Uric acid is not an independent predictor of cardiovascular mortality in type 2 diabetes: A population-based study

Panero, Francesco; Gruden, Gabriella; Perotto, Massimo; Fornengo, Paolo; Barutta, Federica; Greco, Elisabetta; Runzo, Cristina; Ghezzo, Giuseppe; Cavallo‐Perin, P.; Bruno, Graziella

doi:10.1016/j.atherosclerosis.2011.11.042

Cited by 67 publications

(61 citation statements)

References 28 publications

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“…Previous studies have suggested that hyperuricemia at the top quantile8, 9, 10 or >7.0 mg/dL11 is associated with a higher risk for CVD‐related mortality. Conversely, other investigations failed to demonstrate the independent predictive role of hyperuricemia for CVD‐related or all‐cause mortality in adults 65 years and older 12, 13, 14. Limitations pertaining to small sample size,8, 10, 11, 12, 13, 14 specific patient groups,8, 11, 13, 14 single sex,9 and incomplete adjustment for confounders such as eGFR,9, 10 fasting plasma glucose10, 11, 12 or alcohol consumption9, 11 jointly contribute to the conflicting results in these studies.…”

Section: Discussionmentioning

confidence: 99%

“…Earlier studies indicate that hyperuricemia is associated with increased risks of death from any causes and CVD‐related mortality in older adults 8, 9, 10, 11. Nonetheless, several recent studies fail to identify such an association between high SUA levels and increased mortality risks in the aging population 12, 13, 14. These contradictory results may be attributed to the differences in cohort characteristics, adjustment of confounders, and sample size.…”

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confidence: 99%

“…Uric acid, the final product of purine degradation in humans, mediates proinflammatory endothelial dysfunction and is associated with greater risks for CVD events 3, 4. Although a wealth of research has reported that an elevated serum uric acid (SUA) level >7 mg/dL independently predicts all‐cause and CVD‐related mortality in middle‐aged adults,5, 6, 7 studies linking hyperuricemia to mortality risks in the elderly population are conflicting and inconclusive 8, 9, 10, 11, 12, 13, 14. Earlier studies indicate that hyperuricemia is associated with increased risks of death from any causes and CVD‐related mortality in older adults 8, 9, 10, 11.…”

mentioning

confidence: 99%

“…These contradictory results may be attributed to the differences in cohort characteristics, adjustment of confounders, and sample size. In addition, the reference SUA levels among these studies are uneven8, 9, 10, 11, 12, 13, 14 and most studies categorize participants by quantiles,8, 9, 10, 12, 13, 14 which markedly hamper the comparability and clinical applicability of these studies.…”

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confidence: 99%

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U‐Shaped Association Between Serum Uric Acid Levels With Cardiovascular and All‐Cause Mortality in the Elderly: The Role of Malnourishment

Tseng

Chen

et al. 2018

JAHA

127

103

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BackgroundThe link between elevated serum uric acid (SUA) levels and cardiovascular disease (CVD)–related mortality in the elderly population remains inconclusive. Nutritional status influences both SUA and CVD outcomes. Therefore, we investigated whether SUA‐predicted mortality and the effect‐modifying roles of malnourishment in older people.Methods and ResultsA longitudinal Taiwanese cohort including 127 771 adults 65 years and older participating in the Taipei City Elderly Health Examination Program from 2001 to 2010 were stratified by 1‐mg/dL increment of SUA. Low SUA (<4 mg/dL) strata was categorized by malnourishment status defined as Geriatric Nutritional Risk Index <98, serum albumin <38 g/L, or body mass index <22 kg/m2. Study outcomes were all‐cause and CVD‐related mortality. Cox models were used to estimate hazard ratios (HRs) of mortality, after adjusting for 20 demographic and comorbid covariates. Over a median follow‐up of 5.8 years, there were 16 439 all‐cause and 3877 CVD‐related deaths. Compared with the reference SUA strata of 4 to <5 mg/dL, all‐cause mortality was significantly higher at SUA <4 mg/dL (HR, 1.16; 95% confidence interval, 1.07–1.25) and ≥8 mg/dL (HR, 1.13; confidence interval, 1.06–1.21), with progressively elevated risks at both extremes. Similarly, increasingly higher CVD‐related mortality was found at the SUA level <4 mg/dL (HR, 1.19; confidence interval, 1.00–1.40) and ≥7 mg/dL (HR, 1.17; confidence interval, 1.04–1.32). Remarkably, among the low SUA (<4 mg/dL) strata, only malnourished participants had greater all‐cause and CVD‐related mortality. This modifying effect of malnourishment remained consistent across subgroups.Conclusions SUA ≥8 or <4 mg/dL independently predicts higher all‐cause and CVD‐related mortality in the elderly, particularly in those with malnourishment.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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confidence: 99%

