Elevated Serum Uric Acid is an Independent Predictor for Cardiovascular Events in Patients With Severe Coronary Artery Stenosis  Subanalysis of the Japanese Coronary Artery Disease (JCAD) Study

Okura, Takafumi; Higaki, Jitsuo; Kurata, Mie; Irita, Jun; Miyoshi, Katsuhiko; Yamazaki, Tsutomu; Hayashi, Doubun; Kohro, Takahide; Nagai, Ryozo; Investigators, The JCAD Study

doi:10.1253/circj.cj-08-0828

Cited by 67 publications

(43 citation statements)

References 21 publications

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“…17,19- 21 The current literature supports the role of hyperuricemia as an independent, modifiable marker of cardiovascular damage and an independent predictor of cardiovascular event. 18,20, 37 Mehran et al 38 evaluated a total of 5,571 patients who underwent PCI for the detection of risk factors for AKI, and have demonstrated that multivessel coronary involvement is only a univariate predictor of AKI (P=0.003), which is consistent with our results. In patients with multivessel coronary involvement, other vessels in the body, such as the renal artery, can be involved.…”

Section: Discussionsupporting

confidence: 89%

The Impact of Hyperuricemia on In-Hospital Mortality and Incidence of Acute Kidney Injury in Patients Undergoing Percutaneous Coronary Intervention

Park

Shin

Lee

et al. 2011

Circ J

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Background: There is very little information about the relationship between hyperuricemia, acute kidney injury (AKI) and in-hospital mortality. Methods and Results:With a retrospective analysis of the medical records, 1,247 patients who had percutaneous coronary intervention (PCI) were investigated. AKI was defined as an increase in serum creatinine of ≥0.5 mg/dl or ≥50% over baseline within 7 days of PCI. The association of AKI with clinical, biochemical and procedural variables were examined. In addition, the association of hyperuricemia with in-hospital mortality was also examined. Of the 1,247 patients in the study population, 51 (4.1%) experienced AKI after PCI, 15 of whom required hemodialysis. In-hospital mortality occurred in 1.6% (20 of 1,247) in 19.6% (10 of 51) of AKI individuals, and 0.8% (10 of 1,186) of the non-AKI participants (odd ratios, 28.927; 95% confidence intervals, 11.411-73.328; P<0.001). In our study, the most powerful predictors of these variables were acute myocardial infarction, baseline estimated glomerular filtration rate (eGFR) <60 ml · min -1 · 1.73 m -2 , diabetics mellitus, anemia and hyperuricemia. Notably, the incidence of AKI after PCI markedly increased in diabetic or hyperuricemic patients with a baseline eGFR of <60 ml · min -1 · 1.73 m -2 . Conclusions:It is clear that AKI develops due to multiple risk factors. Our results indicate that hyperuricemia is independently associated with an increased risk of in-hospital mortality and AKI in patients treated with PCI. (Circ J 2011; 75: 692 - 697)

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Section: Discussionsupporting

confidence: 89%

The Impact of Hyperuricemia on In-Hospital Mortality and Incidence of Acute Kidney Injury in Patients Undergoing Percutaneous Coronary Intervention

Park

Shin

Lee

et al. 2011

Circ J

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“…An increasing number of studies demonstrated the relationship between SUA levels and CAD patients [13,14,15,16]. However, the relationship between SUA levels and clinical outcomes in CKD patients remains controversial.…”

Section: Discussionmentioning

confidence: 99%

Predictive Value of Serum Uric Acid Levels on Mortality in Acute Coronary Syndrome Patients with Chronic Kidney Disease after Drug-Eluting Stent Implantation

et al. 2013

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Objectives: Despite optimal treatments, prognosis in acute coronary syndrome (ACS) patients with chronic kidney disease (CKD) remains poor. Elevated serum uric acid (SUA) levels may predict worse outcomes in these patients. The objective was to assess the predictive value of SUA levels on mortality in ACS patients with CKD after drug-eluting stent (DES) implantation. Methods: We retrospectively assessed ACS patients with CKD who underwent successful DES implantation between January 2007 and December 2009. Patients were followed up from January to March 2012. CKD was defined as an estimated glomerular filtration rate <60 ml/min/1.73 m². We assessed the association between SUA levels and mortality. Results: A total of1,132 patients were included. The mean age was 67.7 years. During a mean follow-up of 38.5 months, 145 patients died: 50 from cardiac diseases, 28 from cerebral diseases, 14 from renal diseases and 53 from other causes. After adjustment for confounders, SUA levels increased the risk of all-cause, cerebral and other-cause mortality. Adjusted hazard ratios for quartiles 3 and 4 versus quartile 1 of SUA were: all-cause, 1.66 [95% confidence interval (CI) 1.08-2.78] and 1.99 (95% CI 1.21-3.23); cerebral, 2.24 (95% CI 0.43-11.7) and 5.89 (95% CI 1.30-26.6); and other causes, 2.81 (95% CI 1.17-6.78) and 3.89 (95% CI 1.63-9.29), respectively. SUA levels had no impact on cardiac and renal mortality rates. Conclusions: High SUA levels are associated with all-cause, cerebral and other-cause mortality rates in ACS patients with CKD after DES implantation. Future research is needed to determine if lowering SUA levels will decrease mortality in these patients.

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“…Hyperuricemia was also reported to be an independent risk factor for cardiovascular mortality (22,23). In patients with established cardiovascular disease, elevated urate levels were an independent predictor of cardiovascular events (24); and finally, in a meta-analysis of the association between hyperuricemia and stroke, a small but increased risk was found even after adjustment for known cardiovascular risk factors (25). In most studies, the increased risk of hyperuricemia for cardiovascular morbidity (by odds ratio or hazard ratio) was around 1.2-1.4.…”

Section: Hyperuricemia Insulin Resistance Hypertension and Cardiovmentioning

confidence: 99%

Uric acid transport and disease

Thorens²

2010

J. Clin. Invest.

669

496

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Uric acid is the metabolic end product of purine metabolism in humans. It has antioxidant properties that may be protective but can also be pro-oxidant, depending on its chemical microenvironment. Hyperuricemia predisposes to disease through the formation of urate crystals that cause gout, but hyperuricemia, independent of crystal formation, has also been linked with hypertension, atherosclerosis, insulin resistance, and diabetes. We discuss here the biology of urate metabolism and its role in disease. We also cover the genetics of urate transport, including URAT1, and recent studies identifying SLC2A9, which encodes the glucose transporter family isoform Glut9, as a major determinant of plasma uric acid levels and of gout development.Conflict of interest: Alexander So has acted as a consultant and advisor for Novartis.Citation for this article:

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Elevated Serum Uric Acid is an Independent Predictor for Cardiovascular Events in Patients With Severe Coronary Artery Stenosis Subanalysis of the Japanese Coronary Artery Disease (JCAD) Study

Cited by 67 publications

References 21 publications

The Impact of Hyperuricemia on In-Hospital Mortality and Incidence of Acute Kidney Injury in Patients Undergoing Percutaneous Coronary Intervention

The Impact of Hyperuricemia on In-Hospital Mortality and Incidence of Acute Kidney Injury in Patients Undergoing Percutaneous Coronary Intervention

Predictive Value of Serum Uric Acid Levels on Mortality in Acute Coronary Syndrome Patients with Chronic Kidney Disease after Drug-Eluting Stent Implantation

Uric acid transport and disease

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