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

Abstract

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,...

Absence of an independent association between serum uric acid and left ventricular mass in Caucasian hypertensive women and men

“…In a smaller sample of hypertensive subjects Matsumura et al found the opposite [14]. Iwashima et al, in 619 hypertensive individuals, showed that SUA was independently associated with LVMI [8]. More recently, Mitsuhashi et al reported that SUA was positively associated with electrocardiographically diagnosed LVH in healthy Japanese men [13].…”

“…The conflicting findings about the relationships between SUA and LVM seem in part to mirror the controversy on the role of SUA as independent risk factor for CV morbidity and mortality [1,2,8]. Up until today, it is still unclear whether hyperuricemia has a causative role in CVD or, as has been more often suggested, is simply a marker for other risk factors, frequently associated with increased SUA levels, such as hypertension, dyslipidemia, MetS and renal dysfunction [1].…”

“…In some, but not in all, studies [1,2,8] performed in hypertensive subjects, the association between serum uric acid (SUA) and cardiovascular (CV) events remained significant after adjustment for potential confounding factors.…”

Hyperuricemia and Incidence of Hypertension Among Men Without Metabolic Syndrome

“…The link between hyperuricemia and hypertension has been reported in several studies. [5][6][7][8][9][10][11][12][13]16,17 Among children newly diagnosed with hypertension, serum uric acid was highly correlated with both systolic and diastolic blood pressure. 8 In the Framingham cohort, subjects with hypertension have been noted to have a 3-fold increased risk of gout.…”

Association between osteopontin promoter variants and diastolic dysfunction in hypertensive heart in the Japanese population

“…Studies were performed with phased-array echocardiography with M-mode, 2D, pulsed and color-flow Doppler capabilities as previously reported. 24 Left ventricular internal dimension, and septal and posterior wall thickness were measured at end-diastole and end-systole according to the American Society of Echocardiography recommendations. 25 Color-flow Doppler recordings were used to check for aortic and mitral regurgitation, as described previously.…”