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Gan TM, Ye YY, Mo GL, Li JY. Progress of uric acid in cardiovascular disease. Cardiovasc Endocrinol Metab 2024; 13:e0300. [PMID: 38633361 PMCID: PMC11019825 DOI: 10.1097/xce.0000000000000300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 03/10/2024] [Indexed: 04/19/2024]
Abstract
Due to the global prevalence of hyperuricemia (HUA), there is growing interest in research on uric acid (UA). HUA is a common condition that has various adverse consequences, including gout and kidney disease. However, recent studies have also implicated UA in the development of cardiovascular diseases (CVD) such as atrial fibrillation (AF) and coronary heart disease (CHD). Experimental and clinical research has extensively demonstrated the detrimental effects of elevated serum UA levels on cardiovascular health. Furthermore, serum UA levels have been identified as predictors of CVD outcomes following percutaneous coronary intervention (PCI) and catheter ablation. Additionally, the use of UA-lowering therapy holds important implications for the management of CVD. This review aims to consolidate the current evidence on the relationship between serum UA and CVD.
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Affiliation(s)
- Tian-ming Gan
- Department of Cardiology, Affiliated Hospital of Guilin Medical University, Guilin, China
| | - Yu-yu Ye
- Department of Cardiology, Affiliated Hospital of Guilin Medical University, Guilin, China
| | - Guan-lian Mo
- Department of Cardiology, Affiliated Hospital of Guilin Medical University, Guilin, China
| | - Jin-yi Li
- Department of Cardiology, Affiliated Hospital of Guilin Medical University, Guilin, China
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Li YL, Leu HB, Ting CH, Lim SS, Tsai TY, Wu CH, Chung IF, Liang KH. Predicting long-term time to cardiovascular incidents using myocardial perfusion imaging and deep convolutional neural networks. Sci Rep 2024; 14:3802. [PMID: 38360974 PMCID: PMC10869727 DOI: 10.1038/s41598-024-54139-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 02/08/2024] [Indexed: 02/17/2024] Open
Abstract
Myocardial perfusion imaging (MPI) is a clinical tool which can assess the heart's perfusion status, thereby revealing impairments in patients' cardiac function. Within the MPI modality, the acquired three-dimensional signals are typically represented as a sequence of two-dimensional grayscale tomographic images. Here, we proposed an end-to-end survival training approach for processing gray-scale MPI tomograms to generate a risk score which reflects subsequent time to cardiovascular incidents, including cardiovascular death, non-fatal myocardial infarction, and non-fatal ischemic stroke (collectively known as Major Adverse Cardiovascular Events; MACE) as well as Congestive Heart Failure (CHF). We recruited a total of 1928 patients who had undergone MPI followed by coronary interventions. Among them, 80% (n = 1540) were randomly reserved for the training and 5- fold cross-validation stage, while 20% (n = 388) were set aside for the testing stage. The end-to-end survival training can converge well in generating effective AI models via the fivefold cross-validation approach with 1540 patients. When a candidate model is evaluated using independent images, the model can stratify patients into below-median-risk (n = 194) and above-median-risk (n = 194) groups, the corresponding survival curves of the two groups have significant difference (P < 0.0001). We further stratify the above-median-risk group to the quartile 3 and 4 group (n = 97 each), and the three patient strata, referred to as the high, intermediate and low risk groups respectively, manifest statistically significant difference. Notably, the 5-year cardiovascular incident rate is less than 5% in the low-risk group (accounting for 50% of all patients), while the rate is nearly 40% in the high-risk group (accounting for 25% of all patients). Evaluation of patient subgroups revealed stronger effect size in patients with three blocked arteries (Hazard ratio [HR]: 18.377, 95% CI 3.719-90.801, p < 0.001), followed by those with two blocked vessels at HR 7.484 (95% CI 1.858-30.150; p = 0.005). Regarding stent placement, patients with a single stent displayed a HR of 4.410 (95% CI 1.399-13.904; p = 0.011). Patients with two stents show a HR of 10.699 (95% CI 2.262-50.601; p = 0.003), escalating notably to a HR of 57.446 (95% CI 1.922-1717.207; p = 0.019) for patients with three or more stents, indicating a substantial relationship between the disease severity and the predictive capability of the AI for subsequent cardiovascular inciidents. The success of the MPI AI model in stratifying patients into subgroups with distinct time-to-cardiovascular incidents demonstrated the feasibility of proposed end-to-end survival training approach.
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Affiliation(s)
- Yi-Lian Li
- Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei City, Taiwan
| | - Hsin-Bang Leu
- Department of Medicine, Taipei Veterans General Hospital, Taipei City, Taiwan
| | - Chien-Hsin Ting
- Department of Nuclear Medicine, Taipei Veterans General Hospital, Taipei City, Taiwan
| | - Su-Shen Lim
- Department of Medicine, Taipei Veterans General Hospital, Taipei City, Taiwan
| | - Tsung-Ying Tsai
- Department of Medicine, Taipei Veterans General Hospital, Taipei City, Taiwan
| | - Cheng-Hsueh Wu
- Department of Medicine, Taipei Veterans General Hospital, Taipei City, Taiwan
| | - I-Fang Chung
- Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei City, Taiwan.
| | - Kung-Hao Liang
- Department of Medical Research, Taipei Veterans General Hospital, Taipei City, Taiwan.
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Yang Y, Zhang J, Jia L, Su J, Ma M, Lin X. Uric acid to high-density lipoprotein cholesterol ratio predicts adverse cardiovascular events in patients with coronary chronic total occlusion. Nutr Metab Cardiovasc Dis 2023; 33:2471-2478. [PMID: 37586923 DOI: 10.1016/j.numecd.2023.07.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/15/2023] [Accepted: 07/28/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND AND AIMS Uric acid to high-density lipoprotein cholesterol ratio (UHR) is a novel index of metabolism and inflammation proposed by recent studies. The prognostic value of UHR is undetermined in patients with coronary chronic total occlusion (CTO). The aim of this study was to investigate the association of UHR with adverse cardiovascular events in patients with CTO. METHODS AND RESULTS In this retrospective cohort study, we enrolled 566 patients with CTO lesion in our hospital from January 2016 to December 2019. Patients were divided into three groups based on UHR level. The primary endpoint was major adverse cardiovascular event (MACE), defined as a combination of death, non-fatal MI, target vessel revascularization (TVR), and non-fatal stroke. The median follow-up time of this study was 43 months. During the follow-up, 107 (18.9%) MACEs were recorded. Kaplan-Meier survival plots show the cumulative incidence of MACE-free decreased across tertile of UHR (log-rank test, p < 0.001). In the fully adjusted model, the Hazard ratio (95% CI) of MACE was 2.16 (1.17-3.99) in tertile 3 and 2.01 (1.62-2.49) for per SD increase in UHR. CONCLUSION Elevated UHR predicts an increasing risk of MACE in patients with CTO. UHR is a simple and reliable indicator for risk stratification and early intervention in CTO patients.
