Arq Bras CardiolabcArquivos Brasileiros de CardiologiaArq. Bras. Cardiol.0066-782X1678-4170Sociedade Brasileira de Cardiologia - SBC7xzqktzTXMY9Y5CTFynRLcrS0066-782X2021000701079abc.2021039010.36660/abc.20210390MinieditorialAinda Procurando Entender o Papel do Ácido Úrico em Doenças Cardiovasculares0000-0003-4122-0264FeitosaGilson Soares12Escola Bahiana de MedicinaSalvadorBABrazil Escola Bahiana de Medicina , Salvador , BA - Brazil Hospital Santa IzabelSanta Casa da BahiaSalvadorBABrazil Hospital Santa Izabel da Santa Casa da Bahia , Salvador , BA - Brazil Correspondência: Gilson Soares Feitosa • Hospital Santa Izabel - Rua Florida, 211/302. CEP 40050-410, Salvador, BA - Brasil E-mail: gfeitosa@cardiol.br , gilson-feitosa@uol.com.br14062021062021116610791079This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Doenças CardiovascularesÁcido ÚricoHiperuricemiaEstresse OxidativoObesidadeEndotélioFatores de Risco
Neste número dos Arquivos Brasileiros de Cardiologia, Zhu et al. 1 relatam, em estudo transversal, em uma população do norte da China, uma associação entre o nível sérico de ácido úrico e a presença de pré-hipertensão e hipertensão arterial, trazendo à tona, mais uma vez, um possível papel a ser melhor conhecido do ácido úrico na determinação de doenças cardiovasculares. No caso do presente estudo, chama a atenção que essa associação foi vista mesmo que com taxas bem reduzidas para os padrões de valores normais reconhecidos no Ocidente, que são ≥7,0mg/dL (para homens) e ≥6,3mg/dL (para mulheres), 2 enquanto os valores de referência como taxas elevadas no presente estudo foram de ≥4,75mg/dL (para homens) e ≥4,04mg/dL (para mulheres).
No Rio de Janeiro, em trabalhadores de ambos os sexos e com faixa etária predominante entre 50 e 59 anos, da Companhia de Geração e Distribuição de Energia no Rio de Janeiro, 3 a taxa média observada de ácido úrico foi de 4,7 ± 1,3mg/dL. 4
Já no estudo transversal PROCARDIO-UFV, também no Brasil, as médias foram de 4,4 ± 1,6mg/dL e de 5,4 ± 1,4mg/dL, quer se tratasse de indivíduo de baixo ou intermediário risco de Framingham, respectivamente. 5
Estudos dessa natureza realizados na Ásia demonstram valores mais reduzidos de apresentação da taxa de ácido úrico, seja por questões alimentares ou mesmo de origem genética. 6 - 8
O fato é que níveis séricos de AU (mg/dL) no grupo pré-hipertensão (3,5±1,1) e hipertensão (3,4±1,1) em comparação com o grupo controle (3,2±1,0) foram significativamente maiores no grupo de pré-hipertensos e hipertensos, a despeito do ajuste feito para fatores como idade, sexo, IMC, glicemia, e taxas lipídicas.
Uma questão que se levanta é se, diante do minúsculo grau de diferença entre os valores, concorreria tal achado para possíveis conjecturas de disfunção endotelial, como causa de doença cardiovascular nesses indivíduos. 9 - 11
Além disso, há potencial benefício do conhecimento para alguma ação terapêutica a ser oferecida.
Referências1. Zhu L, Zhang X, Fang Z, Jin Y, Chang W, Chen Y, Yao Y. Association between Serum Uric Acid and Pre-hypertension and Hypertension among Chinese Adults. Arq Bras Cardiol. 2021; 116(6):1072-1078.ZhuLZhangXFangZJinYChangWChenYYaoYAssociation between Serum Uric Acid and Pre-hypertension and Hypertension among Chinese AdultsArq Bras Cardiol20211166107210782. Pandya Z CH. Prevalence of gout and hyperuricemia in the US. Arthritis & Rheumatism . 2011;63(10):3136–.41.PandyaZ CHPrevalence of gout and hyperuricemia in the USArthritis & Rheumatism2011631031363.413. Ferreira TS FJ, Araujo LS, Araujo L, Nogueira LP, Leal PM, Antunes I, Rodriges MLG. Serum Uric Acid Levels are Associated with Cardiometabolic Risk Factors in Healthy Young and Middle-Aged Adults. Arq Bras Cardiol . 2018;111(6):833-40.FerreiraTS FJAraujoLSAraujoLNogueiraLPLealPMAntunesIRodrigesMLGSerum Uric Acid Levels are Associated with Cardiometabolic Risk Factors in Healthy Young and Middle-Aged AdultsArq Bras Cardiol201811168338404. Chini LSNG, Suzana; Lugon, Jocemir Ronaldo. Prevalence of metabolic syndrome among workers from the Company of Generation and Distribution of Energy in Rio de Janeiro, Brazil. Cad Saúde Coletiva . 2014;22:359-64.ChiniLSNSuzanaGLugonJocemir RonaldoPrevalence of metabolic syndrome among workers from the Company of Generation and Distribution of Energy in Rio de Janeiro, BrazilCad Saúde Coletiva2014223593645. Rodrigues JA, AP; Barbosa, COR; Hermsdorff, HHM Are Body Fat and Uric Acid associated with Cardiovascular Risk Scores? Cross-Sectional Analysis in the PROCARDIO-UFV Trial. Int J cardiovasc Sci. 2017;30(4):313-24.RodriguesJAAPBarbosaCORHermsdorffHHMAre Body Fat and Uric Acid associated with Cardiovascular Risk Scores? Cross-Sectional Analysis in the PROCARDIO-UFV TrialInt J cardiovasc Sci20173043133246. Zhang MI GY, 2 Wang, X1 Chang H, Huang G. Serum uric acid and appropriate cutoff value for prediction of metabolic syndrome among Chinese adults. J Clin Biochem Nutr . 