Impact of serum uric acid levels on cardiovascular events and quality of life in patients with chronic coronary syndromes: Insights from a contemporary, prospective, nationwide registry

Luca, Leonardo De; Gulizia, Michele Massimo; Gabrielli, Domenico; Meessen, Jennifer; Mattei, L.; D’Urbano, Maurizio; Colivicchi, Furio; Temporelli, Pier Luigi; Borghi, Claudio; Desideri, Giovambattista

doi:10.1016/j.numecd.2021.09.034

Cited by 4 publications

(6 citation statements)

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“…Although these components of the composite endpoint were slightly different from those in our study, elevated SUA levels were consistently associated with increased adverse events. However, some previous studies demonstrated that increased SUA levels were not significantly associated with a higher rate of cardiovascular mortality in patients with CAD (30,31). One prospective observational study from the Stable Coronary Artery Diseases Registry (START) registry in Italy reported that high SUA levels did not significantly influence 1-year cardiovascular events in patients with CCS with or without PCI (30).…”

Section: Discussionmentioning

confidence: 94%

“…However, some previous studies demonstrated that increased SUA levels were not significantly associated with a higher rate of cardiovascular mortality in patients with CAD (30,31). One prospective observational study from the Stable Coronary Artery Diseases Registry (START) registry in Italy reported that high SUA levels did not significantly influence 1-year cardiovascular events in patients with CCS with or without PCI (30). Contrary to our findings, the START registry showed no relationship between SUA levels and cardiovascular events.…”

Section: Discussionmentioning

confidence: 94%

“…The above discordance may be due to the fact that the follow-up period in the START registry (1 year) was shorter than our follow-up period (median 910 days). In fact, the highest SUA tertile group (SUA ≥6.23 mg/dL) tended to have an increased incidence of MACE, including cardiovascular death and hospitalization for myocardial infarction, heart failure, angina, or revascularization, suggesting that a longer follow-up period might have revealed a significant relationship between increased SUA levels and MACE in the START registry ( 30 ).…”

Section: Discussionmentioning

confidence: 99%

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Hyperuricemia predicts increased cardiovascular events in patients with chronic coronary syndrome after percutaneous coronary intervention: A nationwide cohort study from Japan

Akashi

Kuwabara

Matoba

et al. 2023

Front. Cardiovasc. Med.

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BackgroundThe causal relationship between hyperuricemia and cardiovascular diseases is still unknown. We hypothesized that hyperuricemic patients after percutaneous coronary intervention (PCI) had a higher risk of major adverse cardiovascular events (MACE).MethodsThis was a large-scale multicenter cohort study. We enrolled patients with chronic coronary syndrome (CCS) after PCI between April 2013 and March 2019 using the database from the Clinical Deep Data Accumulation System (CLIDAS), and compared the incidence of MACE, defined as a composite of cardiovascular death, myocardial infarction, and hospitalization for heart failure, between hyperuricemia and non-hyperuricemia groups.ResultsIn total, 9,936 patients underwent PCI during the study period. Of these, 5,138 patients with CCS after PCI were divided into two group (1,724 and 3,414 in the hyperuricemia and non-hyperuricemia groups, respectively). The hyperuricemia group had a higher prevalence of hypertension, atrial fibrillation, history of previous hospitalization for heart failure, and baseline creatinine, and a lower prevalence of diabetes than the non-hyperuricemia group, but the proportion of men and age were similar between the two groups. The incidence of MACE in the hyperuricemia group was significantly higher than that in the non-hyperuricemia group (13.1 vs. 6.4%, log-rank P < 0.001). Multivariable Cox regression analyses revealed that hyperuricemia was significantly associated with increased MACE [hazard ratio (HR), 1.52; 95% confidential interval (CI), 1.23–1.86] after multiple adjustments for age, sex, body mass index, estimated glomerular filtration rate, left main disease or three-vessel disease, hypertension, diabetes mellitus, dyslipidemia, history of myocardial infarction, and history of hospitalization for heart failure. Moreover, hyperuricemia was independently associated with increased hospitalization for heart failure (HR, 2.19; 95% CI, 1.69–2.83), but not cardiovascular death or myocardial infarction after multiple adjustments. Sensitive analyses by sex and diuretic use, B-type natriuretic peptide level, and left ventricular ejection fraction showed similar results.ConclusionCLIDAS revealed that hyperuricemia was associated with increased MACE in patients with CCS after PCI. Further clinical trials are needed whether treating hyperuricemia could reduce cardiovascular events or not.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

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Hyperuricemia predicts increased cardiovascular events in patients with chronic coronary syndrome after percutaneous coronary intervention: A nationwide cohort study from Japan

Akashi

Kuwabara

Matoba

et al. 2023

Front. Cardiovasc. Med.