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Affiliation(s)
- Yu Yang
- Department, The First Affiliated Hospital of Anhui Medical University, Hefei City, Anhui province, 230022, China
| | - Jian Zhang
- Department, The First Affiliated Hospital of Anhui Medical University, Hefei City, Anhui province, 230022, China
| | - Lin Jia
- Department, The First Affiliated Hospital of Anhui Medical University, Hefei City, Anhui province, 230022, China
| | - Jiannan Su
- Department, The First Affiliated Hospital of Anhui Medical University, Hefei City, Anhui province, 230022, China
| | - Mengqing Ma
- Department, The First Affiliated Hospital of Anhui Medical University, Hefei City, Anhui province, 230022, China
| | - Xianhe Lin
- Department, The First Affiliated Hospital of Anhui Medical University, Hefei City, Anhui province, 230022, China.
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Yang YL, Chen SC, Wu CH, Huang SS, Leong Chan W, Lin SJ, Chou CY, Chen JW, Pan JP, Charng MJ, Chen YH, Wu TC, Lu TM, Hsu PF, Huang PH, Cheng HM, Huang CC, Sung SH, Lin YJ, Leu HB. Sex and age differences of major cardiovascular events in patients after percutaneous coronary intervention. J Chin Med Assoc 2023; 86:1046-1052. [PMID: 37815291 DOI: 10.1097/jcma.0000000000001011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND Women usually have higher risk after receiving percutaneous coronary interventions (PCIs) than men with coronary artery disease (CAD). The aim of this study was to investigate the association of sex differences with future outcomes in CAD patients undergoing PCI, to assess the role of age, and to extend observed endpoints to stroke and congestive heart failure. METHODS Six thousand six hundred forty-seven patients with CAD who received successful PCIs. The associations between clinic outcomes and sex were analyzed. The primary outcome was major cardiovascular events (MACE), including cardiac death, nonfatal myocardial infraction, and nonfatal stroke. The secondary outcome was MACE and hospitalization for heart failure (total CV events). RESULTS During a mean of 52.7 months of follow-up, 4833 men and 1614 women received PCI. Univariate and multivariate analyses showed that women were independently associated with an increased risk of cardiac death (HR, 1.78; 95% CI, 1.32-2.41), hospitalization for heart failure (HR, 1.53; 95% CI, 1.23-1.89), MACE (HR, 1.34; 95% CI, 1.10-1.63), and total CV events (HR, 1.39; 95% CI, 1.20-1.62). In the subgroup analysis, women aged under 60 years had higher cardiovascular risks than men of the same age category. CONCLUSION Women with CAD after successful PCI had poorer cardiovascular outcomes than men. Additionally, younger women (aged <60 years) were especially associated with a higher risk of developing future adverse cardiovascular outcomes.
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Affiliation(s)
- Ya-Ling Yang
- Department of Cardiology, Cardinal Tien Hospital, New Taipei City, Taiwan, ROC
- School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan, ROC
| | - Su-Chan Chen
- Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Cheng-Hsueh Wu
- Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Shao-Sung Huang
- Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Healthcare and Management Centre, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Wan Leong Chan
- Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Shing-Jong Lin
- Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chia-Yu Chou
- Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Jaw-Wen Chen
- Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Healthcare and Management Centre, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Ju-Pin Pan
- Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Min-Ji Charng
- Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Ying-Hwa Chen
- Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Tao-Cheng Wu
- Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Tse-Min Lu
- Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Healthcare and Management Centre, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Pai-Feng Hsu
- Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Po-Hsun Huang
- Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Hao-Min Cheng
- Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chin-Chou Huang
- Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Shih-Hsien Sung
- Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yenn-Jiang Lin
- Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Hsin-Bang Leu
- Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Healthcare and Management Centre, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Clinical Medicine and Cardiovascular Research Centre, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
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Li Z, Yuan J, Hu E, Wei D. Relation of serum uric acid levels to readmission and mortality in patients with heart failure. Sci Rep 2023; 13:18495. [PMID: 37898627 PMCID: PMC10613251 DOI: 10.1038/s41598-023-45624-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 10/21/2023] [Indexed: 10/30/2023] Open
Abstract
Data on the association between uric acid (UA) levels and clinical outcomes, such as readmission and mortality, in patients with heart failure are scarce. This study explores whether UA exhibits an independent association with the composite endpoint (clinical outcome during 6 months after discharge, including mortality and 6-month readmission) in patients with chronic heart failure while controlling for other covariates. This study was an observational retrospective study. A cohort of 1943 consecutive patients diagnosed with chronic heart failure, who were admitted between December 2016 and June 2019, was included in the study. Data were sourced from PhysioNet. The independent variable analyzed was the UA level, and the dependent variable was a composite endpoint comprising mortality and 6-month readmission. The study had 1943 participants, of which 91.04% were aged more than 60 years and 58.05% were female. The fully-adjusted model yielded a positive correlation between UA levels (per 10 µmol/L) and the composite endpoint as well as readmission, following adjustment for confounding variables (HR = 1.01, 95% CI 1.00-1.01). Notably, a non-linear relationship was observed between UA levels and the composite endpoint, particularly readmission, with a J-shaped correlation observed between UA levels and both the composite endpoint and readmission. Overall, we found that the serum UA levels at admission were independently and positively associated with the risk of the composite endpoint (clinical outcomes during 6 months after discharge), especially readmission after adjusting other covariates. A J-shaped relationship was observed between UA levels and the composite endpoint and readmission.
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Affiliation(s)
- Zengpan Li
- Department of Emergency, Ningbo Medical Center Lihuili Hospital, Ningbo, 315040, China.
| | - Jie Yuan
- Department of Emergency, Ningbo Medical Center Lihuili Hospital, Ningbo, 315040, China
| | - Encong Hu
- Department of Emergency, Ningbo Medical Center Lihuili Hospital, Ningbo, 315040, China
| | - Diyang Wei
- Department of Emergency, Ningbo Medical Center Lihuili Hospital, Ningbo, 315040, China
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Tao S, Tang X, Yu L, Li L, Zhang G, Zhang L, Huang L, Wu J. Prognosis of coronary heart disease after percutaneous coronary intervention: a bibliometric analysis over the period 2004-2022. Eur J Med Res 2023; 28:311. [PMID: 37658418 PMCID: PMC10472664 DOI: 10.1186/s40001-023-01220-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 07/10/2023] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND As the complexity and diversity of the percutaneous coronary intervention (PCI) are being explored and reported, burgeoning research has progressed in this field. However, there is no comprehensive analysis available on PCI-related studies published in the literature. This study aimed to analyze and visualize the changes of scientific output regarding prognosis of coronary heart disease (CHD) after PCI over the past 20 years and to reveal the knowledge domain and development trends in this field by using CiteSpace software. METHODS Relevant articles published over the period 2004-2022 were retrieved from the Web of Science Core Collection database. After manual selection, qualified documents were included and recorded with the information of their title, abstract, keyword, author, descriptor, citation, identifier, publishing year and publishing organization. We transferred the data to CiteSpace V5.8.R2 (Version 5.8.R2) to draw knowledge maps and to conduct co-occurrence analysis, cluster analysis, timeline analysis, burst term detection and citation analysis. RESULTS A total of 14,699 literature records were found relating prognosis of CHD after PCI in the past 20 years (2004-2022), including 14,212 original articles and reviews, and they were published in 153 different journals. Publication production has increased annually and a total of 1182 authors, 796 institutes and 147 countries have contributed to these publications. Moreover, the most representative author was Gregg W Stone from the CardioVascular Research Foundation (CVRF) with 368 publications, whose team mainly focused on exploring the efficacy and safety of revascularization and the characteristics of susceptible population. The global productivity ranking was led by the USA with 3326 published papers, followed by Italy (n = 1355), Japan (n = 1080), China (n = 1075) and Germany (n = 937). And the keywords of these publications were "percutaneous coronary intervention" (n = 2271), "outcome" (n = 1756), "mortality" (n = 1730) and "impact" (n = 1334). Other commonly-used words were "predictor" (n = 1324), "intervention" (n = 1310), "angioplasty" (n = 1299), "risk" (n = 1144), "acute myocardial infarction" (n = 1136) and "artery disease" (n = 1098). Cluster analysis showed that 15 high connected clusters were generated with a modularity Q of 0.831 and a weighted mean silhouette of 0.9388 by applying the log-likelihood ratio algorithm, and the top 5 clusters were #0 optical coherence tomography, #1 dual antiplatelet therapy, #2 bleeding, #3 clopidogrel and #4 thrombus aspiration. Furthermore, the frontiers in the field of prognosis of CHD after PCI mainly involved "decision making", "reperfusion", "angioplasty", "balloon", "unstable angina", "dual antiplatelet therapy", "cardiac surgical score", "restenosis", "reperfusion", "thrombolytic therapy", etc. CONCLUSIONS: To sum up, efficacy and safety of different types of stents, the risk factors of restenosis and thrombotic events after PCI, early risk assessment, and secondary prevention and complications of patients with CHD after PCI were research hotspots and frontier topics in the area by bibliometric analysis. The results could provide a comprehensive overview of the research hotspots and frontier topics relating prognosis of CHD after PCI, promoting a better understanding of the knowledge domain and development trends in this field during the past 20 years.
