Relationships between serum uric acid and lipids in healthy subjects

Distribution of serum uric acid concentration and its association with lipid profiles: a single-center retrospective study in children aged 3 to 12 years with adenoid and tonsillar hypertrophy

BACKGROUND

Presently, there is no consensus regarding the optimal serum uric acid (SUA) concentration for pediatric patients. Adenoid and tonsillar hypertrophy is considered to be closely associated with pediatric metabolic syndrome and cardiovascular risk and is a common condition in children admitted to the hospital. Therefore, we aimed to evaluate the relationship between SUA and dyslipidemia and propose a reference range for SUA concentration that is associated with a healthy lipid profile in hospitalized children with adenoid and tonsillar hypertrophy.

METHODS

Preoperative data from 4922 children admitted for elective adenoidectomy and/or tonsillectomy surgery due to adenoid and tonsillar hypertrophy were collected. SUA concentrations were scaled to standard deviation (SD), and SUA deviations were expressed as SD from the mean SUA of children without dyslipidemia.

RESULTS

The mean SUA concentration of the participants was 4.27 ± 1.01 mg/dL, and the prevalence of hyperuricemia was 1.6% when it was defined using an SUA of ≥ 7.0 mg/dL. Participants with dyslipidemia (856, 17.4%) had a higher prevalence of hyperuricemia (3.4% vs. 1.2%, P < 0.001) and higher SUA concentrations (4.51 ± 1.15 vs. 4.22 ± 0.97 mg/dL, P < 0.001) than those with ortholiposis. The circulating lipid status of participants with SUAs < 1 SD below the mean value for the participants with ortholiposis (range 1.80-3.28 mg/dL) was more normal. Each 1-SD increase in SUA was associated with a 27% increase in the risk of dyslipidemia (OR = 1.270, 95% CI, 1.185-1.361). Adjustment for a number of potential confounders reduced the strength of the relationship, but this remained significant (OR = 1.125, 95% CI, 1.042-1.215). The higher risk of dyslipidemia was maintained for participants with SUAs > 1 SD above the mean value of the participants with ortholiposis.

CONCLUSIONS

SUA was independently associated with dyslipidemia in children with adenoid and tonsillar hypertrophy, and an SUA < 1 SD below the mean value for patients with ortholiposis was associated with a healthy lipid profile.

Resistin/uric acid index as a marker of metabolic syndrome in females with obesity

BACKGROUND

The resistin/uric index has been considered a prognostic factor for identifying young people with obesity. Obesity and Metabolic Syndrome (MS) are an important health problem in females.

AIMS

The objective of this work was to evaluate the relationship of resistin/acid uric index with Metabolic Syndrome on Caucasian females with obesity.

METHODS

We conducted a cross sectional study in 571 females with obesity. Measurements of anthropometric parameters, blood pressure, fasting blood glucose, insulin concentration, insulin resistance (HOMA-IR), lipid profile, C reactive protein, uric acid, resistin and prevalence of Metabolic Syndrome were determined. The resistin/uric acid index was calculated.

RESULTS

In total, 249 subjects had MS (43.6%). We detected higher levels in the following parameters (Delta; p values); waist circumference (3.1 ± 0.5 cm; p = 0.04), systolic blood pressure (5.3 ± 3.6 mmHg; p = 0.01), diastolic blood pressure (2.3 ± 0.4 mmHg; p = 0.02), glucose levels (7.5 ± 0.9 mg/dL; p = 0.01), insulin levels (2.5 ± 0.3 UI/L; p = 0.02), HOMA-IR (0.7 ± 0.2 units; p = 0.03), uric acid levels (0.9 ± 0.2 mg/dl; p = 0.01), resistin levels (4.1 ± 0.4 ng/dl; p = 0.01) and resistin/uric acid index (0.61 ± 0.01 mg/dl; p = 0.02) in subjects of the high resistin/uric acid index group than low index group. Logistic regression analysis reported a high percentage of hyperglycemia (OR = 1.77, 95% CI = 1.10-2.92; p = 0.02), hypertension (OR = 1.91, 95% CI = 1.36-3.01; p = 0.01), central obesity (OR = 1.48, 95% CI = 1.15-1.84; p = 0.03) and metabolic syndrome percentage (OR = 1.71, 95% CI = 1.22-2.69; p = 0.02) in high resistin/uric acid index group.

