Hyperuricemia and Hypertension, Coronary Artery Disease, Kidney Disease: From Concept to Practice

Since the publication of the Framingham Heart Study, which suggested that uric acid should no longer be associated with coronary heart disease after additional adjustment for cardiovascular disease risk factors, the number of publications challenging this statement has dramatically increased. The aim of this paper was to review and discuss the most recent studies addressing the possible relation between sustained elevated serum uric acid levels and the onset or worsening of cardiovascular and renal diseases. Original studies involving American teenagers clearly showed that serum uric acid levels were directly correlated with systolic and diastolic pressures, which has been confirmed in adult cohorts revealing a 2.21-fold increased risk of hypertension. Several studies involving patients with coronary artery disease support a role for serum uric acid level as a marker and/or predictor for future cardiovascular mortality and long-term adverse events in patients with coronary artery disease. Retrospective analyses have shown an inverse relationship between serum uric acid levels and renal function, and even a mild hyperuricemia has been shown to be associated with chronic kidney disease in patients with type 2 diabetes. Interventional studies, although of small size, showed that uric acid (UA)-lowering therapies induced a reduction of blood pressure in teenagers and a protective effect on renal function. Taken together, these studies support a role for high serum uric acid levels (>6 mg/dL or 60 mg/L) in hypertension-associated morbidities and should bring awareness to physicians with regards to patients with chronic hyperuricemia.

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Correlation Between Serum Uric Acid and Renal Function in Patients With Stable Coronary Artery Disease and Type 2 Diabetes

Journal of Clinical Medicine Research ◽

10.14740/jocmr1909w ◽

2014 ◽

Author(s):

Chen

Keyword(s):

Type 2 Diabetes ◽

Coronary Artery Disease ◽

Renal Function ◽

Uric Acid ◽

Coronary Artery ◽

Serum Uric Acid ◽

Stable Coronary Artery Disease ◽

Artery Disease

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Elevated serum uric acid and risk of cardiovascular or all-cause mortality in people with suspected or definite coronary artery disease: A meta-analysis

Atherosclerosis ◽

10.1016/j.atherosclerosis.2016.10.006 ◽

2016 ◽

Vol 254 ◽

pp. 193-199 ◽

Cited By ~ 36

Author(s):

Ruijuan Wang ◽

Youxin Song ◽

Yaqi Yan ◽

Zhenjiang Ding

Keyword(s):

Coronary Artery Disease ◽

Uric Acid ◽

Coronary Artery ◽

Serum Uric Acid ◽

Meta Analysis ◽

Elevated Serum ◽

All Cause Mortality ◽

Artery Disease ◽

Definite Coronary Artery Disease

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Association between Serum Uric Acid and Mortality among Chinese Patients with Coronary Artery Disease

Cardiology ◽

10.1159/000443518 ◽

2016 ◽

Vol 134 (3) ◽

pp. 347-356 ◽

Cited By ~ 4

Author(s):

Qing Li ◽

Yuan Zhang ◽

Ding Ding ◽

Yunou Yang ◽

Qian Chen ◽

...

Keyword(s):

Coronary Artery Disease ◽

Uric Acid ◽

Coronary Artery ◽

Serum Uric Acid ◽

Cox Regression ◽

Chinese Patients ◽

Risk Of Death ◽

Increased Risk ◽

Artery Disease ◽

Cvd Mortality

Objectives: Several studies have investigated the association between serum uric acid (SUA) and the risks of coronary artery disease (CAD) but have yielded inconsistent results. The aim of this study was to assess whether there is an independent association of SUA with all-cause and cardiovascular disease (CVD) mortality in Chinese patients with CAD. Methods: A prospective cohort study of 1,799 patients was conducted. Cox regression models were used to estimate the association of SUA with the risk of death. Results: During a median follow-up of 3.9 years, 177 deaths were recorded and 126 of these were due to CVD. Patients in the highest SUA quartile had a 2.43-fold risk of all-cause mortality and a 2.44-fold risk of CVD mortality compared with those in the lowest quartile. In the subpopulation analysis, the association between SUA and mortality remained similar when participants were stratified by age, gender, body mass index and type of CAD. In contrast, we found a significant interaction with estimated glomerular filtration rate (eGFR). There was a stronger association between SUA and the risk of all-cause and CVD mortality among patients with an eGFR ≥60 ml/min/1.73 m2, but no significant association was found in the population with an eGFR <60 ml/min/1.73 m2. Conclusions: Elevated SUA levels were positively associated with an increased risk of all-cause and CVD mortality among CAD patients.