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Affiliation(s)
- Shiyi Tao
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Xianwen Tang
- Department of Cardiology, Beijing University of Chinese Medicine Shenzhen Hospital (Longgang), Shenzhen, Guangdong, China
| | - Lintong Yu
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Lingling Li
- The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Gaoyu Zhang
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Lanxin Zhang
- Department of Oncology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Li Huang
- Department of Integrative Cardiology, China-Japan Friendship Hospital, Beijing, China
| | - Jiayun Wu
- Department of Cardiology, Beijing University of Chinese Medicine Shenzhen Hospital (Longgang), Shenzhen, Guangdong, China.
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Tian X, Chen S, Zhang Y, Zhang X, Xu Q, Wang P, Wu S, Luo Y, Wang A. Serum uric acid variation and the risk of cardiovascular disease: A prospective cohort study. Eur J Intern Med 2023; 112:37-44. [PMID: 36764904 DOI: 10.1016/j.ejim.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/26/2023] [Accepted: 02/01/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND The association of serum uric acid (SUA) with cardiovascular disease (CVD) is inconsistent and limited by a single measurement of SUA. This study aimed to investigate the association of SUA variation, considering its magnitude and direction, with the risk of CVD. METHODS This study included 41,578 participants with four biennial measurements of SUA during 2006-2012 from the Kailuan study. SUA variation was measured using the coefficient of variation (primary index), standard deviation, average real variability, and variability independent of mean, and the direction of variation was also assessed. Multivariate-adjusted Cox regressions were used to assess the associations, and Bayesian network was utilized to find the most important pathway from SUA variation to CVD. RESULTS During a median follow-up of 6.74 (interquartile range: 6.45-7.03) years, we identified 1,852 (4.45%) cases of incident CVD. A large SUA variation (top vs. bottom tertiles) was associated with a higher risk of CVD (hazard ratio [HR], 1.24; 95% confidence interval [CI], 1.11-1.40), especially in older adults than that in young adults (Pint=0.0137). The higher risk of CVD was observed with both large rises (HR, 1.24; 95% CI, 1.10-1.39) and falls (HR, 1.19; 95% CI, 1.03-1.38) in SUA variation. The hazardous effect of SUA variation on CVD was mainly induced by excessive inflammation and elevated blood pressure. Similar results were observed for CVD subtypes. CONCLUSIONS Elevated SUA variation was associated with a higher risk of CVD, irrespective of the direction of SUA variation, and inflammation played an important role in the pathway.
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Affiliation(s)
- Xue Tian
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Shuohua Chen
- Department of Cardiology, Kailuan Hospital, North China University of Science and Technology, Tangshan, China
| | - Yijun Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Xiaoli Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Qin Xu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Penglian Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shouling Wu
- Department of Cardiology, Kailuan Hospital, North China University of Science and Technology, Tangshan, China.
| | - Yanxia Luo
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China.
| | - Anxin Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
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Pál K, Mănescu IB, Lupu S, Dobreanu M. Emerging Biomarkers for Predicting Clinical Outcomes in Patients with Heart Disease. Life (Basel) 2023; 13. [PMID: 36676179 DOI: 10.3390/life13010230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/31/2022] [Accepted: 01/09/2023] [Indexed: 01/18/2023]
Abstract
Cardiovascular disease is most frequently caused by the development and progression of atherosclerosis. When coronary arteries are afflicted, and the stenoses caused by atherosclerotic plaques are severe enough, the metabolic supply-and-offer balance is disturbed, leading to myocardial ischemia. If atherosclerotic plaques become unstable and local thrombosis develops, a myocardial infarction occurs. Sometimes, myocardial ischemia and infarction may result in significant and irreversible heart failure. To prevent severe complications, such as acute coronary syndromes and ischemia-related heart failure, extensive efforts have been made for developing biomarkers that would help identify patients at increased risk for cardiovascular events. In this two-part study, we attempted to provide a review of existing knowledge of blood biomarkers that may be used in this setting. The first part of this work was dedicated to conventional biomarkers, which are already used in clinical practice. In the second part, here presented, we discuss emerging biomarkers which have not yet become mainstream.
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Akashi N, Kuwabara M, Matoba T, Kohro T, Oba Y, Kabutoya T, Imai Y, Kario K, Kiyosue A, Mizuno Y, Nochioka K, Nakayama M, Iwai T, Nakao Y, Iwanaga Y, Miyamoto Y, Ishii M, Nakamura T, Tsujita K, Sato H, Fujita H, Nagai R. Hyperuricemia predicts increased cardiovascular events in patients with chronic coronary syndrome after percutaneous coronary intervention: A nationwide cohort study from Japan. Front Cardiovasc Med 2023; 9:1062894. [PMID: 36704454 PMCID: PMC9871893 DOI: 10.3389/fcvm.2022.1062894] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 12/27/2022] [Indexed: 01/12/2023] Open
Abstract
Background The causal relationship between hyperuricemia and cardiovascular diseases is still unknown. We hypothesized that hyperuricemic patients after percutaneous coronary intervention (PCI) had a higher risk of major adverse cardiovascular events (MACE). Methods This was a large-scale multicenter cohort study. We enrolled patients with chronic coronary syndrome (CCS) after PCI between April 2013 and March 2019 using the database from the Clinical Deep Data Accumulation System (CLIDAS), and compared the incidence of MACE, defined as a composite of cardiovascular death, myocardial infarction, and hospitalization for heart failure, between hyperuricemia and non-hyperuricemia groups. Results In total, 9,936 patients underwent PCI during the study period. Of these, 5,138 patients with CCS after PCI were divided into two group (1,724 and 3,414 in the hyperuricemia and non-hyperuricemia groups, respectively). The hyperuricemia group had a higher prevalence of hypertension, atrial fibrillation, history of previous hospitalization for heart failure, and baseline creatinine, and a lower prevalence of diabetes than the non-hyperuricemia group, but the proportion of men and age were similar between the two groups. The incidence of MACE in the hyperuricemia group was significantly higher than that in the non-hyperuricemia group (13.1 vs. 6.4%, log-rank P < 0.001). Multivariable Cox regression analyses revealed that hyperuricemia was significantly associated with increased MACE [hazard ratio (HR), 1.52; 95% confidential interval (CI), 1.23-1.86] after multiple adjustments for age, sex, body mass index, estimated glomerular filtration rate, left main disease or three-vessel disease, hypertension, diabetes mellitus, dyslipidemia, history of myocardial infarction, and history of hospitalization for heart failure. Moreover, hyperuricemia was independently associated with increased hospitalization for heart failure (HR, 2.19; 95% CI, 1.69-2.83), but not cardiovascular death or myocardial infarction after multiple adjustments. Sensitive analyses by sex and diuretic use, B-type natriuretic peptide level, and left ventricular ejection fraction showed similar results. Conclusion CLIDAS revealed that hyperuricemia was associated with increased MACE in patients with CCS after PCI. Further clinical trials are needed whether treating hyperuricemia could reduce cardiovascular events or not.