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U‐Shaped Association Between Serum Uric Acid Levels With Cardiovascular and All‐Cause Mortality in the Elderly: The Role of Malnourishment

Tseng

Chen

et al. 2018

JAHA

127

103

View full text Add to dashboard Cite

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“…Differences in the baseline characteristics of the study population, as well as in the cohort size, length of the follow-up, study endpoints, statistical adjustments for confounding variables and design of the analyses, may have contributed to the conflicting conclusions. In addition, although recent studies have examined the combined associations of hyperuricemia and kidney function with CVD, the results varied according to kidney function and study population [15,16,17,18]. In patients undergoing percutaneous coronary intervention (PCI), contrast-induced acute kidney injury (CI-AKI) is a common and important complication that can follow the administration of iodinated contrast media to patients at risk for AKI [19].…”

Section: Introductionmentioning

confidence: 99%

Hyperuricemia Is an Independent Risk Factor for Mortality Only if Chronic Kidney Disease Is Present

Chung¹,

Kim²,

Ro³

et al. 2013

Am J Nephrol

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Background/Aims: Hyperuricemia has been considered a risk factor for renal disease and cardiovascular disease. However, the potential contribution of hyperuricemia to mortality remains uncertain, and the results in the available literature vary according to kidney function. The aim of this study was to determine the association between hyperuricemia and mortality in patients undergoing percutaneous coronary intervention (PCI) across the interaction of kidney function. Method: We retrospectively reviewed patients who underwent PCI from 2003 to 2009. Propensity scores for hyperuricemia (>7 mg/dl for males and >6 mg/dl for females) were used to assemble a matched cohort of 693 pairs of patients with and without hyperuricemia for analysis from the 3,201 patients who fulfilled the inclusion criteria among the 4,842 patients who underwent PCI. Results: Of the 3,201 patients who underwent PCI and for whom data were available regarding their baseline serum uric acid level, 763 (23.8%) had hyperuricemia. The hyperuricemia-associated hazard ratios (HRs) [95% confidence intervals (CIs)] for all-cause mortality were 1.780 (1.270-2.495) in the unmatched cohort and 1.655 (1.109-2.468) in the matched cohort. The HRs (95% CI) for all-cause mortality among those with and without chronic kidney disease (CKD) were 2.080 (1.318-3.283) and 1.592 (0.778-3.256), respectively (p for interaction, 0.001). Conclusions: Hyperuricemia is an independent risk factor for all-cause mortality in those patients with CKD but not in those without CKD.

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Uric acid and risk of periprocedural myocardial infarction in patients undergoing percutaneous coronary intervention

Verdoia¹,

Schaffer²,

Barbieri³

et al. 2014

Diabetes Metabolism Res

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Uric acid is not an independent predictor of cardiovascular mortality in type 2 diabetes: A population-based study

Cited by 67 publications

References 28 publications

U‐Shaped Association Between Serum Uric Acid Levels With Cardiovascular and All‐Cause Mortality in the Elderly: The Role of Malnourishment

U‐Shaped Association Between Serum Uric Acid Levels With Cardiovascular and All‐Cause Mortality in the Elderly: The Role of Malnourishment

Hyperuricemia Is an Independent Risk Factor for Mortality Only if Chronic Kidney Disease Is Present

Uric acid and risk of periprocedural myocardial infarction in patients undergoing percutaneous coronary intervention

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