Serum Uric Acid Quartiles Research Articles

Serum Uric Acid Levels and the Risk of Obesity: a Longitudinal Population-Based Epidemiological Study.

Obesity is a common chronic disease, and elevated serum uric acid has been suggested to be associated with obesity. However, whether the elevation is casual or a consequence of obesity remains unclear. We performed the study to investigate the longitudinal association between serum uric acid levels and obesity. A total of 4411 initially obesity-free subjects were followed up for 9 years. The subjects were divided into groups according to the serum uric acid quartile. Univariable and multivariable Cox regression models were used to analyze the risk factors for the development of obesity. Of the 4411 subjects, 1272 (28.8%) subjects developed obesity over 9 years of follow-up. The cumulative incidence of obesity was 21.7%, 26.4%, 31.0%, and 36.4% in quartile 1, 2, 3 and 4, respectively (p for trend < 0.001). Cox regression analyses indicated that serum uric acid levels were independently and positively associated with the risk of incident obesity. Our longitudinal study demonstrated that high serum uric acid levels increase the risk of obesity.

The study of the correlation between serum uric acid and insulin resistance in middle-aged and elderly hospitalized patients with type 2 diabetes

Objective To study the relationship between serum uric acid and insulin resistance in type 2 diabetic patients Methods A total of 728 middle-aged and elderly type 2 diabetic patients were recruited and the anthropometric, clinical and biochemical parameters and fasting serum C-peptide were measured and retrospectively studied.All patients were divided into groups based on the levels of uric acid and on metabolic syndrome diagnosis or not. Results Among a total of 728 patients, the proportion of hyperuricemia was 26.9%(196 /728), and metabolic syndrome(MS)was 64.6%.The levels of body mass index(BMI), waist circumference(WC), systolic pressure(SBP), diastolic pressure(DBP), triglyceride(TG), fasting C-peptide, HOMA(C-Peptide)were significantly higher in hyperuricemia group than in normal uric acid group, while the level of HDL was lower in hyperuricemia group than in normal uric acid group.The proportion of MS was statistically higher in hyperuricemia group(81.6%)than in normal uric acid group(58.3%, P<0.05). Groups Ⅰ, Ⅱ, Ⅲ, Ⅳ-the four quartiles of serum uric acid from low-to high-level were correlated with MS component number of 2.1±1.0, 3.1±1.1, 3.3±1.2, 3.7±0.8, separately, and with HOMA(CP)of 3.7±0.8, 3.7±0.8, 4.0±0.6, 4.1±0.9, separately(all P<0.05). When all patients were divided into groups based on with or without MS, the level of uric acid in MS group was(377.3±43.5)μmol/L, and the proportion of hyperuricemia was 34.0%(160/470), and HOMA(CP)was 3.90±0.72, all were significantly higher than those of non-MS group[(318.2±47.9)μmol/L, 14.0%(36/258), 3.64±0.67]. The levels of serum uric acid in groups with 1-5 components of MS were(285.0±62.8)μmol/L, (335.7±62.7)μmol/L, (367.1±45.0)μmol/L, (377.9±40.2)μmol/L, (389.8±46.6)μmol/L, and HOMA(CP)was 3.6±0.6, 3.7±0.7, 3.9±0.8, 3.9±0.7, 4.3±0.7 separately(P<0.05). Serum uric acid was positively correlated with age, WC, BMI, TG, SBP, fasting C-peptide, and HOMA(CP), while negatively correlated with glycosylated hemoglobin(HbA1C), high density lipoprotein cholesterol(HDL-C). Binary logistic regression showed that the OR value of MS was 1.033 with the increase of serum uric acid, and 95%CI: 1.026-1.041, P<0.05. Conclusions Serum uric acid is correlated with insulin resistance in middle-aged and elderly hospitalized patients with type 2 diabetes.Hyperuricemia might be a new risk factor for MS. Key words: Diabetes, type 2; Hyperuricemia; Metabolic syndrome X

Sex-specific association between serum uric acid and prolonged corrected QT interval: Result from a general rural Chinese population.

