Elevated uric acid and obesity-related cardiovascular disease risk factors among hypertensive youth

Reschke, Lauren; Miller, Edgar R.; Fadrowski, Jeffrey J.; Loeffler, Lauren F.; Holmes, Kathryn W.; Appel, Lawrence J.; Brady, Tammy M.

doi:10.1007/s00467-015-3154-y

Cited by 18 publications

(13 citation statements)

References 26 publications

(31 reference statements)

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“…Two recent studies of adolescents included in NHANES 1999-2000 and a small study conducted in Italy found that elevated UA levels were associated with higher BP. 395 -397 In the Italian study and in another US study of youth with obesity and HTN, 397,398 elevated UA was also associated with other markers of CV risk. These findings suggest that the measurement of UA levels may best be viewed as 1 component of CV risk assessment, especially in those with obesity.…”

Section: Uric Acidmentioning

confidence: 99%

Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents

et al. 2017

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These pediatric hypertension guidelines are an update to the 2004 "Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents." Significant changes in these guidelines include (1) the replacement of the term "prehypertension" with the term "elevated blood pressure," (2) new normative pediatric blood pressure (BP) tables based on normal-weight children, (3) a simplified screening table for identifying BPs needing further evaluation, (4) a simplified BP classification in adolescents ≥13 years of age that aligns with the forthcoming American Heart Association and American College of Cardiology adult BP guidelines, (5) a more limited recommendation to perform screening BP measurements only at preventive care visits, (6) streamlined recommendations on the initial evaluation and management of abnormal BPs, (7) an expanded role for ambulatory BP monitoring in the diagnosis and management of pediatric hypertension, and (8) revised recommendations on when to perform echocardiography in the evaluation of newly diagnosed hypertensive pediatric patients (generally only before medication initiation), along with a revised definition of left ventricular hypertrophy. These guidelines include 30 Key Action Statements and 27 additional recommendations derived from a comprehensive review of almost 15 000 published articles between January 2004 and July 2016. Each Key Action Statement includes level of evidence, benefit-harm relationship, and strength of recommendation. This clinical practice guideline, endorsed by the American Heart Association, is intended to foster a patient- and family-centered approach to care, reduce unnecessary and costly medical interventions, improve patient diagnoses and outcomes, support implementation, and provide direction for future research.

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Section: Uric Acidmentioning

confidence: 99%

Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents

et al. 2017

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“…We generally consider that young persons constitute one of multiple populations at risk for primary hyperuricemia [19] and a recent report by Reschke et al [20] indicated an increased incidence of hyperuricemia among adults aged 3 to 19 years. The most common clinical symptom of hyperuricemia is gouty arthritis, so the majority of patients are treated; furthermore, hyperuricemia may also cause cardiovascular disease, cerebrovascular disease, and metabolic syndrome.…”

Section: Discussionmentioning

confidence: 99%

Relationship between oxidative stress and inflammation in hyperuricemia

Zhou

Zhao²,

Pu³

et al. 2018

Medicine

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The average age of hyperuricemia patients has gradually decreased, but young patients with primary hyperuricemia often do not exhibit clinical symptoms and have not received sufficient attention. However, a lack of symptoms with primary hyperuricemia does not mean that high serum uric acid (UA) levels cannot lead to pathological effects, such as oxidative stress and inflammation, and the specific damage is still unclear. We aimed to determine the relationship between oxidative stress and inflammation to explore the possible role of pathological damage in asymptomatic young patients with primary hyperuricemia.A total of 333 participants were enrolled in our study: 158 asymptomatic young patients with primary hyperuricemia and 175 healthy persons from a health check-up population. Malondialdehyde (MDA), superoxide dismutase (SOD), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and general biochemical markers were measured.We found no differences in biochemical markers (fasting glucose, TG, TC, LDL-C, HDL-C, SCr, BUN, AST, and ALT) between the patients and healthy persons. Subsequent analyses of oxidative stress and inflammation revealed that the serum levels of MDA, IL-6, and TNF-α in the patients were significantly higher than those in the healthy control group (P < .001), and the SOD activity was significantly lower (P < .001). As the UA levels increased, MDA increased significantly and SOD decreased significantly; likewise, IL-6 and TNF-α increased significantly as the UA level increased. MDA showed a significant positive correlation with IL-6 (r = 0.367, P < .001) and TNF-α (r = 0.319, P < .001), and SOD was negatively correlated with IL-6 (r = −0.241, P < .01) and TNF-α (r = −0.308, P < .001). Multivariable logistic regression analysis showed that UA (OR: 2.379, 95% CI: 1.698–3.286, P < .001; OR: 3.261, 95% CI: 1.729–3.857, P < .001; for IL-6 and TNF-α, respectively) and MDA (OR: 1.836, 95% CI: 1.283–2.517, P < .01; OR: 2.532, 95% CI: 1.693–3.102, P < .001; for IL-6 and TNF-α, respectively) were risk factors for high IL-6 and TNF-α and that SOD (OR: 0.517, 95% CI: 0.428–0.763, P < .01; OR: 0.603, 95% CI: 0.415–0.699, P < .001; for IL-6 and TNF-α, respectively) was a protective factor.In our study, some abnormal pathological effects were found in asymptomatic young patients with hyperuricemia, suggesting that in young hyperuricemia patients, oxidative stress, inflammation and the inflammatory response may be related to the oxidative stress induced by UA. Therefore, we should pay more attention to the pathological damage caused by these alterations.

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“…Each medical statistical method has its scope of application and its confounding factor control strategy; if these are ignored during the scope of its application, erroneous results may be obtained, such that the effectiveness of the research will be questioned. 4 – 12…”

Section: Discussionmentioning

confidence: 99%

Differential analysis of disease risk assessment using binary logistic regression with different analysis strategies

Zhao

Nian

et al. 2018

J Int Med Res

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ObjectiveTo investigate the importance of controlling confounding factors during binary logistic regression analysis.MethodsMale coronary heart disease (CHD) patients (n = 664) and healthy control subjects (n = 400) were enrolled. Fourteen indexes were collected: age, uric acid, cholesterol, triglyceride, high density lipoprotein cholesterol, low density lipoprotein cholesterol, apolipoprotein A1, apolipoprotein B100, lipoprotein a, homocysteine, total bilirubin, direct bilirubin, indirect bilirubin, and γ-glutamyl transferase. Associations between these indexes and CHD were assessed by logistic regression, and results were compared by using different analysis strategies.Results1) Without controlling for confounding factors, 14 indexes were directly inputted in the analysis process, and 11 indexes were finally retained. A model was obtained with conflicting results. 2) According to the application conditions for logistic regression analysis, all 14 indexes were weighed according to their variances and the results of correlation analysis. Seven indexes were finally included in the model. The model was verified by receiver operating characteristic curve, with an area under the curve of 0.927.ConclusionsWhen binary logistic regression analysis is used to evaluate the complex relationships between risk factors and CHD, strict control of confounding factors can improve the reliability and validity of the analysis.

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Elevated uric acid and obesity-related cardiovascular disease risk factors among hypertensive youth

Cited by 18 publications

References 26 publications

Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents

Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents

Relationship between oxidative stress and inflammation in hyperuricemia

Differential analysis of disease risk assessment using binary logistic regression with different analysis strategies

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