uric acid – ABC CARDIOL

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Letter to the Editor

The Relationship between Uric Acid/Albumin Ratio and Carotid Intima-Media Thickness in Patients with Hypertension

Cristian Rodrigues do Nascimento et al. João Luis Matos Ribeiro Rodrigo Mendes Romero Henrique de Almeida Barbosa … Johnnatas Mikael Lopes Pedro Pereira Tenório

To the Editor,

We carefully read the article entitled: “The relationship between the uric acid/albumin ratio and the carotid intima-media thickness in patients with hypertension“, whose objective was to investigate the association of the uric acid/albumin ratio (UAR) and carotid intima-media thickness (CIMT) in hypertensive patients. Although the present study demonstrated a significant correlation between UAR and CIMT, with UAR showing greater discriminatory capacity for increased CIMT values than uric acid and albumin alone and than the other inflammatory markers analyzed in the study, such as the systemic immune inflammation index (III), the neutrophil/lymphocyte ratio (NLR), the platelet/lymphocyte ratio (PLR) and the C-reactive protein/albumin ratio (CAR), some aspects observed, when reading the article, are worthy of note.

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Original Article

The Relationship between Uric Acid/Albumin Ratio and Carotid Intima-Media Thickness in Patients with Hypertension

Faysal Şaylık et al. Tufan Çınar Murat Selçuk İbrahim Halil Tanboğa

Abstract

Background

Hypertension causes subendothelial inflammation and dysfunction in resulting atherosclerosis. Carotid intima-media thickness (CIMT) is a useful marker of endothelial dysfunction and atherosclerosis. The uric acid to albumin ratio (UAR) has emerged as a novel marker for predicting cardiovascular events.

Objective

We aimed to investigate the association of UAR with CIMT in hypertensive patients.

Methods

Two hundred sixteen consecutive hypertensive patients were enrolled in this prospective study. All patients underwent carotid ultrasonography to classify low (CIMT < 0.9 mm) and high (CIMT ≥ 0.9 mm) CIMT groups. The predictive ability of UAR for high CIMT was compared with systemic immune inflammation index (SII), neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and C-reactive protein/albumin ratio (CAR). A two-sided p-value <0.05 was accepted as statistically significant.

Results

Patients with high CIMT were older and had higher UAR, SII, NLR, and CAR than low CIMT. Age, UAR, SII, NLR, and CAR, but not PLR, were associated with high CIMT. In multivariable analysis, age, CRP, SII, and UAR were independent predictors of high CIMT. The discrimination ability of UAR was higher than uric acid, albumin, SII, NLR, and CAR, and UAR had a higher model fit than those variables. UAR had higher additive improvement in detecting high CIMT than other variables, as assessed with net-reclassification improvement, IDI, and C-statistics. UAR was also significantly correlated with CIMT.

Conclusion

UAR might be used to predict high CIMT and might be useful for risk stratification in hypertensive patients.

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Original Article

Arterial Hypertension and Serum Uric Acid in Elderly- SEPHAR III Study

Roxana Buzas et al. Vlad-Sabin Ivan Oana-Florentina Gheorghe-Fronea Adina Flavia Morgovan … Melania Ardelean Nicolae Albulescu Maria Dorobantu Daniel Florin Lighezan

Abstract

Background:

Hyperuricemia is a frequent finding in patients with arterial hypertension, and there is increasing evidence that this entity is also a risk factor for cardiovascular disease.

Objective:

In the context of an aging population, this study aims to evaluate serum uric acid levels and arterial hypertension prevalence and control in a subgroup of Romanian adults (>65 years), concerning the influence of age on these parameters.

Method:

The study sample consists of 1,920 adults included in SEPHAR III survey, of whom 447 were elderly patients (>65 years of age). During the two study visits, three blood pressure (BP) measurements were performed at 1-min intervals and serum uric acid levels, kidney function by estimated glomerular filtration rate, blood pressure, and intima media thickness measurements were conducted. Hypertension and controls were defined according to the current guidelines. Intima-media thickness evaluation was assessed by B-mode Doppler ultrasound evaluation. A significance level p < 0.05 was adopted for the statistical analysis.