CONCLUSIONS

Resistin/uric acid index is related with Metabolic syndrome (MS) risk and criteria of it in a population of Caucasian females with obesity and this index is a correlated with glucose levels, insulin levels and insulin resistance (HOMA-IR).

Lowering and Raising Serum Urate Levels: Off-Label Effects of Commonly Used Medications

Drug-induced hyperuricemia and gout present an increasingly prevalent problem in clinical practice. Herein, we review the urate-lowering or urate-raising effects of commonly used agents. We performed a PubMed search using the terms gout, urate, and medication, along with the specific agents/classes described herein. Reports were reviewed until 2022, and original studies were considered if they primarily or secondarily reported the effects of 1 or more drugs on serum urate level. Previous reviews were assessed for references to additional studies that described urate-altering effects of medications. Urate-changing drugs are summarized regarding their magnitude of effect, mechanism of action, and clinical significance. Potentially urate-lowering drugs include angiotensin II receptor blockers, calcium channel blockers, high-dose aspirin and salicylates, some nonsalicylate nonsteroidal anti-inflammatory drugs, angiotensin-converting enzyme inhibitors, sodium-glucose cotransporter 2 inhibitors, statins, and fenofibrate. Potentially urate-increasing drugs discussed include diuretics, β-blockers, insulin, pyrazinamide, ethambutol, calcineurin inhibitors, low-dose aspirin, testosterone, and lactate. In patients who have or are at risk for hyperuricemia or gout, an increased awareness of drugs that affect serum urate level may allow for prescribing that effectively treats the indicated problem while minimizing adverse effects on hyperuricemia and gout.

Association of serum uric acid concentration with components of pediatric metabolic syndrome: A systematic review and meta-analysis

Background:

Hyperuricemia is implicated in the pathogenesis of inflammatory diseases and metabolic disorders. Metabolic syndrome (MetS) in childhood is one of the most important causes of different noncommunicable diseases in adulthood. This study aimed to systematically review the association between serum uric acid (UA) concentration and components of pediatric MetS.

Materials and Methods:

In this meta-analysis and systematic review, related articles were gathered by searching English databases including PubMed, Web of Science, Scopus, and Google Scholar. We used the following keywords: uric acid, metabolic syndrome, hypertension, fasting blood sugar (FBS), hyperglycemia; the search was limited to English language and included observational and cohort studies performed among children or adolescents. Pooled relative risks (odds ratio [OR]) and corresponding 95% confidence interval (95% CI) were extracted. A random-effect model was used.

Results:

On the basis of 34 eligible studies, the pooled correlation between UA with metabolic components including FBS (r = 0.24, 95% CI = 0.09–0.40), fasting insulin (r = 0.26, 95% CI = 0.15–0.37), and hyperglycemia (r for triglyceride and UA = 0.23, 95% CI = 0.19–0.38) (r for high-density lipoprotein and UA = −0.28, 95% CI = −0.37 to −0.20) was statistically significant. The association of both diastolic blood pressure (DBP) and systolic blood pressure (SBP) was statistically significant with UA (r for SBP and UA = 0.34, 95% CI = 0.24–0.43; r for DBP and UA = 0.18, 95% CI = 0.11–0.25). The OR between risk of abdominal obesity with UA was statistically significant (OR = 2.62, 95% CI = 1.41–3.84).

Conclusion:

Serum UA concentration is associated with major components of the pediatric MetS. Its measurement and control should be underscored in at-risk children and adolescents.

