P1683Optimal serum uric acid levels for hypertension: 5-year cohort study

Abstract Background Although hyperuricemia is known as a risk factor for hypertension, the optimal range of serum uric acid (SUA) for preventing hypertension has not been established, especially in a healthy population. Methods This is a 5-year cohort study to clarify the optimal SUA for hypertension. Subjects consisted of Japanese adults between 30 and 85 years of age were enrolled in the study at our Center for Preventive Medicine, and available at enrollment (2004) and at 5-year follow-up (2009). We excluded the study subjects who were hypertensive, diabetic, dyslipidemic, had a history of gout or hyperuricemia on medications, or if they had chronic kidney disease as estimated glomerular filtration rate <60 ml/min/1.73m2. Linear and logistic regression analyses were used to examine the relationship between each 1 mg/dL of serum uric acid range and development of hypertension with multiple adjustments for age, smoking, drinking habits, body mass index and baseline systolic blood pressure. Results Of 13,070 subjects enrolled at this step, we included 6,476 subjects (46.9±10.1 years old, 34.6% men) without comorbidities. The cumulative incidences of hypertension over 5 years were 5.9% in women and 12.1% in men. The lowest cumulative incidences of hypertension were 2.6% in 2.0–3.0 mg/dL of serum uric acid in women and 6.9% in 4.0–5.0 mg/dL in men. In contrast, the highest uric acid range showed highest cumulative incidence of hypertension both in women (28.6% in 8.0–9.0 mg/dL) and men (21.0% in ≥9.0 mg/dL). Hypouricemic (<2.0 mg/dL) subjects had higher cumulative incidences of hypertension than subjects with 2.0–3.0 mg/dL of serum uric acid levels, we excluded these subjects in multivariable logistic analysis. The odds ratio of 1 mg/dL increase of serum uric acid for developing hypertension was 1.395 (95% CI, 1.182–1.648) in women and 1.139 (95% CI, 1003–1.294) in men after multiple adjustments. Conclusion The optimal serum uric acid range for preventing hypertension was 2.0–3.0 mg/dL in women and 4.0–5.0 mg/dL in men. Higher uric acid levels increase cumulative incidence of hypertension. Acknowledgement/Funding None

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Abstract P146: Uric Acid is an Independent Risk Factor for Developing Hypertension From Prehypertension: A 5-year Japanese Cohort Study

Hypertension ◽

10.1161/hyp.70.suppl_1.p146 ◽

2017 ◽

Vol 70 (suppl_1) ◽

Author(s):

Masanari Kuwabara ◽

Shigeko Hara ◽

Koichiro Niwa ◽

Minoru Ohno ◽

Ichiro Hisatome

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Blood Pressure ◽

Body Mass Index ◽

Uric Acid ◽

Risk Factor ◽

Cohort Study ◽

Serum Uric Acid ◽

Independent Risk Factor ◽

Drinking Habits

Objectives: Prehypertension frequently progresses to hypertension and is associated with cardiovascular diseases, stroke, excess morbidity and mortality. However, the identical risk factors for developing hypertension from prehypertension are not clarified. This study is conducted to clarify the risks. Methods: We conducted a retrospective 5-year cohort study using the data from 3,584 prehypertensive Japanese adults (52.1±11.0 years, 2,081 men) in 2004 and reevaluated it 5 years later. We calculated the cumulative incidences of hypertension over 5 years, then, we detected the risk factors and calculated odds ratios (ORs) for developing hypertension by crude analysis and after adjustments for age, sex, body mass index, smoking and drinking habits, baseline systolic and diastolic blood pressure, pulse rate, diabetes mellitus, dyslipidemia, chronic kidney disease, and serum uric acid. We also evaluated whether serum uric acid (hyperuricemia) provided an independent risk for developing hypertension. Results: The cumulative incidence of hypertension from prehypertension over 5 years was 25.3%, but there were no significant differences between women and men (24.4% vs 26.0%, p=0.28). The cumulative incidence of hypertension in subjects with hyperuricemia (n=726) was significantly higher than those without hyperuricemia (n=2,858) (30.7% vs 24.0%, p<0.001). After multivariable adjustments, the risk factors for developing hypertension from prehypertension were age (OR per 1 year increased: 1.023; 95% CI, 1.015-1.032), women (OR versus men: 1.595; 95% CI, 1.269-2.005), higher body mass index (OR per 1 kg/m 2 increased: 1.051; 95% CI 1.021-1.081), higher baseline systolic blood pressure (OR per 1 mmHg increased: 1.072; 95% CI, 1.055-1.089) and diastolic blood pressure (OR per 1 mmHg increased: 1.085; 95% CI, 1.065-1.106), and higher serum uric acid (OR pre 1 mg/dL increased: 1.149; 95% CI, 1.066-1.238), but not smoking and drinking habits, diabetes mellitus, dyslipidemia, and chronic kidney diseases. Conclusions: Increased serum uric acid is an independent risk factor for developing hypertension from prehypertension. Intervention studies are needed to clarify whether the treatments for hyperuricemia in prehypertensive subjects are useful.