Recently, it has been found that high level of serum uric acid (SUA) is causally related to sudden cardiac death (SCD). We examined the sex-specific associations of SUA with prolonged heart rate-corrected QT (QTc) interval in a general Chinese population.A large sample of 11,206 Chinese research participants aged 35 years and older was recruited from rural areas of Liaoning Province during 2012 to 2013. SUA were divided into quartiles separated for males and females. Prolonged QTc interval, assessed by the Bazett formula, was defined as cut points of 460 ms or longer in females and 450 ms or longer in males. Mean (+/− standard deviation) QTc intervals were 422.1 ± 24.2 ms among 5104 males and 436.1 ± 23.5 ms among 6102 females, respectively. In both sexes, SUA showed significant correlations with QTc interval (both P < 0.001). Among male participants, the highest quartile of SUA (>379 μmol/L) was related to an increased risk for prolonged QTc interval (odds ratios: 1.402, 95% confidence interval: 1.073–1.831) compared to the lowest quartile (≤276 μmol/L) after fully adjustment. However, there were no significant relationships between SUA and prolonged QTc interval among females in all the models.Males with high SUA are prone to a higher risk for prolonged QTc interval. This study provides novel explanation for population-based findings on SUA and SCD, as well as important implications for management strategies for hyperuricemic patients in clinical practice.

Dose-response relationship between serum uric acid levels and risk of incident coronary heart disease in the Dongfeng-Tongji Cohort

BackgroundIn prospective studies, relationship of serum uric acid (SUA) with risk of coronary heart disease (CHD) incidence is inconsistent. We evaluated the association of SUA with incident CHD and the potential modifying effect of major CHD risk factors related to SUA among a middle aged and elderly Chinese population. MethodsWe included 16, 063 participants who were free of CHD, stroke, cancer and renal diseases at baseline from Sep. 2008 to June 2010, and were followed until Oct. 2013. Cox proportional hazard model was used to estimate the hazard ratios (HR) and 95% confidence interval (95% CI) of CHD incidence in relation to SUA. ResultsThe adjusted HR for incident CHD increased gradually with the increasing SUA levels (P for linear trend=0.005), and the HR across sex-specific SUA quartile was 1.26 (95% CI: 1.09, 1.47), 1.13 (95% CI: 0.97, 1.31), 1.23 (95% CI: 1.06, 1.43) and 1.00 (reference; P for trend=0.014), respectively. In particular, the association was more evident in individuals with normal-weight and those without hypertension or metabolic syndrome (all P for interactions<0. 05). ConclusionsThese findings suggested that higher SUA levels were independently associated with a dose-response increased risk of CHD incidence.

MPS 08-03 Uric acid, all cause and cardiovascular mortality

Objective: Serum uric acid (SUA) is reported to be associated with cardiovascular and all-cause mortality but previous studies have shown inconsistent results. The aim of this study was to investigate whether SUA is independently associated with cardiovascular and all-cause mortality in relatively healthy Korean adults. Design and Method: A total of 396,951 individuals from Kangbuk Samsung Health Care Center who participated in comprehensive health examination were enrolled between 2002 and 2012. 40,941 subjects were excluded for various reasons. All-cause and cardiovascular mortality data were collected. The total population was grouped according to baseline uric acid quartiles. Cox proportional hazards models were used to estimate adjusted hazard ratios (HR) and 95% confidence intervals (CIs), for all cause and cardiovascular mortality and the lowest SUA quartile group was the reference group. Results: A total of 357,032 subjects were eligible for the analysis and mean follow up duration were 5.67 ± 3.29 years. The lowest and highest quartiles of SUA were < 5.4 mg/dL, ≥ 7.0 mg/dL in men and < 3.6 mg/dL and ≥4.8 mg/dL in women. 2028 deaths (312 from cardiovascular disease and 1770 from other causes) occurred during follow-up. In the highest SUA group, adjusted hazard ratio for all-cause mortality were 1.10 [0.93, 1.30] in men and 0.89 [0.68, 1.16] in women; and for cardiovascular mortality were 1.22 [0.80, 1.86] in men and 0.80 [0.42, 1.53] in women after adjustment of age, sex, year of screening exam, smoking status, body mass index, alcohol intake, regular exercise, educational level, history of hypertension, diabetes and CVD. Conclusions: In this large relatively healthy population based observational study, SUA showed no significant association with all-cause and cardiovascular mortality.