Atherogenic Index of Plasma Predicts Hyperuricemia in Rural Population: A Cross-Sectional Study from Northeast China

We aimed to determine the association of atherogenic index of plasma (AIP) with hyperuricemia (HUA) in the rural population of northeast China. This cross-sectional study was conducted in the rural areas of northeast China from January 2012 to August 2013, and the final analysis included data obtained form 5253 men and 6092 women. 1104 participants (9.7%) suffered from HUA. Spearman rank test showed that AIP was positively correlated with uric acid in both sexes (r = 0.310 for men and r = 0.347 for women, both p < 0.001). AIP was classified into three groups: the low (<0.11), the intermediate (0.11-0.21) and the increased (>0.21) risk. The prevalence of HUA increased with AIP. Multivariate logistic regression analysis showed that, compared to the low AIP group, participants in increased AIP group had a 2.536-fold risk for HUA (2.164-fold in male and 2.960-fold in female) after adjustment for covariates. Results of receiver operating characteristic curves showed that the area under the curve (95% confidence intervals) was 0.686 (0.665-0.707) for male and 0.730 (0.706-0.755) for female. We indicated that increased AIP was associated with higher serum uric acid levels and could be identified as an independent risk factor of HUA in the rural population of northeast China.

Associations of non-high density lipoprotein cholesterol and traditional blood lipid profiles with hyperuricemia among middle-aged and elderly Chinese people: a community-based cross-sectional study

Background

Increased serum uric acid (SUA) is associated with dyslipidemia. However, there are conflicting data about the role of single lipid species including non-high density lipoprotein cholesterol (non-HDL-C) in promoting SUA accumulation. Here, we aimed to compare non-HDL-C with other traditional blood lipid profiles in relation to hyperuricemia in a middle-aged and elderly Chinese population.

Methods

Data was collected from 9580 participants undergoing routine physical examinations in Xiangcheng district of Suzhou. SUA, total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C), and high density lipoprotein cholesterol (HDL-C) were examined for all participants. Non-HDL-C was calculated by subtracting HDL-C from TC. The associations of blood lipid profiles with hyperuricemia were examined in men and women, respectively. The areas under Receiver Operating Characteristic (ROC) curves (AUCs) were compared to assess the discriminatory value of blood lipid parameters for predicting hyperuricemia.

Results

All blood lipid parameters significantly correlated with SUA (all P values <0.001). The correlation coefficient between SUA and TG was the highest in both genders. The correlation coefficient of non-HDL-C was higher than HDL-C in males and was higher than TC and LDL-C but followed HDL-C in females. In male group, AUC of TG (0.659) was greater than that of non-HDL-C (0.595) (P values <0.001). The AUC values of HDL-C, TC and LDL-C were lower; respectively 0.581, 0.559 and 0.552. In female group, AUC was highest for TG (0.678) followed by HDL-C (0.616), non-HDL-C (0.610), LDL-C (0.559) and TC (0.557) (all P values < 0.001).

Conclusions

In both genders, serum TG has the strongest association with hyperuricemia among blood lipid parameters. Non-HDL-C is also significantly associated with hyperuricemia.

Serum uric acid and target organ damage in essential hypertension

Background

Hypertension is a major risk factor for cardiovascular mortality, as it acts through its effects on target organs, such as the heart and kidneys. Hyperuricemia increases cardiovascular risk in patients with hypertension.

Objective

To assess the relationship between serum uric acid and target organ damage (left ventricular hypertrophy and microalbuminuria) in untreated patients with essential hypertension.

Patients and methods: A cross-sectional study was carried out in 130 (85 females, 45 males) newly diagnosed, untreated patients with essential hypertension. Sixty-five healthy age- and sex-matched non-hypertensive individuals served as controls for comparison. Left ventricular hypertrophy was evaluated by cardiac ultrasound scan, and microalbuminuria was assessed in an early morning midstream urine sample by immunoturbidimetry. Blood samples were collected for assessing uric acid levels.

Results

Mean serum uric acid was significantly higher among the patients with hypertension (379.7±109.2 μmol/L) than in the controls (296.9±89.8 μmol/L; P<0.001), and the prevalence of hyperuricemia was 46.9% among the hypertensive patients and 16.9% among the controls (P<0.001). Among the hypertensive patients, microalbuminuria was present in 54.1% of those with hyperuricemia and in 24.6% of those with normal uric acid levels (P=0.001). Similarly, left ventricular hypertrophy was more common in the hypertensive patients with hyperuricemia (70.5% versus 42.0%, respectively; P=0.001). There was a significant linear relationship between mean uric acid levels and the number of target organ damage (none versus one versus two: P=0.012).