2013;52(1):38-42.ZhangMIGY2WangX1ChangHHuangGSerum uric acid and appropriate cutoff value for prediction of metabolic syndrome among Chinese adultsJ Clin Biochem Nutr201352138427. Liu PW CT, Chen JD. Serum uric acid and metabolic syndrome in Taiwanese adults. Metabolism . 2010;59(6):802–7.LiuPW CTChenJDSerum uric acid and metabolic syndrome in Taiwanese adultsMetabolism20105968028078. Hara S TH, Ohmoto Y, Amakawa K, Hsieh SD, Arase Y, Nakajima H.High serum uric acid level and low urine pH as predictors of metabolic syndrome: a retrospective cohort study in a Japanese urban population. Metabolism . 2012;61(2):281–8.HaraS THOhmotoYAmakawaKHsiehSDAraseYNakajimaHHigh serum uric acid level and low urine pH as predictors of metabolic syndrome: a retrospective cohort study in a Japanese urban populationMetabolism20126122812889. Sánchez-Lozada LG LM, Cristóbal-García M, García-Arroyo F, Soto V C-RD, Nakagawa T, Yu MA, Kang DH and Johnson RJ. Uric acidinduced endothelial dysfunction is associated with mitochondrial alterations and decreased intracellular ATP concentrations. Nephron Exp Nephrol . 2012;121(3-4):e71-e78.Sánchez-LozadaLGLMCristóbal-GarcíaMGarcía-ArroyoFSotoVC-RDNakagawaTYuMAKangDHJohnsonRJUric acidinduced endothelial dysfunction is associated with mitochondrial alterations and decreased intracellular ATP concentrationsNephron Exp Nephrol20121213-4e71e7810. Zhang YT, Hisatome I, Li Y, Cheng W, Sun N, Cai B, Huang T, et al. Uric acid induces oxidative stress and growth inhibition by activating adenosine monophosphate-activated protein kinase and extracellular signal-regulated kinase signal pathways in pancreatic β cells. Mol Cell Endocrinol . 2013;375(1-2):89-96.ZhangYTHisatomeILiYChengWSunNCaiBHuangTet alUric acid induces oxidative stress and growth inhibition by activating adenosine monophosphate-activated protein kinase and extracellular signal-regulated kinase signal pathways in pancreatic β cellsMol Cell Endocrinol20133751-2899611. Kanbay M SM, Afsar B, Kang DH, Rodriguez-Iturbe B and Johnson RJ:. The role of uric acid in the pathogenesis of human cardiovascular disease. Heart . 2013;99(11):759-66KanbayM SMAfsarBKangDHRodriguez-IturbeBJohnsonRJThe role of uric acid in the pathogenesis of human cardiovascular diseaseHeart20139911759766
Minieditorial referente ao artigo: Associação entre Ácido Úrico Sérico e Pré-Hipertensão e Hipertensão entre Adultos Chineses
Short EditorialStill Trying to Understand the Role of Uric Acid in Cardiovascular Diseases0000-0003-4122-0264FeitosaGilson Soares12BrazilEscola Bahiana de Medicina, Salvador, BA - BrazilBrazilHospital Santa Izabel da Santa Casa da Bahia, Salvador, BA - BrazilMailing Address: Gilson Soares Feitosa • Hospital Santa Izabel - Rua Florida, 211/302. Postal Code 40050-410, Salvador, BA – Brazil E-mail: gfeitosa@cardiol.br, gilson-feitosa@uol.com.brCardiovascular DiseasesUric AcidHyperurisemiaOxidative StressObesityEndotheliumRisk Factors
In this issue of Arquivos Brasileiros de Cardiologia , Zhu et al.1 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 women2 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,3 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.4
In another study in Brazil, in a cross-sectional study named PROCARDIO-UFV, the mean serum uric acid levels were 4.4±1.6 mg/dL and 5.4±1.4 mg/dL in low and intermediate Framingham risk score, respectively.5
Similar studies that come from Asia display lesser uric acid values in the general population, and eating habits or genetic factors are speculated as its cause.6 - 8
In the study the values of 3.5±1.1 mg/dL in pre-hypertensives and 3.4±1.1 mg/dL in hypertensives were significantly higher than 3.2±1.0 mg/dL in the control group, regardless of the adjustments made for confounding factors such as age, sex, body mass index, glucose, and lipid levels.
A question that arises is whether such a minuscule difference of values would justify the conjectured changes in endothelial function as a cause of cardiovascular disease in such individuals,9 - 11 in addition to its potential therapeutic target.
Short Editorial related to the article: Association between Serum Uric Acid and Pre-hypertension and Hypertension among Chinese Adults