Risk Factor for Preterm Delivery in Women with Pre-Eclampsia

Objective: To determine hyperuricemia as a risk factor for preterm delivery in women with pre-eclampsia. Study Type: Case control study. Duration and Place of Study: Department of Gynaecology and Obstetrics, Sadiq Abbasi Hospital Bahawalpur from 1st July to 31st December 2019. Material and Methods: One hundred cases of pre-eclamptic and hyperuricemic women admitted for delivery through out-patient and emergency departments were divided in two groups, 50 cases in each group. Results: 70% women had hyperuricemia and pre-eclampsia deliver preterm and 34% women who had hyperuricemia and preeclampsia deliver at term. Conclusion: High serum uric acid concentration increased the chances of preterm delivery in pre-eclamptic women. Keywords: Hyperuricemia, Pre-eclampsia, Gestational hypertension, Uric acid, Pre-term delivery

Prevalence of metabolic syndrome among undergraduate students in University of Nigeria, Nsukka

<h2>Summary</h2> Elevation of serum uric acid (SUA) is linked with the development of certain disease conditions such as cardiovascular diseases, chronic kidney disease, stroke, hypertension, and metabolic syndrome (MS). Although limited information exists to prove its association, a good number of studies and clinical trials support its role. This study investigate the relationship between MS and SUA of the undergraduate students of the University of Nigeria, Nsukka. Body mass index (BMI), blood pressure, fasting blood sugar (FBS), serum lipid profile, and SUA concentrations of 229 students comprising of 89 males and 140 females were determined following standard procedures with little modifications where necessary. Result reveals that body weight, systolic blood pressure (SBP), diastolic blood pressure (DBP), FBS, low density lipoprotein (LDL), total cholesterol (TC), high density lipoprotein (HDL), triacylglycerol (TAG) and serum uric acid concentration had no significant difference between the age groups while height, pulse, waist, and BMI had significant (p < 0.05) difference between the age groups. The SUA correlates positively with sex (r = 0.650, p < 0.01), SBP (r = 0.250, p < 0.01), TC (r = 0.205, p < 0.01) and triacylglycerol (r = 0.550, p < 0.01). The result of this study demonstrates that an increase in SUA concentration may lead to a concomitant increase in blood pressure, total cholesterol, and triacylglycerol which in turn may predispose the subjects to MS within the different age groups as revealed by our data.

Hyperuricemia as a possible risk factor for abnormal lipid metabolism in the Chinese population: a cross-sectional study

Previous studies have reported that there may be a close relationship between elevated serum uric acid (UA) levels and metabolic syndrome. However, the association between these two factors has not been explored explicitly. Therefore, we carried out this study to investigate the association between UA and lipid profiles. A total of 2,482 subjects participated in this cross-sectional study using a multistage stratified sampling method. Lipid profile, glucose metabolism, and other metabolic factors were measured and classified into UA-stratified and age-stratified groups to investigate the relationship between hyperuricemia and metabolic factors. Pearson correlations and logistic regressions were utilized to further explore the association between UA and lipid profile. The individuals aged 18 to 29 years presented with high serum UA concentrations. Moreover, the prevalence of hyperuricemia was higher among men than in women. Furthermore, statistically significant positive correlations were found between UA and serum triglycerides (TG), serum total cholesterol (TC), and low-density lipoprotein cholesterol (LDL-c). Conversely, only high-density lipoprotein cholesterol (HDL-c) was negatively correlated. Moreover, TG group status (1.70≤ TG <2.30 mmol/L) was an independent risk factor for hyperuricemia in both univariate and multivariate models. This study found significant positive associations between TG, TC, LDL, and UA but an inverse relationship with HDL-c. Thus hyperuricemia may be a risk factor for abnormal lipid metabolism.

Expression, localization and metabolic function of “resurrected” human urate oxidase in human hepatocytes

A high serum uric acid (SUA) concentration is associated with hyperuricemia (HUA) and gout. In order to obtain long-acting therapeutic effect, correction of purine metabolism at genetic level is advantageous. For this purpose, we expressed three “human-like” urate oxidases in human hepatocytes (HL-7702) by lentivirus-mediated transduction. Enzymatic assay revealed that the recombinant urate oxidases expressed in HL-7702 cells were functionally active. Electron microscopy study showed that the recombinant enzymes were localized to peroxisome and formed distinct crystalloid core structures as in other mammal cells. Although similar rate of uric acid degradation was observed for all recombinant urate oxidases, HL-7702-pLVX-UOX83 cells and HL-7702-pLVX-UOX214/217 cells retained more cell viability compared with HL-7702-pLVX-UOXPBC at high uric acid level. This study provides a new direction for the treatment of gout and hyperuricemia.