Conclusion

These results indicate that serum uric acid is associated with target organ damage in patients with hypertension, even at the time of diagnosis; thus, it is a reliable marker of cardiovascular damage in our patient population.

Serum uric acid: marker for atherosclerosis as it is positively associated with "atherogenic index of plasma"

CONTEXT

Serum uric acid (SUA) has been known to be associated with cardiovascular diseases. "Atherogenic index of plasma" (AIP) is considered a very sensitive predictor of future cardiovascular events.

OBJECTIVES

This study was conducted to analyse the association of AIP with SUA and various other lipid parameters.

METHODS

Parameters were measured on a fully automated analyser using standard reagent kits in a retrospective study involving 248 male Indian subjects between 40 to 59 years of age.

RESULTS

AIP correlates: moderately with TC/HDL-C (r = 0.47, p < 0.0001); to a lesser extent but comparably (r = 0.2, p < 0.01) with SUA, LDL-C/HDL-C and TC; negligibly with LDL-C and age.

DISCUSSION AND CONCLUSION

As SUA is positively associated with AIP it can be used as a supplementary marker for atherosclerosis/CVD in upper-middle-aged men.

Serum uric acid plays a protective role for bone loss in peri- and postmenopausal women: a longitudinal study

OBJECTIVE

Oxidative stress has been linked to osteoporosis. Serum uric acid (UA), a strong endogenous antioxidant, has been associated with higher bone mineral density (BMD), lower bone turnover and lower prevalence of fractures in a large cross-sectional study of men. Whether this relationship is present in women and how UA relates to changes in BMD longitudinally has not been examined.

METHODS

A sample of 356 peri- and postmenopausal women, mean age 60.5 years was studied. Each individual had baseline BMD and body composition measurements by dual energy x-ray absorptiometry (DXA) and at least one repeat measure, on average 9.7 years later. Annual rate of change in BMD (A%ΔBMD) was calculated. UA was measured at each DXA visit. Calciotropic hormones and bone turnover markers were measured at the final visit only.

RESULTS

Cross-sectional data analyses revealed that women with higher UA levels had significantly higher absolute BMD measures at all skeletal sites. These women also had higher measures of body weight and its components such as lean mass (LM) and fat mass (FM). Results of multiple regression analyses showed a positive association between UA and BMD that remained significant even after accounting for possible confounders including LM and FM. Regression analyses of the longitudinal BMD data demonstrated significant associations between serum UA levels and annual rates of change in BMD at all skeletal sites. After adjustment associations remained significant for lumbar spine, forearm and whole body BMD but not for hip BMD.

CONCLUSION

Higher serum UA levels appear to be protective for bone loss in peri- and postmenopausal women and this relationship is not affected by changes in body composition measures.

Cross-sectional and longitudinal associations between serum uric acid and metabolic syndrome