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Affiliation(s)
- Naoyuki Akashi
- Division of Cardiovascular Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | | | - Tetsuya Matoba
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Takahide Kohro
- Department of Clinical Informatics, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Yusuke Oba
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Tomoyuki Kabutoya
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Yasushi Imai
- Division of Clinical Pharmacology, Department of Pharmacology, Jichi Medical University, Tochigi, Japan
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Arihiro Kiyosue
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Yoshiko Mizuno
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Kotaro Nochioka
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Clinical Research, Innovation and Education Center, Tohoku University Hospital, Sendai, Japan
| | - Masaharu Nakayama
- Department of Medical Informatics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takamasa Iwai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yoko Nakao
- Open Innovation Center, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yoshitaka Iwanaga
- Open Innovation Center, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yoshihiro Miyamoto
- Open Innovation Center, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Masanobu Ishii
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Taishi Nakamura
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | | | - Hideo Fujita
- Division of Cardiovascular Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan,*Correspondence: Hideo Fujita ✉
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10
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Kawamoto R, Kikuchi A, Ninomiya D, Kumagi T. Change in Serum Uric Acid is a Useful Predictor of All-Cause Mortality among Community-Dwelling Persons. Int J Anal Chem 2023; 2023:7382320. [PMID: 36915709 DOI: 10.1155/2023/7382320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 02/09/2023] [Accepted: 02/10/2023] [Indexed: 03/07/2023] Open
Abstract
There is limited research on the association between longitudinal variability in serum uric acid (SUA) and all-cause mortality in the general population, although recent studies have suggested that changes in SUA are associated with all-cause mortality in adults. This study aims to examine the association between percentage change in SUA (%dSUA = 100 × (cohort 2 SUA - cohort 1 SUA)/(time × cohort 1 SUA) and all-cause mortality. This study is based on 1,301 participants, of whom 543 were male (63 ± 11 years) and 758 were female (63 ± 9 years). We obtained adjusted relative risk estimates for all-cause mortality and used a Cox proportional hazards model, adjusted for possible confounders, to determine the hazard ratio (HR) and 95% confidence interval (CI) of %dSUA. Of all the participants, 79 (6.1%) were deceased, and of these, 45 were male (8.3%) and 34 were female (4.5%). The multivariable-adjusted HRs (95% CI) for all-cause mortality for the first, second to fourth (reference), and fifth %dSUA quintiles were 3.79 (1.67-8.48), 1.00, and 0.87 (0.29-2.61) for male participants and 4.00 (1.43-11.2), 1.00, and 1.19 (0.46-3.05) for female participants, respectively. Participants with a body mass index of <22 kg/m2 had a significantly higher HR, forming a U-shaped curve for the first (HR, 7.59; 95% CI, 2.13-27.0) and fifth quintiles (HR, 2.93; 95% CI, 1.05-8.18) relative to the reference. Percentage change in SUA is independently and significantly associated with future all-cause mortality among community-dwelling persons.
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11
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Lian H, Zhao Z, Ma K, Ding Z, Sun L, Zhang Y. Establishment of a Predictive Model for Poor Prognosis of Incomplete Revascularization in Patients with Coronary Heart Disease and Multivessel Disease. Clin Appl Thromb Hemost 2022; 28:10760296221139258. [PMID: 36573034 PMCID: PMC9806495 DOI: 10.1177/10760296221139258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To establish a predictive model for poor prognosis after incomplete revascularization (ICR) in patients with multivessel coronary artery disease (MVD). METHODS Clinical data of 757 patients with MVD and ICR after percutaneous coronary intervention (PCI) in the Affiliated Hospital of Chengde Medical University from January 2020 to August 2021 were retrospectively collected. The least absolute shrinkage and selection operator regression method was used to screen variables, and multivariate logistic regression was used to establish a predictive model. An independent cohort was used to validate the model. The C-statistic was used to verify and evaluate the discriminative ability of the model; the calibration curve was drawn, and the decision curve analysis (DCA) was performed to evaluate the calibration degree, the clinical net benefit, and the practicability of the model. RESULTS The predictive factors included female, age, unconjugated bilirubin, uric acid, low-density lipoprotein, hyperglycemia, total occlusion, and severe tortuosity lesion on coronary angiography. The C-statistic of the training and validation sets were 0.628 and 0.745, respectively. The statistical value of the Hosmer-Lemeshow test for the calibration curve of the training and validation sets were 5.27(P = 0.873) and 6.27 (P = 0.792), respectively. DCA showed that the model was clinically applicable when the predicted probability value of major adverse cardiovascular events(MACEs) ranged from 0.07 to 0.68. CONCLUSIONS We established a predictive model for poor prognosis after ICR in patients with MVD. The predictive and calibration ability and the clinical net benefit of the predictive model were good, indicating that it can be used as an effective tool for the early prediction of poor prognosis after ICR in patients with MVD.
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Affiliation(s)
| | | | | | | | | | - Ying Zhang
- Ying Zhang, Department of Cardiology, The
Affiliated Hospital of Chengde Medical University, Chengde 067000, Hebei, China.
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12
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Tsai TY, Leu HB, Hsu PF, Yang YL, Chen SC, Huang SS, Chan WL, Lin SJ, Chen JW, Pan JP, Charng MJ, Chen YH, Wu TC, Lu TM, Huang PH, Cheng HM, Huang CC, Sung SH, Lin YJ, Wu CH. Association between visit-to-visit blood pressure variability and adverse events in coronary artery disease patients after coronary intervention. J Clin Hypertens (Greenwich) 2022; 24:1327-1338. [PMID: 36094363 PMCID: PMC9581098 DOI: 10.1111/jch.14565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 08/09/2022] [Accepted: 08/10/2022] [Indexed: 11/30/2022]
Abstract
Blood pressure variability (BPV) is independently associated with higher cardiovascular risks. However, whether BPV is associated with poor outcomes for coronary artery disease (CAD) patients after percutaneous coronary intervention (PCI) remained undetermined. We aimed to investigate the relationship between BPV and the outcomes of CAD patients undergoing PCI. Two thousand seven hundred and sixty-two CAD patients (1938 males, mean age 69.6 ± 12.9) who received PCI at Taipei Veterans General Hospital from 2006 to 2015 with multiple blood pressure measurements before and after the index PCI were enrolled. We calculated the standard deviation of systolic blood pressure, diastolic blood pressure, and pulse pressure as parameters of BPV. The primary endpoint was the composite of major adverse cardiovascular events [MACE comprising of cardiovascular death, nonfatal myocardial infarction (MI), and non-fatal stroke] and heart failure hospitalization (HHF). The key secondary endpoint was MACE. Both pre-PCI and post-PCI BPV were associated with CV events even after adjusting for co-morbidities and mean blood pressure. In Cox analysis, for every 1 mmHg increase in systolic BPV, the hazard ratio for the MACE + HHF, MACE, HHF, and cardiovascular death was 1.04 (95%CI: 1.03-1.05), 1.04 (95%CI: 1.02-1.05), 1.05 (95%CI: 1.04-1.06), and 1.06 (95%CI: 1.03-1.09), respectively. The association between BPV and cardiovascular risk is independent of blood pressure control status. The prognostic value of BPV was superior to mean blood pressure in both pre-PCI and post-PCI period. BPV is independently associated with cardiovascular events after PCI and has a better prognostic value than mean blood pressure suggesting the importance of maintaining stable blood pressure for CAD patients.