The relationship between serum uric acid and metabolic syndrome in premenopausal and postmenopausal women in the Jinchang Cohort

The aim of the study was to explore the association between serum uric acid (SUA) and metabolic syndrome (MetS) in premenopausal and postmenopausal women in the Jinchang Cohort. We studied 3808 female Jinchuan Nonferrous Metals Corporation workers aged 40–60 years. Cohort data from epidemiological surveys and medical exams were used. MetS was defined using the 2009 Joint Interim Society criteria. The relationship between SUA and MetS was evaluated using multiple logistic regression after adjusting for potential confounders. MetS and hyperuricemia were more prevalent in postmenopausal women than premenopausal ones (35.3% versus 15.2% and 9.2% versus 4.2%, respectively). Premenopausal and postmenopausal women with hyperuricemia had 2.81 (95% CI: 1.72–4.61) and 2.10 (95% CI: 1.44–3.08), respectively, times the odds of having MetS than their counterparts without hyperuricemia. Even within normal SUA quartiles, only premenopausal women in the highest and second-highest quartile had 3.57 (95% CI: 2.24–5.68) and 2.78 (95% CI: 1.71–4.50), respectively, times the odds of having MetS than those in the lowest quartile. Even in the normal range, the odds ratios for MetS increased gradually according to SUA levels in all women (Ptrend < 0.001). In conclusion, there was a significant correlation between SUA levels and MetS, and the association was stronger in premenopausal women than postmenopausal ones.

Associations between serum uric acid and the incidence of hypertension: a Chinese senior dynamic cohort study.

BackgroundThe prevalence of hyperuricemia has increased dramatically during the past several decades. Studies indicating uric acid is an independent risk factor for hypertension did not sufficiently control for other known risk factors. We explored this relationship in a comprehensive Chinese senior dynamic cohort.MethodsTo investigate the relationship between serum uric acid (SUA) levels and hypertension, we carried out a 6-year retrospective study (2006–2011) in a dynamic cohort with 3591 subjects free of hypertension. The first occasion of documented hypertension per subject was the index event. A Cox proportional hazards model assessed the relationship between SUA and hypertension. Kaplan–Meier survival analysis compared incidence of hypertension among individuals with each SUA quartile. Receiver operating characteristic curves were generated to obtain the area under the curve as a prediction of hypertension from SUA levels.ResultsThe cumulative prevalence of hypertension in our cohort was 20.7 %. The prevalence of hyperuricemia was 17.5 %. Cox regression analysis showed that, compared with the lowest SUA quartile (<4.69 mg/dl), the 4.69–5.58, 5.58–6.52, and ≥6.52 mg/dl quartiles yielded hazard ratios (95 % confidence intervals) for hypertension of 1.652 (1.265–2.156), 2.195 (1.705–2.825), and 3.058 (2.399–3.899), respectively. Cumulative incidence of hypertension was consistently higher among individuals with hyperuricemia than among those with normal SUA levels. A Kaplan–Meier survival analysis showed that hyperuricemia predicted higher incidences of hypertension in a dose-dependent manner: hypertension onset significantly differed across SUA quartiles. SUA levels were significantly and independently associated with incidence of hypertension in our cohort.ConclusionsOur results, controlling for known risk factors, suggest that SUA level is an independent risk factor for hypertension and could be a useful indicator of hypertension.Electronic supplementary materialThe online version of this article (doi:10.1186/s12967-016-0866-0) contains supplementary material, which is available to authorized users.

Association between Serum Uric Acid and Mortality among Chinese Patients with Coronary Artery Disease

Objectives: Several studies have investigated the association between serum uric acid (SUA) and the risks of coronary artery disease (CAD) but have yielded inconsistent results. The aim of this study was to assess whether there is an independent association of SUA with all-cause and cardiovascular disease (CVD) mortality in Chinese patients with CAD. Methods: A prospective cohort study of 1,799 patients was conducted. Cox regression models were used to estimate the association of SUA with the risk of death. Results: During a median follow-up of 3.9 years, 177 deaths were recorded and 126 of these were due to CVD. Patients in the highest SUA quartile had a 2.43-fold risk of all-cause mortality and a 2.44-fold risk of CVD mortality compared with those in the lowest quartile. In the subpopulation analysis, the association between SUA and mortality remained similar when participants were stratified by age, gender, body mass index and type of CAD. In contrast, we found a significant interaction with estimated glomerular filtration rate (eGFR). There was a stronger association between SUA and the risk of all-cause and CVD mortality among patients with an eGFR ≥60 ml/min/1.73 m², but no significant association was found in the population with an eGFR <60 ml/min/1.73 m². Conclusions: Elevated SUA levels were positively associated with an increased risk of all-cause and CVD mortality among CAD patients.