Research on the importance of serum uric acid (SUA) as a contributing metabolic factor to cardiovascular diseases has conducted to conflicting results, with most studies assuming a cross-sectional design. The aim of this study was to evaluate the association of SUA and metabolic syndrome (MetS) and its features. A representative sample of 2,485 individuals aged ≥18 years was randomly selected from the non-institutionalized resident population of Porto, Portugal. A total of 1,054 eligible subjects were included for the longitudinal analyses. Hyperuricemia was defined as SUA ≥70 mg/L in men and ≥60 mg/L in women. MetS was defined according the Joint Interim (2009) criteria. Associations were estimated using Poison regression and binomial models. In the cross-sectional analysis, subjects with hyperuricemia had a 2.10-fold increased risk of MetS as compared with normouricemic subjects (PR = 2.10, 95% CI: 1.68-2.63). Among MetS features, high triglycerides presented the strongest association with hyperuricemia (PR = 2.32, 95% CI: 1.84-2.91). The MetS crude incidence rate was 4.5/100 person-year (95% CI: 3.9-5.2) in normal uricemic and 13.0/100 person-year (95% CI: 8.5-20.0) in hyperuricemic participants. Using a multivariate longitudinal approach, hyperuricemia was positively associated with MetS incidence rate ratios (IRR = 1.73, 95% CI: 1.08-2.76). One standard deviation increase of SUA concentration was associated with a 1.22-fold increase in MetS risk (IRR = 1.22, 95% CI: 1.05-1.42). Elevated SUA presented the strongest association with high-triglycerides concentration (IRR = 1.44, 95%: 1.22-1.71) and waist circumference (IRR = 1.25, 95%: 1.05-1.49). The independent positive association between SUA and MetS suggested by this longitudinal study supports that SUA might be a risk factor for MetS.

Relationship between uric acid and metabolic syndrome according to menopausal status

OBJECTIVE

Uric acid, the levels of which have been shown to increase after menopause, has been associated with metabolic syndrome. The prevalence of metabolic syndrome has also been determined to increase after menopause. Therefore, we surmised that menopausal status-specific analyses for the characterisation of the relationship between uric acid and the metabolic syndrome were warranted.

METHODS

We included 1644 patients: 1018 premenopausal women and 626 postmenopausal women, all of whom participated in annual health examinations at Anam Hospital in Seoul, Korea, from January 2008 through December 2008.

RESULTS

On the multivariate logistic regression analysis, uric acid was identified as an independent risk factor for metabolic syndrome in both premenopausal and postmenopausal women. Uric acid levels had different relationships with blood pressure based on menopausal status, however, no such relationships with fasting glucose or age were found.

CONCLUSIONS

Increased uric acid levels were associated with increased risk for metabolic syndrome in both premenopausal and postmenopausal women. In studies regarding uric acid and metabolic syndrome in women, the effects of menopausal status should be considered.

Ten-year change in serum uric acid and its relation to changes in other metabolic risk factors in young black and white adults: the CARDIA study

Elevated serum uric acid is commonly seen in association with obesity, glucose intolerance, hypertension and dyslipidemia. There is currently no satisfactory explanation for the relation of uric acid and the metabolic syndrome (MetSyn). This study aimed to evaluate the relations of change in serum uric acid with changes in components of the MetSyn in young adults. We studied 1,249 male and 1,362 female black and white subjects aged 17-35 years (baseline) from the Coronary Artery Risk Development in Young Adults (CARDIA) Study, which attended a 10-year follow-up. Metabolic factors assessed at both time periods included BMI, waist circumference, blood pressure, fasting glucose, insulin, and lipids. Confounders examined (baseline and change variables) were serum creatinine, alcohol, smoking, physical activity, and oral contraceptives. Mean uric acid increased the most in black males (+0.5 mg/dl), followed by white males (+0.3 mg/dl) and black females (+0.2 mg/dl) (all P < 0.01), with the least change among white females (+0.1 mg/dl) (ns). Although change in all of the metabolic factors was associated with change in uric acid in the anticipated directions, in multivariable analyses only BMI and triglycerides had a significant independent association with uric acid in all race-sex-groups. Among confounders, only change in serum creatinine showed a strong independent association with uric acid. In conclusion, besides weight gain and renal excretion, increasing uric acid concentrations in young adults are strongly related to corresponding changes in triglycerides. The correlation of uric acid and triglycerides was found within the normal range and could not be explained by obesity.