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Affiliation(s)
- Tsung-Ying Tsai
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Division of Cardiology, Department of Cardiovascular Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Hsin-Bang Leu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan.,Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming Chiao Tung University, Taipei, Taiwan
| | - Pai-Feng Hsu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan.,Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming Chiao Tung University, Taipei, Taiwan
| | - Ya-Ling Yang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming Chiao Tung University, Taipei, Taiwan
| | - Su-Chan Chen
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming Chiao Tung University, Taipei, Taiwan
| | - Shao-Sung Huang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan
| | - Wan Leong Chan
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan
| | - Shing-Jong Lin
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan.,Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming Chiao Tung University, Taipei, Taiwan
| | - Jaw-Wen Chen
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan.,Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming Chiao Tung University, Taipei, Taiwan
| | - Ju-Pin Pan
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan
| | - Min-Ji Charng
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan
| | - Ying-Hwa Chen
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan
| | - Tao-Cheng Wu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan
| | - Tse-Min Lu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan
| | - Po-Hsun Huang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan
| | - Hao-Min Cheng
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan.,Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming Chiao Tung University, Taipei, Taiwan
| | - Chin-Chou Huang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan
| | - Shih-Hsien Sung
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan
| | - Yenn-Jiang Lin
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan
| | - Cheng-Hsueh Wu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan
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13
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Zhang S, Liu X, Song B, Yu H, Zhang X, Shao Y. Impact of serum uric acid levels on the clinical prognosis and severity of coronary artery disease in patients with acute coronary syndrome and hypertension after percutaneous coronary intervention: a prospective cohort study. BMJ Open 2022; 12:e052031. [PMID: 35022171 PMCID: PMC8756275 DOI: 10.1136/bmjopen-2021-052031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE The impact of serum uric acid (sUA) levels on the clinical prognosis and severity of coronary artery disease in patients with acute coronary syndrome (ACS) and hypertension after percutaneous coronary intervention (PCI) is not fully clear. This study aimed to assess the association among sUA levels, clinical prognosis and severity of coronary artery disease in patients with ACS and hypertension after PCI. DESIGN In this prospective cohort study, we followed-up patients with ACS and hypertension after PCI for 1 year to explore the risk factors for 1 year total major adverse cardiovascular events (MACEs) and multivessel coronary artery disease, the dose-effect relationship among sUA levels, MACEs and severity of coronary artery disease and correlation between sUA levels and severity of coronary artery disease (Gensini score). SETTING/PATIENTS Several Chinese internists followed-up 422 patients who were diagnosed with ACS and hypertension after PCI in a large tertiary hospital of Qingdao during the period from 1 June 2019 to 1 December 2019. OUTCOME MEASURES One-year follow-up MACEs results and coronary angiography results. RESULTS In the coronary angiography results, multivessel coronary artery disease (28.5% vs 21.4%, p=0.006) and non-culprit lesion vascular occlusion (11.7% vs 5.3%, p=0.042) were more common in the hyperuricaemia group, and the Gensini score (26.69±13.46 vs 17.66±10.57, p<0.001) was also higher. In the results of 1-year MACEs, the incidence of all-cause mortality (3.5% vs 2.5%, p=0.037), PCI or coronary artery bypass grafting therapy due to myocardial infarction or angina pectoris (15.1% vs 7.6%, p=0.027), medication conservative therapy in hospital due to myocardial infarction or angina pectoris (12.9% vs 6.7%, p=0.041) and total MACEs (31.8% vs 16.9%, p=0.001) were higher in patients with hyperuricaemia. Univariate and multivariate logistic regression analysis models showed that hyperuricaemia was still an independent risk factor for total MACEs within 1 year (OR=2.618, 95% CI 1.656 to 4.139, p<0.001; OR=1.920, 95% CI 1.158 to 3.183, p=0.011, respectively) and multivessel coronary artery disease (OR=2.140, 95% CI 1.371 to 3.342, p=0.001; OR=1.688, 95% CI 1.051 to 2.710, p=0.030, respectively) after adjusting for confounding factors. The severity of coronary artery disease (non-culprit lesion vascular occlusion (4.7% vs 8.4% vs 9.6% vs 16.2%, p=0.041); multivessel coronary artery disease (17.9% vs 22.4% vs 29.8% vs 35.2%, p=0.022); Gensini score (16.96±10.35 vs 19.31±10.63 vs 26.12±11.48 vs 33.33±14.01, p<0.001)) and the incidence of total MACEs (13.2% vs 14.2% vs 34.6% vs 41%, p<0.001) increased significantly with the sUA levels increasing. Further, the Gensini score was positively correlated with uric acid levels (r=0.515, p<0.001). CONCLUSIONS Hyperuricaemia is an independent risk factor for 1-year total MACEs and multivessel coronary artery disease in patients with ACS and hypertension after PCI.
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Affiliation(s)
- Shiyu Zhang
- Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, shandong, China
| | - Xin Liu
- Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, shandong, China
| | - Bingxue Song
- Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, shandong, China
| | - Haichu Yu
- Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, shandong, China
- Cardiology, The Affiliated Cardiovascular Hospital of Qingdao University, qingdao, shandong, china
| | - Xiaodong Zhang
- Cardiology, Jiaozhou Branch of Shanghai East Hospital,Tongji University, qingdao, shandong, china
| | - Yanming Shao
- Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, shandong, China
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14
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Kim HK, Lee M, Lee YH, Lee BW, Cha BS, Kang ES. Uric Acid Variability as a Predictive Marker of Newly Developed Cardiovascular Events in Type 2 Diabetes. Front Cardiovasc Med 2021; 8:775753. [PMID: 34926623 PMCID: PMC8674506 DOI: 10.3389/fcvm.2021.775753] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 11/08/2021] [Indexed: 12/22/2022] Open
Abstract
Background: Cardiovascular disease (CVD) is associated with morbidity and mortality in patients with type 2 diabetes mellitus (T2D). However, the role of serum uric acid as a risk factor for developing cardiovascular disease is controversial. This study investigated whether uric acid variability was associated with new-onset symptomatic CVD in patients with T2D, requiring percutaneous coronary intervention. Methods: A total of 1,071 patients were enrolled in this retrospective cross-sectional study after propensity score matching. Patients with T2D and new-onset symptomatic CVD who received percutaneous coronary intervention for the first time, and with at least three consecutive 6-monthly measurements of serum uric acid were recruited from Severance Hospital between January 2015 and December 2019. Uric acid variability was measured by average successive variability (ASV) and analyzed to evaluate a possible correlation with the risk of developing CVD. Results: The patients were divided into quartiles based on the uric acid variability. Patients in the highest quartile were older and presented lower renal function and a higher mortality from CVD. There was a linear association between a high uric acid variability and the development of CVD. Compared to the lowest quartile, patients in the higher quartiles had a higher risk of CVD [quartile 3: adjusted odds ratio (aOR) = 1.76; 95% confidence interval (CI), 1.20-2.82; P = 0.019; quartile 4 aOR = 2.89; 95% CI, 1.74-4.80; P < 0.001]. Conclusion: High uric acid variability is independently associated with an increased risk of new-onset symptomatic CVD requiring percutaneous coronary intervention in patients with T2D. Thus, maintaining serum uric acid in a narrow range by prescribing effective medications is essential to prevent new-onset CVD in patients with T2D. Nonetheless, the potential use of uric acid variability as a predictive marker of CVD in patients with T2D needs further validation.