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Genetically predicted serum uric acid levels and the risk of coronary artery disease in patients with diabetes: a Mendelian randomization study

Nutrition Metabolism and Cardiovascular Diseases ◽

10.1016/j.numecd.2021.03.007 ◽

2021 ◽

Author(s):

Songzan Chen ◽

Fangkun Yang ◽

Tian Xu ◽

Yao Wang ◽

Kaijie Zhang ◽

...

Keyword(s):

Coronary Artery Disease ◽

Uric Acid ◽

Coronary Artery ◽

Serum Uric Acid ◽

Mendelian Randomization ◽

Patients With Diabetes ◽

Artery Disease

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Serum Uric Acid Levels, but Not rs7442295 Polymorphism of SCL2A9 Gene, Predict Mortality in Clinically Stable Coronary Artery Disease

Current Problems in Cardiology ◽

10.1016/j.cpcardiol.2021.100798 ◽

2021 ◽

Vol 46 (5) ◽

pp. 100798

Author(s):

Chiara Mozzini ◽

Domenico Girelli ◽

Angela Setti ◽

Jacopo Croce ◽

Filippo Stefanoni ◽

...

Keyword(s):

Coronary Artery Disease ◽

Uric Acid ◽

Coronary Artery ◽

Serum Uric Acid ◽

Stable Coronary Artery Disease ◽

Artery Disease

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Abstract P049: Serum Uric Acid Levels Are Associated With Non-Calcified Coronary Plaque Independent of Traditional Cardiovascular Risk Factors in Patients With Psoriasis

Circulation ◽

10.1161/circ.137.suppl_1.p049 ◽

2018 ◽

Vol 137 (suppl_1) ◽

Author(s):

Youssef A Elnabawi ◽

Amit K Dey ◽

Agastya D Belur ◽

Aditya Goyal ◽

Jacob W Groenendyk ◽

...

Keyword(s):

Risk Factors ◽

Coronary Artery Disease ◽

Uric Acid ◽

Coronary Artery ◽

Serum Uric Acid ◽

Coronary Plaque ◽

Chronic Inflammatory Disease ◽

Human Model ◽

Plaque Burden ◽

Artery Disease

Introduction: Serum uric acid (sUA), a known inflammosome-inducer, is associated with prospective risk of coronary artery disease in a dose-dependent fashion. Psoriasis (PSO), a chronic inflammatory disease associated with elevated burden of systemic inflammation and subclinical coronary artery disease, provides a reliable human model to study how sUA may relate to non-calcified coronary plaque burden (NCB) measured by computed coronary tomography angiography (CCTA). Hypothesis: We hypothesized that sUA would directly associate with NCB beyond traditional cardiovascular (CV) risk factors. Methods: 103 consecutive PSO patients and 47 healthy volunteers (HV) underwent CCTA (320 detector row, Toshiba) for coronary plaque burden quantification using QAngio (Medis). PSO severity was assessed by Psoriasis Area Severity Score (PASI) and divided into severe PSO (PASI>10) and mild-moderate PSO (PASI<10). All patients had fasting blood draws for the measurement of sUA at a certified clinical lab. Results: PSO patients were older than HV and had a higher CV risk by Framingham risk score (FRS) (Table 1). We observed a significant trend towards increase in sUA among severe PSO, mild-moderate PSO, and HV groups (mean 6.4, 5.9, 5.4 respectively, p=0.02 for trend). A positive association was observed between sUA and NCB, which was stronger in severe PSO after adjustment for traditional CV risk, alcohol, statins, and systemic/biologic PSO treatment (Severe PSO: β=0.27, p<0.001; Mild-moderate PSO: β=0.18, p=0.03), not significant in HV (β=0.18, p=0.12). Conclusions: sUA is independently associated with NCB in states of chronic inflammation such as PSO, and as such, may potentially serve as a biomarker for subclinical coronary atherosclerosis. However, larger prospective studies of CV outcomes in chronic inflammatory diseases are needed to confirm these results.

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