Plasma uric acid level and risk for incident hypertension among men

Several studies have found that uric acid (UA) level is associated with an increased risk for hypertension, but the association could be confounded by metabolic factors that were not included in these previous studies. UA level and risk for incident hypertension was examined prospectively among men who participated in the Health Professionals' Follow-up Study. From among men without hypertension at the time blood was collected, 750 participants who developed hypertension during the subsequent 8 yr and 750 age-matched controls were selected. In addition to adjustment for standard hypertension risk factors and renal function, adjustments controlled for fasting insulin, triglyceride, and cholesterol levels. The mean age of participants was 61 yr, and mean plasma UA level was 6.0 mg/dl (SD 1.25 mg/dl). The multivariable relative risk (RR) for a 1-SD increase in UA was 1.02 (95% confidence interval [CI]0.87 to 1.18); the RR comparing the highest with lowest quartile of UA was 1.08 (95% CI 0.71 to 1.63). The multivariable RR associated with a 1-SD increase in UA was 1.38 (95% CI 1.05 to 1.81) for men aged <60 yr and 0.90 (95% CI 0.74 to 1.10) for men >or=60 yr (P = 0.04 for interaction). However, further adjustment for fasting insulin, triglyceride, and cholesterol levels attenuated the results (RR for men <60 yr 1.24; 95% CI 0.93 to 1.66). In conclusion, no independent association between UA level and risk for incident hypertension was found among older men.

Association of methylenetetrahydrofolate reductase (C677T) polymorphism with hyperuricemia

BACKGROUND AND AIMS

Homozygosity for the thermolabile variant of 5,10-methylene tetrahydrofolate reductase (C677T) has been suggested to be positively associated with the risk of vascular disease and neural tube defects. In addition, recent studies have suggested that elevated serum uric acid predicts ischemic heart disease, and epidemiological data on ethnic groups have suggested that genetic factors are determinants of serum uric acid levels. In this study, we tested the hypothesis that 5,10-methylenetetrahydrofolate reductase (C677T) polymorphism may be associated with hyperuricemia.

METHODS AND RESULTS

Samples from 518 healthy individuals (268 men and 250 women) were analyzed for MTHFR genotyping and serum uric acid. The participants were categorized to homozygous wild type (CC), heterozygous for wild type and thermolabile (CT), or homozygous for the thermolabile (TT) variant. Serum uric acid was significantly higher in males and females with TT genotype than those with either CC or CT genotype (p=0.0001, ANOVA). Univariate and multivariate analysis showed that 5,10-methylenetetrahydrofolate reductase (C677T) polymorphism was a strong correlate and predictor of uric acid in males (r=0.28, p=0.0001, beta=0.673, p=<0.001) and in females (r=0.27, p=0.0001, beta=0.599, p=<0.001). Odds ratio analysis has also shown that the risk of hyperuricemia was greater in males (OR 3.1, CI 1.8-5.2, p=0.001) and females (OR 3.3, CI 1.9-5.7, p=<0.001) with CT genotypes and in males (OR 3.7, CI 1.3-10.7, p=0.014) and females (OR 3.2, CI 1.1-9.7, p=0.032) with TT genotypes than in those with CC genotypes.

CONCLUSION

Results from this study suggest that mutation of 5-MTHFR C677T contributes to the higher uric acid levels in both males and females and may be a risk factor for hyperuricemia.

The relation of postmenopausal hormone therapy to serum uric acid and the risk of coronary heart disease events: the Heart and Estrogen-Progestin Replacement Study (HERS)

PURPOSE

To determine whether baseline serum uric acid (UA) levels and estrogen-progestin (E+P)-associated change in serum UA in postmenopausal women with coronary disease are associated with recurrent coronary heart disease (CHD) events.

METHODS

2763 postmenopausal women enrolled in the Heart and Estrogen-Progestin Replacement Study (HERS) were randomly assigned to take conjugated E+P or placebo in a secondary CHD prevention study. The primary outcome for these analyses was nonfatal myocardial infarction or CHD death during a mean follow up of 4.1 years.

RESULTS

The baseline serum UA for the cohort was 5.4 mg/dl and, compared with placebo, E+P on average lowered serum UA levels slightly (0.2 mg/dl) at one year of follow up (p<0.0001). Baseline serum UA levels were associated in simple proportional hazards models with CHD events; each standard deviation increase (1.3 mg/dl) was associated with a 22% increased risk of primary CHD events (p=.0001). This association, however, was no longer statistically significant after multivariable adjustment (p=0.36). There was no association between on-study change in serum UA level and any CHD outcome.