Modification of Dietary Habits for Prevention of Gout in Japanese People: Gout and the Japanese Diet

Gout is the most common form of inflammatory arthritis, and it is characterized by the deposition of monosodium urate crystals that form in the presence of increased uric acid concentrations. A high serum uric acid concentration (hyperuricemia) is frequently associated with gout. The burden of gout has increased between 1990 and 2017 globally. In Japan, most of gout patients are adults, and the number of gout patients are higher in men than in women. The prevalence of gout has increased markedly since the 1960s. The Japanese Society of Gout and Uric & Nucleic Acids has stated that an increase in hyperuricemia and gout patients is attributed to changes in environmental factors (e.g., purine intake, fructose intake, meat and visceral intake, alcohol consumption, strenuous muscle exercise, stress, obesity) rather than genetic factors. The Japanese economy revived to pre-World War II levels around 1955 and the eating habits in 1960s became stable. The menu of Japanese food has been rapidly expanded with a variety of dishes due to the westernization of meals from 1955 to 1965. Compared to the Japanese diet in 1950, in the Japanese diet in 2016, consumption of rice and potatoes decreased, whereas intake of wheat, legumes, seeds and nuts, seaweed, vegetables, fruit, meat, seafood, eggs, milk and dairy products, oils and fats, seasoning and spices increased. This phenomenon is thought to be attributed to the westernization of the Japanese diet since 1955. Recognizing changes in the Japanese diet are important for dietary habits modification to prevent gout in Japanese people. The objective of this article is to propose a preventive method for gout through the evaluation of recent dietary habits in Japanese people. This article suggests that changes in the Japanese diet are possible to be one of the factors contributing to the increase in the number of gout patients in Japan.

Serum uric acid level negatively correlated with the prevalence of clopidogrel low response in patients undergoing antiplatelet treatment with aspirin and clopidogrel

Background and aimsIt has been reported that elevated serum uric acid (SUA) is related to inflammation and potentially to platelet hyper-reactivity. However, the relationship between elevated SUA and residual platelet reactivity is uncertain in patients on dual antiplatelet treatment (DAPT) with aspirin and clopidogrel. Methods and resultsA cross-sectional cohort study was conducted on 2569 patients undergoing DAPT with aspirin and clopidogrel. Patients' SUA levels, residual platelet aggregation, routine blood tests and clinical characteristics were recorded. The relationship between SUA level and residual platelet aggregation was assessed by correlation analysis, and the relationship between SUA level and the prevalence of clopidogrel low response (CLR) was assessed by multivariate logistic regression analysis. Adenosine diphosphate (ADP) induced platelet aggregation (PLADP) was higher in normal-SUA group than that in hyperuricemia group [30(21, 40) % vs. 27(19, 39) %, p = 0.032]. No significant difference was found for arachidonic acid (AA) induced platelet aggregation (PLAA) between the two groups [4(2, 5) % vs. 3(2, 5) %, p = 0.557]. The correlation between SUA and PLADP was statistically significant(r = −0.115, p < 0.001), while that between SUA and PLAA was non-significant (r = −0.012, p = 0.643). Using the multivariate logistic regression analysis, higher SUA concentration was associated with a decreased risk of clopidogrel low response (CLR) (OR [95%CI] = 0.997 [0.995–0.999], p = 0.001). ConclusionThis is the largest study to date showing that in patients receiving DAPT with aspirin and clopidogrel, SUA is independently and negatively associated with the prevalence of clopidogrel low response. Clinical trial registrationURL: http://www.clinicaltrials.gov Unique Identifier: NCT01955200.

Effect of renal function on association between uric acid and prognosis in acute ischemic stroke patients with elevated systolic blood pressure

ABSTRACT Background and aims The prognostic value of uric acid in ischemic stroke remains controversial, and it is unclear whether renal function status modifies the prognostic value of uric acid in ischemic stroke patients. Methods A total of 3284 acute ischemic stroke patients from the China Antihypertensive Trial in Acute Ischemic Stroke (CATIS) with creatinine and uric acid measurements were included in this analysis. The primary outcome was a composite of death and major disability (modified Rankin Scale score ≥3) at 1 year after stroke. Results The prognostic value of uric acid in ischemic stroke was appreciably modified by patients’ renal function status (p for interaction <0.05). After multivariate adjustment, higher uric acid level was significantly associated with a better prognosis in patients with normal renal function (odds ratio, 0.61; 95% confidence interval, 0.45–0.83), but not in those with abnormal renal function (odds ratio, 0.87; 95% confidence interval, 0.48–1.55), when two extreme quartiles were compared. Linear association between uric acid and primary outcome was observed among patients with normal renal function (p for linearity = 0.023). Conclusion The present study suggests that high serum uric acid concentration is associated with better prognosis in ischemic stroke patients with normal renal function, but not in those with abnormal renal function. The establishment of causality between increased uric acid levels and better stroke prognosis needs more suitably designed randomized clinical trials.

J-shaped relationship between serum uric acid levels and the risk of ischemic stroke in high-risk individuals: A hospital-based observational study

ObjectiveThe relationship between serum uric acid (SUA) and the risk of ischemic stroke (IS) has been fully elucidated in previous studies. Therefore, we further investigated the relationship between SUA levels and the risk of IS. Patients and methods2195 patients at the Beijing Hospital, between February 2012 and May 2018, were enrolled in our hospital-based cross-sectional study. The patients were divided into an IS group and a (non-IS) control group, based on their medical records. SUA level was measured using the enzymatic uricase method. Univariate and multivariable logistic regression models were used for the analysis. ResultsA total of 300 patients with IS [176 men; age (mean ± SD): 71.38 ± 10.66 years] and 1895 control patients [1060 men; age (mean ± SD): 66.12 ± 12.04 years] were enrolled in this study. IS patients had higher concentrations of SUA, compared with control group patients [6.11 ± 1.92 vs. 5.77 ± 1.62 (mg/dL)]; P = 0.004). We observed a J-shaped association between SUA levels and the risk of IS. Both the univariate and multivariate logistic regression analyses found a significantly elevated risk of IS in the bottom and upper SUA levels both in quartiles and deciles, compared with the intermediate SUA levels. ConclusionThese results indicate a J-shaped, independent association between SUA levels and the risk of IS in high-risk individuals.