Is Serum Uric Acid Independently Associated With Left Ventricular Mass Index, Ejection Fraction, and B-Type Natriuretic Peptide Among Female and Male Cardiac Patients?

Abstract

SummaryMean serum uric acid (SUA) levels are higher in men than women. In addition, recent studies have suggested that the SUA threshold at which the cardiovascular risk might increase may vary between women and men. In the current retrospective study, by analyzing the data from 219 female and 519 male patients who were free from uric acid-lowering medication, we investigated whether SUA is associated with left ventricular mass index (LVMI), left ventricular ejection fraction (LVEF), and plasma levels of B-type natriuretic peptide (BNP) independent of confounding factors, such as serum calcium, inorganic phosphate, and fibroblast growth factor 23 (FGF23), in a gender-specific manner.In multivariate stepwise linear regression analysis in which age, blood pressure, eGFR, corrected calcium, inorganic phosphate, and FGF23 were entered as potential covariates, SUA was selected as a factor significantly associated with LVEF, LVMI, and plasma levels of BNP in both genders. On the other hand, however, after adding diuretic use as a potential covariate, the association between SUA and LVEF lost statistical significance in both genders, and that between SUA and BNP lost significance among female patients. These findings suggest that diuretic use is a non-negligible confounder in understanding the observed association between SUA and cardiac dysfunction and heart failure.In summary, SUA is associated with left ventricular hypertrophy independent of confounding factors including FGF23 and diuretic use in female and male patients. Whether lowering SUA can influence the progression of cardiac remodeling awaits further investigation. (Int Heart J 2017; 58: 562-569) Key words: Gender, Cardiac hypertrophy, Fibroblast growth factor 23 E levated serum uric acid (SUA) is known to be associated with aggravated insulin resistance, obesity, hypertension, renal dysfunction, and hypothyroidism, 1) which may explain enhanced cardiovascular risk and advanced left ventricular hypertrophy (LVH) among hyperuricemic individuals. 2,3) On the other hand, however, whether uric acid per se plays a causal role in cardiovascular morbidity remains a subject of debate, irrespective of various epidemiological and Mendelian randomization studies. 4-11) Editorial p.467To assess whether serum SUA is associated with cardiac hypertrophy and heart failure, 12) we may have to take various possible confounders into account, such as estimated glomerular filtration rate (eGFR), phosphate, 13) and the recently identified phosphaturic hormone fibroblast growth factor 23 (FGF23) that might directly induce hypertrophy of cardiomyocytes. [14][15][16][17][18] In addition, between women and men, not only mean SUA levels, but also the SUA threshold at which cardiovascular or metabolic syndrome-associated risks might increase, may vary; 19) therefore, we should analyze the data for each gender separately. In addition, the strength of the association between SUA and certain cardiac abnormalities might differ between women and men. 3,[20][21][22] We found that among patie...

Gender-Related Association of Serum Uric Acid Levels with Premature Ventricular Contraction

“…Elevated SUA has been considered to be correlated to cardiovascular diseases, including hypertension, 20) stroke, 21) chronic heart failure, 22,23) myocardial infarction, 24) atrial fibrillation, 25) and left ventricular hypertrophy. 26) The present results were in agreement with the finding reported by Yamada, et al, 27) which revealed that the SUA level is an independent predictor of ventricular arrhythmia in patients with left ventricular hypertrophy. In addition, in the present study, gender-specific analyses were performed, and a significant correlation between elevated SUA levels and PVC prevalence in males, but not in females, was found.…”

Association between serum uric acid and left ventricular hypertrophy/left ventricular diastolic dysfunction in patients with chronic kidney disease

“…Fujita et al reported that SUA levels were independently associated with LVH with an OR of 2.79 in 116 male patients with cardiac diseases [ 9 ]. Yamauchi et al showed that SUA levels were associated with LVH, independent of confounding factors, including fibroblast growth factor (FGF) 23 and diuretics in 219 and 519 female and male patients with cardiac diseases, respectively, who were free from uric acid-lowering medications [ 19 ]. Concerning LVDD, Cicoira et al reported that increased SUA levels were associated with LVDD in 150 patients with dilated cardiomyopathy [ 20 ].…”

Association of Uric Acid with Incident Metabolic Syndrome in a Japanese General Population

“…ric acid is synthesized by the liver during purine metabolism, and serum uric acid levels are determined by the balance between uric acid production and excretion. It has been reported that the uric acid level is associated with incident cardiovascular disease (CVD) and its risk factors, [1][2][3][4][5] which include high blood pressure, diabetes, dyslipidemia, smoking, and obesity. Although these risk factors alone can cause CVD, it has been suggested that the risk of CVD development increases if factors overlap, even if each factor is low.…”