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Affiliation(s)
- Hae Kyung Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Minyoung Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Yong-Ho Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea.,Institute of Endocrine Research, Yonsei University College of Medicine, Seoul, South Korea
| | - Byung-Wan Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea.,Institute of Endocrine Research, Yonsei University College of Medicine, Seoul, South Korea
| | - Bong-Soo Cha
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea.,Institute of Endocrine Research, Yonsei University College of Medicine, Seoul, South Korea
| | - Eun Seok Kang
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea.,Institute of Endocrine Research, Yonsei University College of Medicine, Seoul, South Korea
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15
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Kimura Y, Tsukui D, Kono H. Uric Acid in Inflammation and the Pathogenesis of Atherosclerosis. Int J Mol Sci 2021; 22:ijms222212394. [PMID: 34830282 PMCID: PMC8624633 DOI: 10.3390/ijms222212394] [Citation(s) in RCA: 85] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/06/2021] [Accepted: 11/15/2021] [Indexed: 02/06/2023] Open
Abstract
Hyperuricemia is a common metabolic syndrome. Elevated uric acid levels are risk factors for gout, hypertension, and chronic kidney diseases. Furthermore, various epidemiological studies have also demonstrated an association between cardiovascular risks and hyperuricemia. In hyperuricemia, reactive oxygen species (ROS) are produced simultaneously with the formation of uric acid by xanthine oxidases. Intracellular uric acid has also been reported to promote the production of ROS. The ROS and the intracellular uric acid itself regulate several intracellular signaling pathways, and alterations in these pathways may result in the development of atherosclerotic lesions. In this review, we describe the effect of uric acid on various molecular signals and the potential mechanisms of atherosclerosis development in hyperuricemia. Furthermore, we discuss the efficacy of treatments for hyperuricemia to protect against the development of atherosclerosis.
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Affiliation(s)
- Yoshitaka Kimura
- Department of Internal Medicine, Faculty of Medicine, Teikyo University of Medicine, Tokyo 173-8605, Japan; (Y.K.); (D.T.)
- Department of Microbiology and Immunology, Faculty of Medicine, Teikyo University of Medicine, Tokyo 173-8605, Japan
| | - Daisuke Tsukui
- Department of Internal Medicine, Faculty of Medicine, Teikyo University of Medicine, Tokyo 173-8605, Japan; (Y.K.); (D.T.)
| | - Hajime Kono
- Department of Internal Medicine, Faculty of Medicine, Teikyo University of Medicine, Tokyo 173-8605, Japan; (Y.K.); (D.T.)
- Correspondence: ; Tel.: +81-3-3964-1211
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16
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Tan QH, Liu L, Huang YQ, Yu YL, Huang JY, Chen CL, Tang ST, Feng YQ. Relationship Between Change in Serum Uric Acid and Ischemic Stroke in Chinese Hypertensive Patients. Front Cardiovasc Med 2021; 8:717128. [PMID: 34621799 PMCID: PMC8490735 DOI: 10.3389/fcvm.2021.717128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 08/13/2021] [Indexed: 01/13/2023] Open
Abstract
Background: Limited studies focused on the association between serum uric acid (SUA) change with ischemic stroke, and their results remain controversial. The present study aimed to investigate the relationship between change in SUA with ischemic stroke among hypertensive patients. Method: This was a retrospective cohort study. We recruited adult hypertensive patients who had two consecutive measurements of SUA levels from 2013 to 2014 and reported no history of stroke. Change in SUA was assessed as SUA concentration measured in 2014 minus SUA concentration in 2013. Multivariable Cox proportional hazards models were used to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs). The Kaplan–Meier analysis and log-rank test were performed to quantify the difference in cumulative event rate. Additionally, subgroup analysis and interaction tests were conducted to investigate heterogeneity. Results: A total of 4,628 hypertensive patients were included, and 93 cases of ischemic stroke occurred during the mean follow-up time of 3.14 years. Participants were categorized into three groups according to their SUA change tertiles [low (SUA decrease substantially): <-32.6 μmol/L; middle (SUA stable): ≥-32.6 μmol/L, <40.2 μmol/L; high (SUA increase substantially): ≥40.2 μmol/L]. In the fully adjusted model, setting the SUA stable group as reference, participants in the SUA increase substantially group had a significantly elevated risk of ischemic stroke [HR (95% CI), 1.76 (1.01, 3.06), P = 0.0451], but for the SUA decrease substantially group, the hazard effect was insignificant [HR (95% CI), 1.31 (0.75, 2.28), P = 0.3353]. Age played an interactive role in the relationship between SUA change and ischemic stroke. Younger participants (age < 65 years) tended to have a higher risk of ischemic stroke when SUA increase substantially. Conclusion: SUA increase substantially was significantly correlated with an elevated risk of ischemic stroke among patients with hypertension.