Results:

Adult patients had a significant lower serum uric acid levels, compared to elderly patients, regardless of glomerular filtration rate levels. Adult patients showed a significantly lower intima-media thickness levels, when compared to elderly patients.

Conclusion:

Similar to previous studies, in the present study, age represented one of the factors contributing to the increased level of serum uric acid. An increasing prevalence of arterial hypertension with age, together with a poor control of blood pressure, was also obtained.

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Original Article

Impact of Serum Uric Acid Concentration on the Risk of Cardiovascular Disease: A Cohort Study Conducted in Northern China

Qian Nie et al. Xuemei Zhang Zhihua Hao Liqin Wang … Huanxin Liu Chenghao Liu Zhongli Wang Guangyao Song

Abstract

Background

The results of previous studies of the relationship between serum uric acid (SUA) and the risk of cardiovascular disease (CVD) have been inconsistent due to confounding factors caused by other known cardiovascular risk factors.

Objectives

This study aimed to evaluate the relationship between SUA and incident CVD in middle-aged and elderly Chinese people, who were stratified according to body mass index (BMI).

Methods

This study recruited 5,721 participants of 40–75 years of age, who were free of CVD at baseline and who underwent follow-up from 2008 to 2017. Participants were categorized in SUA quintiles. Cox proportional hazard and Kaplan-Meier survival analysis were used to compare CVD incidence among the SUA groups. The correlations between SUA and CVD incidence in groups with differing BMI and waist circumference (WC) were also analyzed. A P value <0.05 was considered statistically significant.

Results

During a mean follow-up period of 7.6 years, CVD incidence increased with SUA (log-rank test p<0. 001). Compared with the first quintile, the adjusted hazard ratios (95% confidence interval (CI)) for the development of CVD were 1.08 (0.78–1.65), 1.17 (0.88–1.77), 1.47 (1.12–2.21), and 1.68 (1.28–2.44) for the second to fifth quintiles, respectively. This relationship was clearer in participants with normal BMI and WC. The adjusted hazard ratio for each 100 μmol/L increase in SUA was 1.13 (95% CI: 1.02–1.39) for CVD events.

Conclusions

High SUA is an independent risk factor for CVD in middle-aged and elderly northern Chinese people. This effect is maintained even after stratification according to measures of leanness/obesity.

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Original Article

Association between Serum Uric Acid and Pre-hypertension and Hypertension among Chinese Adults

Lijun Zhu et al. Xiaoyu Zhang Zhengmei Fang Yuelong Jin … Weiwei Chang Yan Chen Yingshui Yao

Abstract

Background

Uric acid (UA), the end product of purine nucleotide metabolism, participates in the processes of metabolic and cardiovascular diseases. Experimental evidence suggests it is an important mediator in the physiological response to blood pressure increase.

Objective

To evaluate the association between serum UA levels and pre-hypertension and hypertension in a Chinese population.

Methods

A cross-sectional study was conducted from March to September 2017, and 1,138 participants aged 35 to 75 were enrolled in this study, where 223 normotensive, 316 pre-hypertensive, and 599 hypertensive subjects were selected to evaluate the association between serum UA levels and hypertension. A p-value <0.05 was considered statistically significant.

Results

Serum UA levels were significantly higher in the pre-hypertension and hypertension group compared to the control group in the entire population (p<0.05 for all). Quantitative trait analysis indicated that serum UA levels were (2.92±0.81, 3.06±0.85, 3.22±0.98 mg/d) linearly increased in normotensive, pre-hypertensive and hypertensive females, with a p value of 0.008. Serum UA levels in the quartiles were positively correlated with DBP (p<0.05), particularly in females. After adjusting for age, gender, body mass index (BMI), glucose (GLU), total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-c), the odds ratios (ORs) and 95% confidence intervals (CIs) of pre-hypertension from the lowest (referent) to the highest levels of serum UA were 1.718 (1.028–2.872), 1.018 (0.627–1.654) and 1.738 (1.003–3.010). Additionally, the second quartile of serum UA levels were significantly associated with hypertension, with an OR (95% CI) of 2.036 (1.256–3.298).