Association of serum uric acid levels with the risk of development or progression of albuminuria among Japanese patients with type 2 diabetes: a prospective cohort study [Diabetes Distress and Care Registry at Tenri (DDCRT 10)

To assess the prospective association between baseline serum uric acid level and subsequent risk of development or progression in albuminuria. Longitudinal data were obtained from 2518 patients with type 2 diabetes in the development cohort and registered in a Japanese diabetes registry. To assess the independent correlations between baseline serum uric acid quartiles and either the development or progression of diabetic nephropathy for 2years, the Cox proportional hazards model was used and adjusted for potential confounders. The mean patient age, body mass index, and glycated hemoglobin (HbA1c) level were 66.1years, 24.6kg/m(2), and 7.5% (57.6mmol/mol), respectively. The baseline serum uric acid levels, with mean values of 3.6, 4.9, 5.8, and 7.3mg/dL from the first to fourth quartiles, were significantly associated with the urinary albumin/creatinine ratio at baseline (p<0.001). Baseline uric acid levels were not significantly associated with the development of nephropathy, but they were with the progression of nephropathy. The multivariable-adjusted hazards ratios for the progression from microalbuminuria to macroalbuminuria were 2.17 [95% confidence interval (CI) 1.15-4.08; p=0.016], 3.04 (95% CI 1.67-5.53; p<0.001), and 3.56 (95% CI 1.83-6.93; p<0.0011) for the first, third, and fourth quartiles of serum uric acid levels, respectively, as compared to that for the second quartile. We did not observe significant association between uric acid levels and change in estimated glomerular filtration rate. Low and high serum uric levels, independent of possible confounders, were associated with a subsequent risk of progression, not development, in albuminuria in type 2 diabetes patients. Therefore, serum uric acid levels may be useful for predicting the future risk of progression of microalbuminuria.

Higher serum uric acid level increases risk of prehypertension in subjects with normal glucose tolerance, but not pre-diabetes and diabetes

Although the association between serum uric acid (SUA) levels and prehypertension has been reported in previous studies, it is unknown whether their relationship is similar in subjects with diabetes, pre-diabetes and normal glucose tolerance (NGT). This study thus aimed to investigate the relationship between SUA and prehypertension in subjects with different glycemic status, including NGT, pre-diabetes and diabetes. A total of 12 010 participants were included after excluding subjects with blood pressure ⩾140/90 mm Hg, history of hypertension, leukaemia, lymphoma, hypothyroidism, medication for hypertension and hyperuricemia and missing data. Subjects were divided into four groups based on SUA quartiles (male Q1: ⩽345.0, Q2: 345.0-392.6, Q3: 392.6-440.2, Q4: ⩾440.2 μmol l(-1) and female Q1: ⩽249.8, Q2: 249.8-285.5, Q3: 285.5-333.1, Q4: ⩾333.1 μmol l(-1)). Diabetes, pre-diabetes and NGT were assessed according to the 2010 American Diabetes Association diagnostic criteria. Normotension and prehypertension were defined according to the JNC-7 (The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure) criteria. The SUA was significantly higher in prehypertensive subjects as compared with normotensive subjects. SUA, as a continuous variable, was positively associated with prehypertension in subjects with NGT but not pre-diabetes and diabetes. Besides, NGT subjects with the highest quartile of SUA exhibited a higher risk of prehypertension after adjustment for other confounding factors. In pre-diabetes and diabetes groups, none of SUA quartiles was significantly related to prehypertension. SUA was significantly associated with an increased risk of prehypertension in subjects with NGT but insignificantly in subjects with pre-diabetes and diabetes.