CONCLUSION

Treatment with E+P lowered serum UA levels slightly, but neither baseline UA nor change in UA affected CHD risk.

Prevalence of hyperuricemia and relation of serum uric acid with cardiovascular risk factors in a developing country

BACKGROUND

The prevalence of hyperuricemia has rarely been investigated in developing countries. The purpose of the present study was to investigate the prevalence of hyperuricemia and the association between uric acid levels and the various cardiovascular risk factors in a developing country with high average blood pressures (the Seychelles, Indian Ocean, population mainly of African origin).

METHODS

This cross-sectional health examination survey was based on a population random sample from the Seychelles. It included 1011 subjects aged 25 to 64 years. Blood pressure (BP), body mass index (BMI), waist circumference, waist-to-hip ratio, total and HDL cholesterol, serum triglycerides and serum uric acid were measured. Data were analyzed using scatterplot smoothing techniques and gender-specific linear regression models.

RESULTS

The prevalence of a serum uric acid level >420 micromol/L in men was 35.2% and the prevalence of a serum uric acid level >360 micromol/L was 8.7% in women. Serum uric acid was strongly related to serum triglycerides in men as well as in women (r = 0.73 in men and r = 0.59 in women, p < 0.001). Uric acid levels were also significantly associated but to a lesser degree with age, BMI, blood pressure, alcohol and the use of antihypertensive therapy. In a regression model, triglycerides, age, BMI, antihypertensive therapy and alcohol consumption accounted for about 50% (R2) of the serum uric acid variations in men as well as in women.

CONCLUSIONS

This study shows that the prevalence of hyperuricemia can be high in a developing country such as the Seychelles. Besides alcohol consumption and the use of antihypertensive therapy, mainly diuretics, serum uric acid is markedly associated with parameters of the metabolic syndrome, in particular serum triglycerides. Considering the growing incidence of obesity and metabolic syndrome worldwide and the potential link between hyperuricemia and cardiovascular complications, more emphasis should be put on the evolving prevalence of hyperuricemia in developing countries.

Psychoses and creativity: is the missing link a biological mechanism related to phospholipids turnover?

Recent evidence suggests that genetic and biochemical factors associated with psychoses may also provide an increased propensity to think creatively. The evolutionary theories linking brain growth and diet to the appearance of creative endeavors have been made recently, but they lack a direct link to research on the biological correlates of divergent and creative thought. Expanding upon Horrobin's theory that changes in brain size and in neural microconnectivity came about as a result of changes in dietary fat and phospholipid incorporation of highly unsaturated fatty acids, we propose a theory relating phospholipase A2 (PLA2) activity to the neuromodulatory effects of the noradrenergic system. This theory offers probable links between attention, divergent thinking, and arousal through a mechanism that emphasizes optimal individual functioning of the PLA2 and NE systems as they interact with structural and biochemical states of the brain. We hope that this theory will stimulate new research in the neural basis of creativity and its connection to psychoses.

Serum uric acid and risk of coronary heart disease: Atherosclerosis Risk in Communities (ARIC) Study

PURPOSE

Approximately half of previous studies on serum uric acid have reported it to be an independent risk factor for coronary heart disease (CHD). We tested this hypothesis in the Atherosclerosis Risk in Communities (ARIC) Study.

METHODS

A total of 13,504 healthy middle-aged men and women were followed prospectively for up to eight years. We identified 128 fatal and nonfatal CHD events in women and 264 in men.

RESULTS

The age-, race-, and ARIC field center-adjusted relative risk of CHD for sex-specific quartiles of serum uric acid were 1.0, 1.39, 1.08, and 2.35 in women (p for trend = 0.009) and 1.0, 1.03, 0.89, and 1.21 in men (p for trend = 0.44), respectively. However, serum uric acid was correlated positively with many risk factors, and after multivariable adjustment, there was little evidence of an association of uric acid with CHD in either sex.

CONCLUSIONS

Our results are not consistent with serum uric acid being an independent risk factor for CHD.