U-shaped association of uric acid to overall-cause mortality and its impact on clinical management of hyperuricemia

Crawley, William T.; Jungels, Cyprien G.; Stenmark, Kurt R.; Fini, Mehdi A.

doi:10.1016/j.redox.2022.102271

Cited by 83 publications

(63 citation statements)

References 154 publications

(315 reference statements)

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“…Our study did not investigate food consumption, which might have an impact on SUA levels due to a lack of pertinent data. Third, unlike the general population where the U-shaped associations between SUA levels and CVDs are shown in both males and females [ 12 ], our study showed the U-shaped correlation only in female RA patients. The sample size of male RA patients was less ( n = 237) which may be not large enough to find a significant difference.…”

Section: Discussioncontrasting

confidence: 78%

“…A number of researches have investigated the link between hyperuricemia and harmful outcomes in general population. Several studies demonstrated a positive association between hyperuricemia with all-cause and CVD mortality [ 25 , 26 ], as well as higher risk of CVDs in general [ 12 ]. There are a number of potential explanations for the link between high SUA levels and elevated CVD hazard, including the coexistence of traditional cardiovascular risk factors and the direct interaction of uric acid with several metabolic processes linked to CVDs [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

“…Recent studies reported U-shaped connections between SUA levels and CVDs, as well as mortality in general population [ 12 ]. The harmful effects of hypouricemia are being attracted more and more attention.…”

Section: Discussionmentioning

confidence: 99%

“…The measurement of SUA is also recommended as a part of the screening on hypertensive patients in 2021 European Society of Hypertension Guidelines [ 11 ]. Recently, due to the U-shaped association of SUA levels with the risk of CVDs and mortality found in general population, more attention has been paid to the effect of hypouricemia [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

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Prevalence and influence of hypouricemia on cardiovascular diseases in patients with rheumatoid arthritis

Zou

Zhu

et al. 2022

Eur J Med Res

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Background Serum uric acid (SUA) acts as an antioxidant and abnormally low SUA may raise the risk of developing atherosclerotic disorders. There is a U-shaped association between SUA with cardiovascular diseases (CVDs) in general population. However, the prevalence of hypouricemia and its influence on CVDs in rheumatoid arthritis (RA) remains unclear. Methods This cross-sectional study collected clinical data from a Chinese RA cohort. Hypouricemia was defined as SUA ≤ 3.0 mg/dL, and hyperuricemia was defined as SUA ≥ 7.0 mg/dL. CVDs were defined as a history of angina pectoris, myocardial infarction, heart failure, stroke and peripheral arterial disease. Restricted cubic spline regression and logistic regression analysis were conducted to evaluate the associations between SUA levels and CVDs. Results Among 1130 RA patients recruited, the mean age was 53.2 years and 79.0% were female. The prevalence of hypouricemia and hyperuricemia were 10.6% and 12.0%, respectively. RA patients with hyperuricemia had a higher rate of CVDs than normouricemic patients (27.9% vs. 7.1%, P < 0.05). Surprisingly, RA patients with hypouricemia also had a higher rate of CVDs (20.7% vs. 7.1%, P < 0.05) even without higher traditional cardiovascular risk factors. A U-shaped association between SUA levels and total CVDs was found (Pnon-linear < 0.001). Multivariate logistic regression analysis revealed that compared with normouricemia, both hypouricemia [adjusted OR (AOR) = 4.707, 95% CI 2.570–8.620] and hyperuricemia (AOR = 3.707, 95% CI 2.174–6.321) were associated with higher risk of CVDs. Conclusions Hypouricemia may be a potential risk factor of CVDs in RA patients

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Section: Discussioncontrasting

confidence: 78%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Prevalence and influence of hypouricemia on cardiovascular diseases in patients with rheumatoid arthritis

Zou

Zhu

et al. 2022

Eur J Med Res

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“…39 A previous study demonstrated a U-shaped association of uric acid with renal disease and cardiac events. 40 Elevated uric acid is also known to be associated with increased inflammation and endothelial dysfunction. [41][42][43] Second, serum albumin is a circulating antioxidant protein, and its decreased synthesis and increased catabolism reflect an inflammatory state.…”

mentioning

confidence: 99%

Elevated Serum Uric Acid/Albumin Ratio as a Predictor of Post-Contrast Acute Kidney Injury After Percutaneous Coronary Intervention in Patients with ST-Segment Elevation Myocardial Infarction

Zhang¹,

Xu²,

He³

et al. 2022

JIR

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Background The serum uric acid/albumin ratio (sUAR), a novel inflammatory marker, effectively predicts acute kidney injury (AKI) and cardiovascular outcomes. However, whether the sUAR predicts post-contrast acute kidney injury (PC-AKI) in patients with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI) remains uncertain. In this study, we evaluated the association between the sUAR and PC-AKI in patients with STEMI undergoing PCI. Methods We consecutively recruited patients with STEMI who underwent PCI and stratified them into three groups according to the terciles of the sUAR. The primary outcome was the incidence of PC-AKI. The association between the sUAR and PC-AKI was assessed by multivariate logistic regression analysis. Results A total of 2861 patients with STEMI were included in this study. The incidence of PC-AKI increased stepwise with increasing sUAR tercile (2.6% vs 4.0% vs 11.6%, p < 0.001), and the incidence of in-hospital major adverse clinical events (MACEs) was highest among patients in the Q3 group. Multivariate logistic regression analysis revealed that the sUAR was also an independent predictor of PC-AKI (continuous sUAR, per 1-unit increase, odds ratio [OR] [95% confidence interval (CI)]: 1.06 [1.02–1.10], p = 0.005; tercile of sUAR, OR [95% CI] for Q2 and Q3: 1.18 [0.69–2.01] and 1.85 [1.12–3.06], respectively, with Q1 as a reference) but not in-hospital MACEs. In the receiver operating characteristic (ROC) analysis, the area under the curve (AUC) of the sUAR for predicting PC-AKI was 0.708 (95% CI: 0.666–0.751), and ROC analysis also showed that the sUAR was superior to uric acid and albumin alone in predicting PC-AKI. Conclusion Increasing sUAR was significantly associated with a higher risk of PC-AKI but not in-hospital MACEs in patients with STEMI who underwent PCI, suggesting that sUAR had a predictive value for PC-AKI after PCI in patients with STEMI. Further studies are required to confirm this finding.

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Bempedoic Acid for Primary Prevention of Cardiovascular Events

Goldstein,

Mascitelli

2023

JAMA

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U-shaped association of uric acid to overall-cause mortality and its impact on clinical management of hyperuricemia

Cited by 83 publications

References 154 publications

Prevalence and influence of hypouricemia on cardiovascular diseases in patients with rheumatoid arthritis

Prevalence and influence of hypouricemia on cardiovascular diseases in patients with rheumatoid arthritis

Elevated Serum Uric Acid/Albumin Ratio as a Predictor of Post-Contrast Acute Kidney Injury After Percutaneous Coronary Intervention in Patients with ST-Segment Elevation Myocardial Infarction

Bempedoic Acid for Primary Prevention of Cardiovascular Events

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