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Affiliation(s)
- Qiu-Hong Tan
- School of Biology and Biological Engineering, South China University of Technology, Guangzhou, China.,Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Lin Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yu-Qing Huang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yu-Ling Yu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jia-Yi Huang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Chao-Lei Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Song-Tao Tang
- Department of Cardiology, Community Health Center of Liaobu County, Dongguan, China
| | - Ying-Qing Feng
- School of Biology and Biological Engineering, South China University of Technology, Guangzhou, China.,Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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17
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Xiao S, Zhang L, Wu Q, Hu Y, Wang X, Pan Q, Liu A, Liu Q, Liu J, Zhu H, Zhou Y, Pan D. Development and Validation of a Risk Nomogram Model for Predicting Revascularization After Percutaneous Coronary Intervention in Patients with Acute Coronary Syndrome. Clin Interv Aging 2021; 16:1541-1553. [PMID: 34447245 PMCID: PMC8384150 DOI: 10.2147/cia.s325385] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 08/05/2021] [Indexed: 01/21/2023] Open
Abstract
Objective Percutaneous coronary intervention (PCI) is one of the most effective treatments for acute coronary syndrome (ACS). However, the need for postoperative revascularization remains a major problem in PCI. This study was to develop and validate a nomogram for prediction of revascularization after PCI in patients with ACS. Methods A retrospective observational study was conducted using data from 1083 patients who underwent PCI (≥6 months) at a single center from June 2013 to December 2019. They were divided into training (70%; n = 758) and validation (30%; n = 325) sets. Multivariate logistic regression analysis was used to establish a predictive model represented by a nomogram. The nomogram was developed and evaluated based on discrimination, calibration, and clinical efficacy using the concordance statistic (C-statistic), calibration plot and decision curve analysis (DCA), respectively. Results The nomogram was comprised of ten variables: follow-up time (odds ratio (OR): 1.01; 95% confidence interval (CI): 1.00-1.03), history of diabetes mellitus (OR: 1.83; 95% CI: 1.25-2.69), serum creatinine level on admission (OR: 0.99; 95% CI: 0.98-1.00), serum uric acid level on admission (OR: 1.005; 95% CI: 1.002-1.007), lipoprotein-a level on admission (OR: 1.0021; 95% CI: 1.0013-1.0029), low density lipoprotein cholesterol level on re-admission (OR: 1.33; 95% CI: 0.10-0.47), the presence of chronic total occlusion (OR: 3.30; 95% CI: 1.93-5.80), the presence of multivessel disease (OR: 4.48; 95% CI: 2.85-7.28), the presence of calcified lesions (OR: 1.63; 95% CI: 1.11-2.39), and the presence of bifurcation lesions (OR: 1.82; 95% CI: 1.20-2.77). The area under the receiver operating characteristic curve values for the training and validation sets were 0.765 (95% CI: 0.732-0.799) and 0.791 (95% CI: 0.742-0.830), respectively. The calibration plots showed good agreement between prediction and observation in both the training and validation sets. DCA also demonstrated that the nomogram was clinically useful. Conclusion We developed an easy-to-use nomogram model to predict the risk of revascularization after PCI in patients with ACS. The nomogram may provide useful assessment of risk for subsequent treatment of ACS patients undergoing PCI.
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Affiliation(s)
- Shengjue Xiao
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221004, People's Republic of China
| | - Linyun Zhang
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221004, People's Republic of China.,Department of Cardiology, The People's Hospital of Suzhou New District, Suzhou, Jiangsu, 215000, People's Republic of China
| | - Qi Wu
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221004, People's Republic of China
| | - Yue Hu
- Department of General Practice, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221004, People's Republic of China
| | - Xiaotong Wang
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221004, People's Republic of China
| | - Qinyuan Pan
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221004, People's Republic of China
| | - Ailin Liu
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221004, People's Republic of China
| | - Qiaozhi Liu
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221004, People's Republic of China
| | - Jie Liu
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221004, People's Republic of China
| | - Hong Zhu
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221004, People's Republic of China
| | - Yufei Zhou
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210029, People's Republic of China.,Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Shanghai Medical College of Fudan University, Shanghai, 200030, People's Republic of China
| | - Defeng Pan
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221004, People's Republic of China
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18
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Yang YL, Chen SC, Wu CH, Huang SS, Chan WL, Lin SJ, Chou CY, Chen JW, Ju-Pin P, Charng MJ, Chen YH, Wu TC, Lu TM, Hsu PF, Huang PH, Cheng HM, Huang CC, Sung SH, Lin YJ, Leu HB. Optimal blood pressure for patients with end-stage renal disease following coronary interventions. J Clin Hypertens (Greenwich) 2021; 23:1622-1630. [PMID: 34263995 PMCID: PMC8678782 DOI: 10.1111/jch.14325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 06/11/2021] [Accepted: 07/02/2021] [Indexed: 12/01/2022]
Abstract
Hypertension is a frequent manifestation of chronic kidney disease but the ideal blood pressure (BP) target in patients with coronary artery disease (CAD) with end-stage renal disease (ESRD) (eGFR < 15 ml/min/1.73m2 ) still unclear. The authors aimed to investigate the ideal achieved BP in ESRD patients with CAD after coronary intervention. Five hundred and seventy-five ESRD patients who had undergone percutaneous coronary interventions (PCIs) were enrolled and their clinical outcomes were analyzed according to the category of systolic BP (SBP) and diastolic BP (DBP) achieved. The clinical outcomes included major cardiovascular events (MACE) and MACE plus hospitalization for congestive heart failure (total cardiovascular (CV) event).The mean systolic BP was 135.0 ± 24.7 mm Hg and the mean diastolic BP was 70.7 ± 13.1 mm Hg. Systolic BP 140-149 mm Hg and diastolic BP 80-89 mm Hg had the lowest MACE (11.0%; 13.2%) and total CV event (23.3%; 21.1%). Patients with systolic BP < 120 mm Hg had a higher risk of MACE (HR: 2.01; 95% CI: 1.17-3.46, p = .008) than those with systolic BP 140-149 mm Hg. Patients with systolic BP ≥ 160 mm Hg (HR: 1.84; 95% CI, 3.27-1.04, p = .04) and diastolic blood BP ≥ 90 mm Hg (HR: 2.19; 95% CI: 1.15-4.16, p = .02) had a higher risk of total CV event rate when compared to those with systolic BP 140-149 mm Hg and diastolic BP 80-89 mm Hg. A J-shaped association between systolic (140-149 mm Hg) and diastolic (80-89 mm Hg) BP and decreased cardiovascular events for CAD was found in patients with ESRD after undergoing PCI in non-Western population.