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The Optimal Range of Serum Uric Acid for Cardiometabolic Diseases: A 5-Year Japanese Cohort Study

Journal of Clinical Medicine ◽

10.3390/jcm9040942 ◽

2020 ◽

Vol 9 (4) ◽

pp. 942 ◽

Cited By ~ 7

Author(s):

Masanari Kuwabara ◽

Ichiro Hisatome ◽

Koichiro Niwa ◽

Petter Bjornstad ◽

Carlos A. Roncal-Jimenez ◽

...

Keyword(s):

Uric Acid ◽

Cohort Study ◽

Serum Uric Acid ◽

Protective Factor ◽

Serum Urate ◽

Healthy Population ◽

Optimal Range ◽

Lower Serum ◽

Cardiometabolic Diseases ◽

Japanese Cohort

The optimal range of serum uric acid (urate) associated with the lowest risk for developing cardiometabolic diseases is unknown in a generally healthy population. This 5-year cohort study is designed to identify the optimal range of serum urate. The data were collected from 13,070 Japanese between ages 30 and 85 at the baseline (2004) from the Center for Preventive Medicine, St. Luke’s International Hospital, Tokyo. We evaluated the number of subjects (and prevalence) of those free of the following conditions: hypertension, diabetes, dyslipidemia, and chronic kidney disease (CKD) over 5 years for each 1 mg/dL of serum urate stratified by sex. Furthermore, the odds ratios (ORs) for remaining free of these conditions were calculated with multiple adjustments. Except for truly hypouricemic subjects, having lower serum urate was an independent factor for predicting the absence of hypertension, dyslipidemia, and CKD, but not diabetes. The OR of each 1 mg/dL serum urate decrease as a protective factor for hypertension, dyslipidemia, and CKD was 1.153 (95% confidence interval, 1.068–1.245), 1.164 (1.077–1.258), and 1.226 (1.152–1.306) in men; 1.306 (1.169–1.459), 1.121 (1.022–1.230), and 1.424 (1.311–1.547) in women, respectively. Moreover, comparing serum urate of 3–5 mg/dL in men and 2–4 mg/dL in women, hypouricemia could be a higher risk for developing hypertension (OR: 4.532; 0.943–21.78) and CKD (OR: 4.052; 1.181–13.90) in women, but not in men. The optimal serum urate range associated with the lowest development of cardiometabolic diseases was less than 5 mg/dL for men and 2–4 mg/dL for women, respectively.