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“… 19 However, in a recent study involving 5070 patients with chronic coronary syndrome, scholars found that patients with high UA levels did not significantly influence the rate of cardiovascular death and hospitalization of heart failure during 1‐year follow‐up. 20 Lazzeri et al 21 demonstrated that hyperuricemia was not independently associated with early death in 856 patients with ST‐segment–elevation MI. An analysis of the LURIC (Ludwigshafen Risk and Cardiovascular Health) study demonstrated that high UA levels were not significantly associated with a higher risk of 7.3‐year all‐cause death after adjusting for age, sex, traditional cardiovascular risk factors, the severity of coronary atherosclerosis, and medication use in subjects referred for coronary angiography.…”

Section: Discussionmentioning

confidence: 99%

“… 5 , 6 , 7 , 8 , 9 , 10 Regarding individuals with established CAD, evidence for the positive association of high serum UA levels with poor prognosis seems to be stronger than that in the general population, 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 yet there were still some studies reporting inconsistent results. 20 , 21 , 22 , 23…”

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confidence: 99%

Uric Acid Levels, Number of Standard Modifiable Cardiovascular Risk Factors, and Prognosis in Patients With Coronary Artery Disease: A Large Cohort Study in Asia

Cui,

Song,

Yin

et al. 2023

JAHA

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Background Serum uric acid (UA) is correlated closely with traditional cardiovascular risk factors, which might interfere with the action of UA, in patients with coronary artery disease. We performed this study to evaluate the prognostic effect of UA levels in individuals with different numbers of standard modifiable cardiovascular risk factors (SMuRFs). Methods and Results In this prospective study, we consecutively enrolled 10 486 patients with coronary artery disease. They were stratified into 3 groups according to the tertiles of UA concentrations and, within each UA tertile, further classified into 3 groups by the number of SMuRFs (0–1 versus 2–3 versus 4). The primary end point was major adverse cardiovascular and cerebrovascular events (MACCEs), including death, myocardial infarction, stroke, and unplanned revascularization. Over a median follow‐up of 2.4 years, 1233 (11.8%) MACCEs were recorded. Patients with high UA levels developed significantly higher risk of MACCEs than those with low UA levels. In addition, UA levels were positively associated with MACCEs as a continuous variable. More importantly, in patients with 0 to 1 SMuRF, the risks of MACCEs were significantly higher in the high‐UA‐level group (adjusted hazard ratio [HR], 1.469 [95% CI, 1.197–1.804]) and medium‐UA‐level group (adjusted HR, 1.478 [95% CI, 1.012–2.160]), compared with the low‐UA‐level group, whereas no significant association was found between UA levels and the risk of MACCEs in participants with 2 to 3 or 4 SMuRFs. Conclusions In patients with coronary artery disease who received evidence‐based secondary prevention therapies, elevated UA levels might affect the prognosis of individuals with 0 to 1 SMuRF but not that of individuals with ≥2 SMuRFs.

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Association of hyperuricemia with cardiovascular diseases: current evidence

Chrysant

2023

Hospital Practice

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Impact of serum uric acid levels on cardiovascular events and quality of life in patients with chronic coronary syndromes: Insights from a contemporary, prospective, nationwide registry

Cited by 4 publications

References 50 publications

Hyperuricemia predicts increased cardiovascular events in patients with chronic coronary syndrome after percutaneous coronary intervention: A nationwide cohort study from Japan

Hyperuricemia predicts increased cardiovascular events in patients with chronic coronary syndrome after percutaneous coronary intervention: A nationwide cohort study from Japan

Uric Acid Levels, Number of Standard Modifiable Cardiovascular Risk Factors, and Prognosis in Patients With Coronary Artery Disease: A Large Cohort Study in Asia

Association of hyperuricemia with cardiovascular diseases: current evidence

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