Uric acid and high-residual platelet reactivity in patients treated with clopidogrel or ticagrelor

Background and AimHigh residual platelet reactivity (HRPR) is still an important challenge, despite the advent of new potent ADP-antagonists. Therefore it is of extreme importance to identify factors that can influence platelet activation. Serum uric acid (SUA) has been largely addressed in the past as a possible risk factor for coronary artery disease, with a possible association with platelets hyperreactivity. So far no studies have assessed the role of serum uric acid on the response to dual antiplatelet therapy. Therefore, the aim of our study was to evaluate the impact of uric acid levels on platelet function in patients treated with dual antiplatelet therapy (DAPT) with clopidogrel or ticagrelor. Methods and ResultsWe scheduled for platelet function assessment at 30–90 days post-discharge patients treated with DAPT (ASA + clopidogrel or ticagrelor) for an ACS or elective percutaneous coronary intervention (PCI). Platelet function was assessed by whole blood impedance aggregometry (Multiplate®-Roche Diagnostics AG), HRPR was considered for ASPI test >862 AU∗min (for ASA) and ADP test values ≥417 AU∗min (for ADP-antagonists). ResultsWe included a total of 493 patients (262 were on ASA and clopidogrel and 231 on ASA and ticagrelor). Patients were divided according to quartiles of serum uric acid levels measured at the time of platelet aggregation assessment (Group 1 <4.6 mg/dL, n = 114; Group 2, 4.7–5.8 mg/dL, n = 133; Group 3, 5.9–6.8 mg/dL, n = 124; Group 4, >6.9, n = 122). Patients with higher uric acid levels were older, more often smokers, with history of hypertension and previous coronary artery bypass surgery and renal failure and were more often on therapy with diuretics at admission. Patients with higher SUA had higher triglycerides and fibrinogen. Uric acid levels did not influence ASPI, COL, TRAP and ADP tests. High residual platelet reactivity (HRPR) was observed in 1.5% of patients treated with ASA, with no difference according to SUA quartiles (p = 0.60), confirmed at multivariate analysis after correction for baseline confounders (adjusted OR[95%CI] = 1.05 [0.44–2.52], p = 0.90). HRPR for ADP-antagonists was observed in 23.6% of patients, with no difference according to SUA quartiles (p = 0.47); this result was confirmed also after correction for baseline confounders (adjusted OR[95%CI] = 1.04 [0.84–1.28], p = 0.73). Moreover, no association was found between HRPR and uric acid levels both among patients treated with clopidogrel (p = 0.35) or ticagrelor (p = 0.74), that was confirmed after correction for baseline confounding factors (adjusted OR[95%CI] = 1.18 [0.90–1.55], p = 0.23) and (adjusted OR[95%CI] = 0.96 [0.63–1.47], p = 0.85). The absence of association between SUA and platelet reactivity was confirmed at linear regression analysis both with clopidogrel (r = 0.03, p = 0.55) or ticagrelor (r = −0.01, p = 0.85). ConclusionThis is the first large study showing that in patients receiving DAPT, uric acid levels do not influence response to ticagrelor and clopidogrel or the effectiveness of ASA.

Serum Uric Acid as a Risk Factor for Chronic Kidney Disease in a Japanese Community - The Hisayama Study.

Growing evidence suggests that high serum uric acid (SUA) levels are causally related to increased risk of chronic kidney disease (CKD). However, few studies have investigated the influence of elevated SUA levels on the incidence of kidney dysfunction and albuminuria separately in community-based populations. A total of 2,059 community-dwelling Japanese subjects aged ≥40 years without CKD were followed for 5 years. CKD was defined as kidney dysfunction (estimated glomerular filtration rate <60 ml/min/1.73 m(2)) or albuminuria (urine albumin-creatinine ratio ≥30 mg/g). The odds ratio (OR) for the development of CKD was estimated according to quartiles of SUA (≤4.0, 4.1-4.9, 5.0-5.8, and ≥5.9 mg/dl). During the follow-up, 396 subjects developed CKD, of whom 125 had kidney dysfunction and 312 had albuminuria. The multivariable-adjusted risk of developing CKD increased with higher SUA levels (OR 1.00 [reference] for ≤4.0, 1.21 [95% confidence interval, 0.84-1.74] for 4.1-4.9, 1.47 [1.01-2.17] for 5.0-5.8, and 2.10 [1.37-3.23] for SUA ≥5.9 mg/dl, respectively). Similarly, there were positive associations between SUA level and the adjusted risk of developing kidney dysfunction (OR 1.00 [reference], 2.30 [1.10-4.82], 2.81 [1.34-5.88], and 3.73 [1.65-8.44]) and albuminuria (1.00 [reference], 1.12 [0.76-1.65], 1.35 [0.90-2.03], and 1.81 [1.14-2.87], respectively). Higher SUA levels were a significant risk factor for the development of both kidney dysfunction and albuminuria in a general Japanese population. (Circ J 2016; 80: 1857-1862).