Conclusions

This study suggests that higher serum UA levels are positively associated with pre-hypertension and hypertension among Chinese adults.

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Editorial

Still Trying to Understand the Role of Uric Acid in Cardiovascular Diseases

Gilson Soares Feitosa

In this issue of Arquivos Brasileiros de Cardiologia , Zhu et al. report an association between uric acid and the presence of pre-hypertension or hypertension in a cross-sectional study done in a population in North China, bringing about, once more, a possible role of uric acid in the determination of cardiovascular disease. In the study, the authors call our attention to the possibility of a relationship even though the measured uric acid serum level is relatively low as compared to what is referred to as normal in several Western populations, which presents a cutoff value of ≥7.0 mg/dL for men and ≥6.3 mg/dL for women in the United States and also so considered, a cutoff value of ≥7.0 mg/dL for men and ≥ 6.0 mg/dL for women in a Brazilian population of healthy individuals aged 20 to 55, in Rio de Janeiro, whereas in their the cut off values were ≥4.75 mg/dL and ≥4.04 mg/dL for men and women, respectively.

In workers from the Company of Generation and Distribution of Energy in Rio de Janeiro, Brazil, from both sexes, aged predominantly between 50 and 59, the mean uric acid level was 4.7±1.3 mg/dL.

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Original Article

Are Body Fat and Uric Acid associated with Cardiovascular Risk Scores? Cross-Sectional Analysis in the PROCARDIO-UFV Trial

Juliane Soares Rodrigues et al. Alinne Paula de Almeida Carla de Oliveira Barbosa Rosa Helen Hermana Miranda Hermsdorff

Abstract

Background:

Risk scores are tools used to indicate the probability of occurrence of a certain cardiovascular event and to previously identify individuals at low, medium, and high risk for the development of cardiovascular diseases.

Objective:

To establish the cardiovascular risk of users of a cardiovascular health attention program of a university, and assess its association with lifestyle, clinical, sociodemographic data, and other cardiometabolic risk markers.

Methods:

Cross-sectional study with a sample of 197 participants. Demographic, anthropometric, clinical, and metabolic data, eating habits and lifestyle information were collected using the Global Risk Score and the Framingham Risk Score. P-value < 0,05 was considered statistically significant.

Results:

According to the Framingham Risk Score, 84% of the assessed population was considered low risk and 16% as intermediate/high risk. However, according to the Global Risk Score, 18% of the participants were low risk, 45% were intermediate risk and 37% were high risk for infarction or death from coronary heart disease in 10 years.

Maria do Rosário Gondim Peixoto et al. Estelamaris Tronco Monego Paulo César B. Veiga Jardim Magna Maria Carvalho … Ana Luiza Lima Sousa Jonivan Siqueira de Oliveira Otavio Balestra Neto

OBJECTIVE: To evaluate the effects of diet and medication, either isolated or associated, on serum levels of uric acid in patients with hyperuricemia. METHODS: We studied patients from the Hypertension Unit of the University of Goias who had hyperuricemia (men > or = 8.5mg/dL and women > or = 7.5mg/dL). We divided the patients into three groups: G1 (low purine diet), G2 (low purine diet + medication), and G3 (medication only). Patients received allopurinol, 150mg/day titrated up to 300mg/dL when necessary. Patients were evaluated with regards to their lifestyles (diet, smoking, physical, activity, alcohol consumption), uric acid, blood pressure, use of medication, body mass index, cholesterol, and triglyceride. Follow-up took place in weeks 0 (M1), 6 (M2), 12 (M3) during the intervention and in week 36(M4) after the study was completed. RESULTS: Fifty-five patients participated in the study, 31 women, mean age 54.4±10.6 years, body mass index 28.6±3.9kg/m². A similar reduction (p<0.001) in uric acid levels occurred in the three intervention groups. In week 36 (M4), after 24 weeks without intervention, a tendency toward elevation of uricemia was noted in G2 and G3, and a continuous drop in uricemia was noted in G1. No significant modifications were observed in the other variables analyzed. CONCLUSION: Considering the cost x benefit relationship, a diet low in purine should be the 1st therapeutic option for controlling hyperuricemia in patients with similar characteristic to the ones presented in this study.

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