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Serum uric acid control for prevention of gout flare in patients with asymptomatic hyperuricaemia: a retrospective cohort study of health insurance claims and medical check-up data in Japan

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-220439 ◽

2021 ◽

pp. annrheumdis-2021-220439

Author(s):

Ruriko Koto ◽

Akihiro Nakajima ◽

Hideki Horiuchi ◽

Hisashi Yamanaka

Keyword(s):

Uric Acid ◽

Cohort Study ◽

Health Insurance ◽

Serum Uric Acid ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Disease Status ◽

Insurance Claims ◽

Health Insurance Claims ◽

Gout Flare

ObjectivesIn patients with gout, treating to target serum uric acid levels (sUA) of ≤6.0 mg/dL is universally recommended to prevent gout flare. However, there is no consensus on asymptomatic hyperuricaemia. Using Japanese health insurance claims data, we explored potential benefits of sUA control for preventing gout flare in subjects with asymptomatic hyperuricaemia.MethodsThis retrospective cohort study analysed the JMDC Claims Database from April 2012 through June 2019. Subjects with sUA ≥8.0 mg/dL were identified, and disease status (prescriptions for urate-lowering therapy (ULT), occurrence of gout flare, sUA) was investigated for 1 year. Time to first onset and incidence rate of gout flare were determined by disease status subgroups for 2 years or more. The relationship between gout flare and sUA control was assessed using multivariable analysis.ResultsThe analysis population was 19 261 subjects who met eligibility criteria. We found fewer occurrences of gout flare, for both gout and asymptomatic hyperuricaemia, in patients who achieved sUA ≤6.0 mg/dL with ULT than in patients whose sUA remained >6.0 mg/dL or who were not receiving ULT. In particular, analysis by a Cox proportional-hazard model for time to first gout flare indicated that the HR was lowest, at 0.45 (95% CI 0.27 to 0.76), in subjects with asymptomatic hyperuricaemia on ULT (5.0<sUA ≤ 6.0 mg/dL), compared with untreated subjects (sUA ≥8.0 mg/dL).ConclusionsOccurrences of gout flare were reduced by controlling sUA at ≤6.0 mg/dL in subjects with asymptomatic hyperuricaemia as well as in those with gout.Trial registration numberUMIN000039985.

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MO427SAFE USE OF ALLOPURINOL TO TREAT ACUTE URIC ACID NEPHROPATHY IN PREGNANCY: A CASE REPORT

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab083.0019 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Fahd Khan ◽

Aizaz Ali ◽

Jamie Willows ◽

Didem Tez

Keyword(s):

Uric Acid ◽

Case Report ◽

Serum Creatinine ◽

Serum Uric Acid ◽

Renal Tubules ◽

Normal Range ◽

History Of ◽

Uric Acid Nephropathy ◽

Acute Uric Acid Nephropathy ◽

In Pregnancy

Abstract Introduction Acute uric acid nephropathy (UAN) is characterized by acute kidney injury (AKI) due to uric acid crystal precipitation within the distal tubules and collecting ducts. We present a young woman, with a history of hyperuricaemia, who was treated with allopurinol for acute UAN during her first pregnancy. She also continued allopurinol treatment during her second pregnancy for prevention of further acute UAN. To the author’s knowledge, this is the first case report of biopsy-confirmed acute UAN during pregnancy. Case report A 20 year old woman, who was 13 weeks pregnant, was admitted with AKI. Past medical history included chronic kidney disease (CKD) and gout since the age of 17. She had an extensive family history of CKD and gout (without diagnosis, despite genetic testing). She had been on daily allopurinol 300mg, but this was stopped 8 weeks prior by her rheumatology team due to concerns about teratogenicity. At that time serum creatinine was at her baseline of 100 μmol/L (normal range 50-120 μmol/L) and serum uric acid had been 740 μmol/L (normal range 140-360 μmol/L). On admission, she felt well and was euvolemic. Serum creatinine was now 352 μmol/L and her serum uric acid level was 1720 μmol/L, with an elevated urine uric acid to creatinine ratio of 1.1. She underwent renal biopsy, which showed significant deposition of uric acid crystals in the renal tubules, confirming a diagnosis of acute UAN. She was given intravenous fluids. The uncertainties of allopurinol use in pregnancy were discussed with her, and she was restarted on allopurinol 200 mg daily. Over the next 3 weeks, serum uric acid decreased to 470 μmol/L and serum creatinine to 116 μmol/L. She was maintained on allopurinol during her pregnancy and delivered a healthy baby girl. She was advised against further pregnancies due to increased risk of maternal and fetal complications. However, three years later she presented at 15 weeks’ gestation. After a discussion regarding the potential teratogenic effects of allopurinol versus the risk of recurrent severe AKI due to acute UAN if it was again discontinued, she chose to continue allopurinol. The pregnancy proceeded without complication. Her daughters are now 8 and 5 years old. They do not have any congenital malformations, though both have mild to moderate learning difficulties. Discussion Allopurinol is approved for the treatment of hyperuricaemia outside of pregnancy, but given it interrupts purine synthesis there is a biologically plausible concern regarding teratogenicity. However, in our patient with long-standing hyperuricaemia it was the discontinuation of allopurinol that precipitated AKI due to the resultant crystal formation when serum uric acid reached very high levels. Biopsy confirmation of acute UAN was vital in this case, given the possibility of missing an alternative diagnosis and the risks of giving empirical allopurinol therapy. Once the diagnosis for her severe AKI was confirmed, it was clear our patient would benefit from uric acid lowering therapy. Our patient had two healthy girls despite using allopurinol from week 16 in her first pregnancy and throughout her second pregnancy. Unfortunately, both girls have mild to moderate learning needs, though it is unprovable whether allopurinol was causative as no study has followed up long term outcomes after foetal exposure during pregnancy.

