Serum Uric Acid and Left Ventricular Mass in Essential Hypertension

Abstract

Serum uric acid (sUA) has been associated with cardiovascular risk. Although the recent mechanistic hypothesis poses the basis for the association between sUA and left ventricular mass index (LVMi), the issue remains poorly investigated in a clinical setup. Through a retrospective analysis of the database of the departmental Hypertension Clinic of University Hospital of Salerno Medical School, we identified 177 essential hypertensives (age 60.3 ± 13.3 years; 85 men), free from uric acid-modulating medications and severe chronic kidney disease, and whose sUA values, anthropometric, clinical, and echocardiographic data were available. In the studied cohort, the average duration of hypertension was 8.4 ± 7.1 years. LVMi associated with classical determinants, such as age, blood pressure, and kidney function, although after multivariate correction, only age remained significant. Also, sUA correlated positively with LVMi, as well as body size, metabolism, and kidney function. In a multivariate analysis, sUA confirmed the independent association with LVMi. Also, levels of sUA >5.6 mg/dl are associated with larger cardiac size. We confirmed our data in a replicate analysis performed in a larger population (1,379 hypertensives) from an independent clinic. Our results demonstrate that sUA increases with LVMi, and a cutoff of 5.6 mg/dl predict larger LV sizes. Our data suggest that hyperuricemia might help to stratify the risk of larger cardiac size in hypertensives.

Insulin Resistance and Vitamin D Deficiency: A Link Beyond the Appearances

“…The contribution of vitamin D deficiency in pathogenesis of LVH is also corroborated by the evidence that the morphology of the left ventricle was preserved in healthy individuals of the Baltimore Longitudinal Study of Aging having normal levels of vitamin D, while the risk of concentric left ventricular remodeling was higher in those with lower vitamin D concentration ( 106 ). To note, hyperuricemia, being associated with poor vitamin D status, was found to be a determinant of LVH in subjects with arterial hypertension ( 107 ), supporting the notion that vitamin D status plays a leading role in the pathogenesis of CV risk.…”

Insulin resistance surrogates predict hypertension plus hyperuricemia

“…High UA levels led to endothelial dysfunction, smooth muscle proliferation, inflammation and oxidative stress, resulting in stiff arteries and blood pressure elevation 33 . In particular, hyperuricemia was associated with left ventricular mass index and elevated serum UA could predict larger cardiac size in people with hypertension 34 .…”

Sex-specific cardiometabolic risk markers of left ventricular mass in physically active young adults: the CHIEF heart study

“…The independent cardiometabolic risk markers of LVM may vary according to the subjects selected. In hypertensive patients, age, systolic BP, fasting glucose, serum triglycerides and SUA were correlated with LVM 2,6,8 ; however, the relationship for serum triglycerides might be only present in men, and the predictor of LVM in the overweight or obese was only systolic BP 31 . In contrast, in type 2 diabetic patients, Jørgensen et al reported a correlation of systolic BP and HDL-C with LVM 30 , whereas there were no associations for hemoglobin A1c.…”

“…Hypertriglyceridemia was found as another risk marker of Cornell based LVH; however abdominal obesity and metabolic syndrome had a lower risk of Sokolow-Lyon based ECG-LVH. Most prior studies were designed to investigate the association between cardio-metabolic risk markers and LVM index in hypertensive or diabetic individuals, who were at middle or old ages 2,30 , and the physical activity or fitness was rarely taken into account 6 . The independent cardiometabolic risk markers of LVM may vary according to the subjects selected.…”