Serum uric acid is associated with mortality and heart failure hospitalizations in patients with complicated myocardial infarction: findings from the High-Risk Myocardial Infarction Database Initiative.

Serum uric acid (SUA) levels are associated with poorer outcomes in healthy cohorts and patients with stable and unstable coronary heart disease. We investigated the relationship between SUA and clinical outcomes in subjects with acute myocardial infarction (MI) complicated by reduced left ventricular (LV) function, heart failure (HF), or both. Univariable and multivariable Cox proportional hazards modelling was performed to study the association of baseline SUA and all-cause mortality, cardiovascular (CV) mortality, and HF hospitalization in an individual patient meta-analysis of four merged large randomized trials (CAPRICORN, EPHESUS, OPTIMAAL, and VALIANT). Three trials (excluding VALIANT) reported SUA, which was available in a total of 12 677 subjects. The ranges of SUA for quartiles I-IV were 45-280, 281-344, 345-420, and 420-1640 mmol/L, respectively. While almost 90% of patients in the lowest SUA quartile were alive after a mean follow-up of 23 ± 11 months, <70% were alive in the highest SUA quartile. Compared with the lowest SUA quartile as reference, hazard ratios (HRs) and 95% confidence intervals (CIs) of SUA quartiles III and IV showed an increase in all-cause mortality [HR 1.18, 95% CI 0.95-1.46, and HR 1.36, 95% CI 1.11-1.67) and CV mortality (HR 1.27, 95% 1.01-1.61, and HR 1.47, 95% CI 1.17-1.83). SUA quartiles III and IV also exhibited increased HF hospitalization (HR 1.22, 95% CI 1.09-1.36, and HR 1.28, 95% CI 1.14-1.43; P < 0.001 for all comparisons) in multivariable analyses. The addition of SUA was associated with a significant improvement in reclassification to predict CV mortality (net reclassification improvement 17.6%, 95% CI 14.9-20.5%, P < 0.001). Elevated SUA is associated with poor outcomes in patients after MI complicated by reduced LV function, HF, or both. The quantification of SUA, a low-cost routinely available biomarker, could improve risk stratification of patients with complicated MI.

Gender Specific Association between Serum Uric Acid and Diastolic Dysfunction

Background and Purpose: Serum uric acid (SUA) is related with the severity and prognosis of the systolic heart failure. We assessed the association between SUA and diastolic dysfunction. Methods and Results: Total of 744 patients (202 women, 542 men) with LVEF of O50% and sinus rhythm were enrolled. Presence or absence of cardiac diastolic function was assessed by E/e0 , E/A, DcT, BNP, and cardiac hypertrophy. Positive relationship between SUA and diastolic dysfunction prevalence was apparent in women, but not in men (Figure). Logistic regression analysis showed that the third and fourth SUA quartile was associated with diastolic dysfunction with an odds ratio of 3.22 and 8.16, respectively, compared with the lowest SUA quartile. Conclusions: Higher SUA was independently associated with cardiac diastolic dysfunction in women, but not in men.

