Serum uric acid, diuretic treatment and risk of cardiovascular events in the Systolic Hypertension in the Elderly Program (SHEP)

Franse, Lonneke V.; Pahor, Marco; Bari, Mauro Di; Shorr, Ronald I.; Wan, Jim Y.; Somes, Grant W.; Applegate, William B.

doi:10.1097/00004872-200018080-00021

Cited by 276 publications

(195 citation statements)

References 24 publications

Supporting

Mentioning

173

Contrasting

Unclassified

Order By: Relevance

“…Previous epidemiologic studies have also shown that UA level was independently predictive for the development of CVD even after antihypertensive treatment. 7,8,35,36 Furthermore, in the Systolic Hypertension in the Elderly Program trial, a subanalysis showed that the cardioprotection by diuretics was lost in those treated patients in whom UA levels increased. 36 One notable result of this study is that, in the group with higher LVMI, the risk of CVD became higher with increasing UA level.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Uric Acid, Left Ventricular Mass Index, and Risk of Cardiovascular Disease in Essential Hypertension

et al. 2006

View full text Add to dashboard Cite

Abstract-Elevated serum uric acid (UA) is frequently encountered in individuals with hypertension, but whether the relationship between UA and cardiovascular events is circumstantial or causal remains to be answered. We examined the association between serum UA and left ventricular mass index (LVMI) and investigated prospectively whether the combination of UA and LVMI can predict the incidence of cardiovascular disease (CVD) in asymptomatic subjects with essential hypertension. A total of 619 subjects (mean age, 61 years; 52% female) free of prior CVD were included in this study. A significant association between UA and LVMI was also confirmed in multiple regression analysis (male: Fϭ4.29, PϽ0.04; female: Fϭ4.24, PϽ0.05). During follow-up (mean, 34 months), 28 subjects (14 female) developed CVD including myocardial infarction, angina pectoris, congestive heart failure, cerebral infarction, and transient cerebral ischemia. Sex-specific median values were used to separate the higher group from the lower group of UA and LVMI. Kaplan-Meier curves showed a significantly poorer survival rate in the group with higher UA and LVMI (LVMI, male: Ͼ126.9, female: Ͼ112.0 g/m 2 ; UA, male: Ͼ374.7, female: Ͼ303.3 mol/L; log-rank 2 ϭ13.18; PϽ0.01). Multivariate Cox regression analysis showed that the combination of higher UA and LVMI was an independent predictor for CVD events (hazard ratio, 2.38; PϽ0.03). Our findings demonstrate that UA is independently associated with LVMI and suggest that the combination of hyperuricemia combined with left ventricular hypertrophy is an independent and powerful predictor for CVD. The association between UA and CVD events may be introduced in part because of a direct association of UA with LVMI. Key Words: uric acid Ⅲ cardiovascular diseases Ⅲ hypertrophy Ⅲ risk factors E ffective prevention of cardiovascular disease (CVD) requires the early detection and correction of predisposing conditions and risk factors in susceptible patients. Hypertension is a common risk factor for CVD, and the cardiovascular prognosis in patients with hypertension depends not only on the level of blood pressure (BP), but also on the presence of associated risk factors. Hyperuricemia is frequently encountered in hypertensive patients. 1 Several large epidemiologic studies have identified an association between increased serum uric acid (UA) and cardiovascular risk in the general population 2-6 and among patients with hypertension. 7,8 Other recent reports have also confirmed these associations by angiographic procedure. 9,10 Some studies have claimed that UA is an independent risk factor for CVD, whereas others have failed to identify UA as a significant and independent risk factor. 11-13 Thus, the status of UA as an independent risk marker remains controversial, and whether the relationship between UA level and cardiovascular events is circumstantial or causal remains to be answered. 2 On the other hand, the level of serum UA is affected by or linked to many factors, such as obesity, insulin resistance, dyslipidemia,...

show abstract

Section: Discussionmentioning

confidence: 99%

“…24 In the present study, we also found that DcT had a significant positive relationship with age (male: rϭ0. 36 …”

Section: Association Between Ua and Lvmimentioning

confidence: 99%

Uric Acid, Left Ventricular Mass Index, and Risk of Cardiovascular Disease in Essential Hypertension

et al. 2006

View full text Add to dashboard Cite

show abstract

“…The reason why diuretics do not seem protect renal function may be due to diuretic-induced hyperuricemia, which could counteract some of the beneficial effects of diuretics in these latter conditions. While this has not been studied directly, it is interesting that in the Systolic Hypertension in the Elderly Program (SHEP) trial, the use of diuretics resulted in a significant reduction of cardiovascular events, but this protection was largely prevented in those patents whose uric acid levels increased [22]. However, we need randomized clinical trials to address the causal role of hyperuricemia in renal and cardiovascular disease.…”

Section: Clinical Evidence For Hyperuricemia In Renal Diseasementioning

confidence: 99%

The conundrum of hyperuricemia, metabolic syndrome, and renal disease

et al. 2008

View full text Add to dashboard Cite

The level of serum uric acid in human has been increasing over the last decades, and correlates with an increase prevalence of renal disease and metabolic syndrome. Understanding the role of uric acid in these conditions may provide clues for preventing the current epidemic of renal disease. Controversy still remains if hyperuricemia is simply a consequence or a cause of renal disease although epidemiological studies have attempted to resolve this issue. In this review, we discuss the clinical and experimental evidence for a causal role of hyperuricemia in renal diseases and potential relationships of hyperuricemia with metabolic syndrome.

show abstract

“…Raised serum uric acid concentrations are associated with increased risk of stroke in high risk patient groups like hypertension, cardiovascular diseases and diabetes mellitus (27) . It is unclear whether high uric acid concentration promotes or protects against the development of ischemic stroke or simply act as a passive marker of increased risk.…”

Section: Discussionmentioning

confidence: 99%

A comparative study on oxidative stress and antioxidant status in ischemic stroke patients with and without diabetes

D’Souza

Sowmya

et al. 2008

Indian J Clin Biochem

View full text Add to dashboard Cite

show abstract

Serum uric acid, diuretic treatment and risk of cardiovascular events in the Systolic Hypertension in the Elderly Program (SHEP)

Abstract: Serum uric acid independently predicts cardiovascular events in older persons with isolated systolic hypertension. Monitoring serum uric acid change during diuretic treatment may help to identify patients who will most benefit from treatment.

Cited by 276 publications

References 24 publications

Uric Acid, Left Ventricular Mass Index, and Risk of Cardiovascular Disease in Essential Hypertension

Uric Acid, Left Ventricular Mass Index, and Risk of Cardiovascular Disease in Essential Hypertension

The conundrum of hyperuricemia, metabolic syndrome, and renal disease

A comparative study on oxidative stress and antioxidant status in ischemic stroke patients with and without diabetes

Contact Info

Product

Resources

About