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Changes in serum uric acid levels after allogeneic hematologic stem cell transplantation: A retrospective cohort study

Blood Research ◽

10.5045/br.2016.51.3.200 ◽

2016 ◽

Vol 51 (3) ◽

pp. 200 ◽

Cited By ~ 1

Author(s):

Sang Hyun Joo ◽

Jin Kyun Park ◽

Eunyoung Emily Lee ◽

Yeong Wook Song ◽

Sung-Soo Yoon

Keyword(s):

Uric Acid ◽

Cohort Study ◽

Stem Cell ◽

Stem Cell Transplantation ◽

Cell Transplantation ◽

Serum Uric Acid ◽

Retrospective Cohort Study ◽

Retrospective Cohort

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Serum Uric Acid as a Prognostic Factor of Acute Myocardial Infarction in Hospitalized Patients

TAJ Journal of Teachers Association ◽

10.3329/taj.v34i1.54902 ◽

2021 ◽

Vol 34 (1) ◽

pp. 26-32

Author(s):

Md Amzad Hossain Sardar ◽

Md Khalilur Rahman ◽

Md Mahidul Alam ◽

Md Aminul Hasan ◽

Ashoke Sarker ◽

...

Keyword(s):

Risk Factors ◽

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Uric Acid ◽

Family History ◽

Serum Uric Acid ◽

Acid Level ◽

Serum Uric Acid Level ◽

High Serum ◽

History Of

Background: Among non-communicable diseases, acute myocardial infarction (AMI) is a common killer of people in the world. The management of AMI patients is one of the major challenges in the field of cardiology. Uric acid has several effects of potential interest in cardiovascular disease. There are some markers indicating an unfavorable prognosis in AMI patients. Uric acid is one of the markers that have been evaluated in research. Objective: The aim of this study was to assess the association between serum uric acid level and in-hospital outcomes of AMI patients. Patients and methods: This longitudinal descriptive study was conducted over 115 AMI patients in the Cardiology Unit of Rajshahi Medical College Hospital during the period of January 2015 to December 2016. Baseline characteristics such as age, sex, BMI, BP, RBS, risk factors (hypertension, DM, smoking, family history of IHD, dyslipidemia), and outcomes of AMI patients (acute LVF, arrhythmia, conduction block, cardiogenic shock, death) were recorded. We measured the serum uric acid of this patient at admission. Results: The mean age of patients was 52.83±10.71 years. Out of 115 patients, 83.5% were male, and 16.5% were female. Among the risk factors, 65.2% of patients had HTN, 20.9% DM, 64.3% smoking, 16.5% family history of IHD, and 47.8% dyslipidemia. Out of 115, 35.7% of patients demonstrated high serum uric acid. In outcomes of AMI patients, acute LVF 24.4% (p=0.031) and death 12.2% (p=0.041) were significantly higher in patients with high serum uric acid levels. Conclusion: Significant association was found between high serum uric acid level and in-hospital outcomes of AMI patients. So, estimation of serum uric acid may offer an inexpensive, quick, and non-invasive method for identifying such high-risk patients. TAJ 2021; 34: No-1: 26-32