Prognostic Value of Red Blood Cell Distribution Width for Patients with Heart Failure with Preserved Ejection Fraction

Background and Purpose: Serum uric acid (SUA) is related with the severity and prognosis of the systolic heart failure. We assessed the association between SUA and diastolic dysfunction. Methods and Results: Total of 744 patients (202 women, 542 men) with LVEF of O50% and sinus rhythm were enrolled. Presence or absence of cardiac diastolic function was assessed by E/e0 , E/A, DcT, BNP, and cardiac hypertrophy. Positive relationship between SUA and diastolic dysfunction prevalence was apparent in women, but not in men (Figure). Logistic regression analysis showed that the third and fourth SUA quartile was associated with diastolic dysfunction with an odds ratio of 3.22 and 8.16, respectively, compared with the lowest SUA quartile. Conclusions: Higher SUA was independently associated with cardiac diastolic dysfunction in women, but not in men.

Prognostic Significance of Uric Acid Levels in Ischemic Stroke Patients.

The importance and function of serum uric acid (UA) levels in patients with cardiovascular disease or stroke are unclear. We sought to evaluate the appropriate UA levels for stroke patients and the association between endogenous UA levels and clinical outcomes in acute ischemic stroke (AIS) patients, particularly regarding the possible interaction between gender and UA levels with respect to AIS prognosis. We examined 303 patients who had an onset of ischemic stroke within 48 h. Of those, 101 patients received thrombolytic treatment. Serum UA (μmol/L) levels were measured the second morning after admission. Patient prognosis was evaluated 90 days after clinical onset by modified Rankin Scale. Patients were divided into four groups according to serum UA quartiles. A binary multivariate logistic regression model was used to assess clinical relevance in regard to functional outcome and endogenous UA levels. Analysis of subgroups by gender and normal glomerular filtration rate were also been done. Poor functional outcome was associated with older age, history of atrial fibrillation, or higher baseline National Institutes of Health Stroke Scale scores. After adjustment for potential confounders, patients with higher UA levels (>380 μmol/L) or lower UA levels (≤250 μmol/L) were 2-3 times more likely to have a poor outcome (OR 2.95, 95% CI 1.14-7.61; OR 2.78, 95% CI 1.02-7.58, respectively) compared to the baseline group (UA level 316-380 μmol/L). The same results were observed in thrombolyzed patients. Patients with high and low UA levels were 9-18 times more likely to having poor outcomes compared to the baseline group (UA level: 316-380 μmol/L; OR 18.50, 95% CI: 2.041-167.67; OR 9.66, 95% CI 1.42-65.88, respectively). In men, patients with high UA levels were 6 times more likely to have poor outcomes compared to the baseline group (UA level: 279-334 μmol/L; OR 6.10, 95% CI 1.62-22.93). However, female patients with UA level 271-337 μmol/L were seven times more likely to perform badly compared to the baseline group (UA level >337 μmol/L, OR 7.06, 95% CI 1.00-49.81). Serum UA levels in an appropriate range were associated with better outcome in patients with AIS but may be harmful when too high or too low. The association of UA levels with AIS prognosis differed in male and female patients, which highlights the necessity of stratifying by gender in investigations of cerebrovascular risk factors.

Association Between Serum Uric Acid Levels/Hyperuricemia and Hypertension Among 85,286 Japanese Workers.

This cross-sectional study from January 2012 to December 2012 aimed to examine the sex-specific association between serum uric acid (SUA) levels/hyperuricemia and hypertension among Japanese patients. SUA level, medical histories, and lifestyle-related items were collected from 85,286 of 136,770 participants. Among those with hyperuricemia, the median age was 46 years and 97% were men, which was significantly different than those without hyperurecemia (44 years and 56%, respectively; P<.01). Hyperuricemia was 1.79 times more likely in hypertensive men than normotensive men and almost six times more likely in hypertensive women (odds ratio=5.92 and adjusted odds ratio=1.33 for men and adjusted odds ratio=1.81 for women) after multivariate analysis. SUA quartiles positively correlated with systolic and diastolic blood pressures in both sexes. Hyperuricemia and SUA levels were significantly associated with hypertension in both sexes. These findings underscore the importance of maintaining normal SUA levels to manage and prevent hypertension. Better management of SUA as well as blood pressure may have potential in preventing future cardiovascular disorders.

Serum uric acid is associated with cardiac diastolic dysfunction among women with preserved ejection fraction.