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Evaluating serum uric acid levels in patients with acute myocardial infarction

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20203124 ◽

2020 ◽

Vol 7 (8) ◽

pp. 1256

Author(s):

Piyush Gosar ◽

Ajay Pal Singh ◽

Pravi Gosar ◽

Bhawana Rani

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Uric Acid ◽

Serum Uric Acid ◽

Uric Acid Level ◽

Acid Level ◽

Serum Uric Acid Level ◽

Control Group ◽

Cardiovascular Morbidity And Mortality ◽

History Of

Background: Elevated levels of serum uric acid are associated with increased cardiovascular morbidity and mortality. However, this association with cardiovascular diseases is still unclear, and perhaps controversial. The objective of study was to assess the serum uric acid level in patients with Acute Myocardial Infarction (AMI).Methods: Sixty patients with AMI were studied in Department of Medicine/ Department of Cardiology, J.A. Group of Hospitals between 2016 -2018.Details of age, sex, smoking, alcohol consumption and history of ischemic heart disease (IHD) was obtained and recorded. Serum uric acid level was estimated and compared with control group (healthy subjects).Results: Serum uric acid level was significantly higher among AMI patients (6.43±2.60) as compared to control group (4.05±0.95) (p<0.001). Majority (46.7%) of the AMI patients had uric acid level of >7.1 followed by 20% patients who had uric acid level between 4.5-5.9 (p<0.001). Uric acid level was comparable between smoker and non-smokers (p=0.803), alcoholic and non-alcoholic (p=0.086), hypertensive and non-hypertensive (p=0.668), patients with and without diabetes (p=0.278) and patients with a history of IHD and without history of IHD (p=0.403).Conclusions: Serum uric acid may be useful for prognostication among those with pre-existing AMI.

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Serum Uric Acid Levels and Their Changes and Risk of Stroke: A 7-Year Prospective Cohort Study in Northwest China

Cerebrovascular Diseases ◽

10.1159/000519142 ◽

2021 ◽

pp. 1-10

Author(s):

Shan Zheng ◽

Yan Luo ◽

Qian Miao ◽

Zhiyuan Cheng ◽

Yanli Liu ◽

...

Keyword(s):

Uric Acid ◽

Cohort Study ◽

Serum Uric Acid ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Reference Group ◽

Northwest China ◽

Stroke Incidence ◽

Increased Risk ◽

Over Time

Introduction: It is not clear whether serum uric acid (SUA) levels and their changes over time are associated with the risk of stroke. A 7-year prospective cohort study in northwest China was conducted to analyze effects of SUA and their changes on the risk of stroke. Methods: A total of 23,262 individuals without cardiovascular disease in the Jinchang cohort were followed up for an average of 5.26 years. The Cox proportional hazard model was used to estimate the hazard ratios (HRs) and 95% confidence interval (95% CI) of stroke incidence to SUA and relative changes in SUA. Sensitivity analysis was performed after controlling the effect of renal insufficiency. Results: Baseline SUA and relative changes in SUA were positively correlated with the incidence of stroke in both males and females (p for overall association <0.0001). Stroke risk increased by 4.6% per 10% increase in the relative change of SUA (HR = 1.046, 95% CI, 1.007–1.086). The fully adjusted regression analysis demonstrated that only the large gain (>30%) in SUA was associated with an increased risk of stroke by 36.5% (95% CI, 1.8–83.0%), compared with the reference group (participants within ±10% changes in SUA). The same trend was observed in people with normal baseline SUA. In the unadjusted model, the risk of stroke associated with elevated SUA was significantly higher in the hyperuricemia group than in the normal SUA group. Conclusion: High initial SUA concentration and an increase in SUA concentration over time would increase the risk of stroke, and this means that there is no safe increase in SUA.

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