Serum uric acid (SUA) is associated with the severity and prognosis of systolic heart failure. We investigated the potential association between SUA and cardiac diastolic dysfunction among total of 744 cardiac patients (202 women and 542 men) who had preserved left ventricular ejection fraction. Presence of diastolic dysfunction was assessed by echocardiographic data, plasma B-type natriuretic peptide concentration, and left ventricular hypertrophy. Univariate analysis showed that the prevalence of diastolic dysfunction increased with increasing SUA value in women, but not in men. When sex-nonspecific SUA quartiles were used, multivariate logistic regression analysis, among female patients who were not taking uric acid lowering medication, showed that the third (SUA, 5.7-6.4 mg) and the fourth (SUA, ≥6.5 mg/dl) SUA quartiles were associated with diastolic dysfunction with an odds ratio of 3.25 (P < 0.05) and 8.06 (P < 0.001), respectively, when compared with the first SUA quartile (≤4.7 mg/dl). When sex-specific SUA quartiles were used among these population, multivariate logistic regression analysis showed that the fourth SUA quartile (≥5.7 mg/dl) was associated with diastolic dysfunction with an odds ratio of 5.34 (P < 0.05) when compared with the first SUA quartile (≤4.1 mg/dl). By contrast, the relationship between SUA and diastolic dysfunction was not significant in men, irrespective of which of the sex-nonspecific or sex-specific SUA quartiles were used. These data indicated that among cardiac patients with preserved ejection fraction, SUA was significantly associated with diastolic dysfunction in women but not in men.

Association between serum uric acid levels and obesity among university students (China).

To evaluate the association between serum uric acid and obesity among university students who participated in routine health screening in 2013. In this cross-sectional study, 3529 subjects were analyzed. Obesity categories were classified by BMI levels references in China. And serum uric acid levels were classified by serum uric acid quartiles. Two-sample T-test and Wilcoxon Rank sum test were used to compare age, biochemical and anthropometric parameters of subjects of two genders. Rank correlation used to analyze relationship between serum uric acid and obesity. There were 1285 males (mean age, 19.8 ± 1.3 years) and 2244 females (mean age, 19.9 ± 1.3 years) in this study. Association between 2nd serum uric acid quartile and normal in male are significant and coefficient was 0.519. The 3rd serum uric acid quartile and normal in female was associated significantly (r = 0.173, p = 0.010). And associations between overweight and 3rd and 4th serum uric acid quartiles in female were significant (r = 0.128, p = 0.038 in 1st quartile and r = 0.282, p = 0.004 in 4th quartile). The 4th serum uric acid quartile and Obesity in two gender groups were significantly associated (r = 0.291, p = 0.000 in male and r = 0.484, p = 0.001 in female). High serum uric acid was positively associated with obesity in overweight and obesity group. However, the association was weak between two variables because serum uric acid influenced obesity with other related factors together.

Relationship between serum uric acid, metabolic syndrome and resting heart rate in Chinese elderly

Both serum uric acid (SUA) and resting heart rate (RHR) are positively associated with metabolic syndrome (MetS). However, little is known regarding the relationship between SUA and RHR. We aimed to investigate the relationship between SUA and RHR in the elderly with MetS. With a retrospective observational analysis, 867 Chinese elderly subjects (437 males and 430 females) were divided into 4 groups according to SUA quartiles. We first investigated the relationship between SUA and MetS. Then we evaluated whether there is an independent association of SUA with RHR in these subjects. There were significant differences of MetS incidence in groups of Quartile 1-4 in male and female (all P<0.01). Female had higher MtS incidence than male (53.49% versus 43.24%; P=0.003). After adjusting age, sex and diuretics usage, SUA levels intimately correlate with RHR, creatinine, waist-to-height ratio, waist circumference, high-sensitivity C-reactive protein (hsCRP) and white blood cells (all r>0.30, P<0.05). When RHR exceeded 86bpm, after adjusting for various known risk factors, Odds ratios of concomitant SUA level were 1.243, 1.908, and 2.194 in the second, third, and fourth urate quartile respectively compared to the first quartile. ROC curve analysis demonstrated statistically significant value of RHR for hyperuricemia diagnosis (area under the curve was 0.702 with 95% CI of 0.605-0.791, P=0.000). The SUA has significant correlation with RHR in MetS. RHR appears to be a potentially detective marker to predict the elevated SUA and cardio-metabolic risk in Chinese elderly.