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Affiliation(s)
- Ya-Ling Yang
- Division of Cardiology, Department of Medicine, Cardinal Tien Hospital, Taiwan, ROC.,Department of Medicine, School of Medicine, National Yang-Ming Chiao University, Taipei, Taiwan, ROC
| | - Su-Chan Chen
- Department of Medicine, School of Medicine, National Yang-Ming Chiao University, Taipei, Taiwan, ROC.,Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Cheng-Hsueh Wu
- Department of Medicine, School of Medicine, National Yang-Ming Chiao University, Taipei, Taiwan, ROC.,Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Shao-Sung Huang
- Department of Medicine, School of Medicine, National Yang-Ming Chiao University, Taipei, Taiwan, ROC.,Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.,Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Wan Leong Chan
- Department of Medicine, School of Medicine, National Yang-Ming Chiao University, Taipei, Taiwan, ROC.,Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Shing-Jong Lin
- Department of Medicine, School of Medicine, National Yang-Ming Chiao University, Taipei, Taiwan, ROC.,Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chia-Yu Chou
- Department of Medicine, School of Medicine, National Yang-Ming Chiao University, Taipei, Taiwan, ROC.,Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Jaw-Wen Chen
- Department of Medicine, School of Medicine, National Yang-Ming Chiao University, Taipei, Taiwan, ROC.,Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.,Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Pan Ju-Pin
- Department of Medicine, School of Medicine, National Yang-Ming Chiao University, Taipei, Taiwan, ROC.,Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Min-Ji Charng
- Department of Medicine, School of Medicine, National Yang-Ming Chiao University, Taipei, Taiwan, ROC.,Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Ying-Hwa Chen
- Department of Medicine, School of Medicine, National Yang-Ming Chiao University, Taipei, Taiwan, ROC.,Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Tao-Cheng Wu
- Department of Medicine, School of Medicine, National Yang-Ming Chiao University, Taipei, Taiwan, ROC.,Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Tse-Min Lu
- Department of Medicine, School of Medicine, National Yang-Ming Chiao University, Taipei, Taiwan, ROC.,Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.,Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Pai-Feng Hsu
- Department of Medicine, School of Medicine, National Yang-Ming Chiao University, Taipei, Taiwan, ROC.,Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Po-Hsun Huang
- Department of Medicine, School of Medicine, National Yang-Ming Chiao University, Taipei, Taiwan, ROC.,Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Hao-Min Cheng
- Department of Medicine, School of Medicine, National Yang-Ming Chiao University, Taipei, Taiwan, ROC.,Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chin-Chou Huang
- Department of Medicine, School of Medicine, National Yang-Ming Chiao University, Taipei, Taiwan, ROC.,Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Shih-Hsien Sung
- Department of Medicine, School of Medicine, National Yang-Ming Chiao University, Taipei, Taiwan, ROC.,Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yenn-Jiang Lin
- Department of Medicine, School of Medicine, National Yang-Ming Chiao University, Taipei, Taiwan, ROC.,Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Hsin-Bang Leu
- Department of Medicine, School of Medicine, National Yang-Ming Chiao University, Taipei, Taiwan, ROC.,Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.,Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.,Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan, ROC
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19
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Li X, Li Z, Wu X, Zhang M, Xu L, Hao X, Li H, Qiao P, Wang W. Serum uric acid variability increases the risk of postoperative chronic kidney disease in patients with renal cell carcinoma after radical nephrectomy. Urol Oncol 2021; 39:500.e1-500.e7. [PMID: 34187751 DOI: 10.1016/j.urolonc.2021.05.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 05/15/2021] [Accepted: 05/21/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Serum uric acid (SUA) level is associated with the progression of chronic kidney disease (CKD). However, little is known about the predictive value of SUA variability for postoperative CKD in patients with renal cell carcinoma after radical nephrectomy. We aimed to investigate the association of SUA variability with postoperative CKD in this population. METHOD 85 patients with preoperative estimated glomerular filtration rate (eGFR)≥60 ml/min/1.73 m2 were enrolled in this single-center retrospective study and followed up for at least 6 months. Intra-individual SUA variability was defined as the standard deviation (SD) of SUA and the patients were stratified into three groups according to the tertiles of SUA SD (the lower, middle and upper tertile). The association of SUA variability with postoperative CKD, defined as an eGFR<60 ml/min/1.73m2, was analyzed by Cox proportional hazard models and Kaplan-Meier analyses. RESULTS After a median follow-up time of 24(10-43) months, 44(51.7%) patients developed postoperative CKD. Kaplan-Meier curves showed that patients in the lower tertile had a longer CKD-free survival time [median CKD-free survival time 74(52.2-95.8) months] than those in the middle tertile [38(19.2-56.8) months] and upper tertile [21(17.9-24.1) months] (overall generalized Wilcoxon test: P=0.001; lower vs middle tertile: P=0.001; lower vs upper tertile: P<0.001). Adjusted Cox analyses indicated that increasing SUA SD tertiles were associated with a higher risk of postoperative CKD independent of baseline SUA, mean SUA during follow-up and other confounding variables. Compared with patients in the lower tertile, the risk for developing CKD increased by 4.6-fold for patients in the middle tertile and 7.9-fold in the upper tertile, respectively. CONCLUSION Increasing SUA variability was associated with an increased risk of postoperative CKD in patients with renal cell carcinoma after radical nephrectomy.
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Affiliation(s)
- Xin Li
- Department of Nephrology, Shanghai Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Zhen Li
- Clinical Research Center, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiaojing Wu
- Department of Nephrology, Shanghai Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Muyin Zhang
- Department of Nephrology, Shanghai Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Lili Xu
- Department of Nephrology, Shanghai Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xu Hao
- Department of Nephrology, Shanghai Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Hao Li
- Department of Nephrology, Shanghai Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Panpan Qiao
- Department of Nephrology, Shanghai Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Weiming Wang
- Department of Nephrology, Shanghai Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
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20
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Hromadka M, Opatrny J, Miklik R, Suchy D, Bruthans J, Jirak J, Rokyta R, Mayer O. Uricemia in the acute phase of myocardial infarction and its relation to long-term mortality risk. J Comp Eff Res 2021; 10:979-988. [PMID: 34114471 DOI: 10.2217/cer-2021-0082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: Although uric acid has antioxidant effects, hyperuricemia has been established as an indicator of increased cardiovascular mortality in various patient populations. Treatment of asymptomatic hyperuricemia in patients with acute myocardial infarction (MI) is not routinely recommended, and the efficacy of such treatment in terms of cardiovascular risk reduction remains doubtful. Materials & methods: In a prospective cohort study, we followed 5196 patients admitted for a MI between 2006 and 2018. We assessed the relationship between baseline uricemia and the incidence of all-cause death and cardiovascular mortality and the effect of long-term allopurinol treatment. Hyperuricemia was defined as serum uric acid >450 μmol/l in men and >360 μmol/l in women. Results: In the entire cohort, the 1-year all-cause and cardiovascular mortality rates were 8 and 7.4%, and the 5-year rates were 18.3 and 15.3%, respectively. Using a fully adjusted model, hyperuricemia was associated with a 70% increased risk of both all-cause death and cardiovascular mortality at 1 year, and the negative prognostic value of hyperuricemia persisted over the 5-year follow-up (for all-cause death, hazard risk ratio = 1.45 [95% CI: 1.23-1.70] and for cardiovascular mortality, hazard risk ratio = 1.52 [95% CI: 1.28-1.80], respectively). Treatment of asymptomatic hyperuricemia with allopurinol did not affect mortality rates. Conclusion: Hyperuricemia detected in patients during the acute phase of an MI appears to be independently associated with an increased risk of subsequent fatal cardiovascular events. However, hyperuricemia treatment with low-dose allopurinol did not prove beneficial for these patients.
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Affiliation(s)
- Milan Hromadka
- Cardiology Department, University Hospital & Faculty of Medicine, Pilsen, Charles University, Czech Republic
| | - Jan Opatrny
- Cardiology Department, University Hospital & Faculty of Medicine, Pilsen, Charles University, Czech Republic
| | - Roman Miklik
- Cardiology Department, University Hospital & Faculty of Medicine, Pilsen, Charles University, Czech Republic
| | - David Suchy
- Department of Clinical Pharmacology, Rheumatology, University Hospital & Faculty of Medicine, Pilsen, Charles University, Czech Republic
| | - Jan Bruthans
- Centre for Cardiovascular Prevention, First Faculty of Medicine, Charles University & Thomayer's Hospital, Prague, Czech Republic.,2nd Department of Internal Medicine, University Hospital & Faculty of Medicine, Pilsen, Charles University, Czech Republic
| | - Josef Jirak
- Department of Informatics, University Hospital, Pilsen, Czech Republic
| | - Richard Rokyta
- Cardiology Department, University Hospital & Faculty of Medicine, Pilsen, Charles University, Czech Republic
| | - Otto Mayer
- 2nd Department of Internal Medicine, University Hospital & Faculty of Medicine, Pilsen, Charles University, Czech Republic.,Biomedical Center, Faculty of Medicine, Pilsen, Charles University, Czech Republic
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21
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Abstract
Several studies suggest that, together with glucose variability, the variability of other risk factors, as blood pressure, plasma lipids, heart rate, body weight, and serum uric acid, might play a role in the development of diabetes complications. Moreover, the variability of each risk factor, when contemporarily present, may have additive effects. However, the question is whether variability is causal or a marker. Evidence shows that the quality of care and the attainment of the target impact on the variability of all risk factors. On the other hand, for some of them causality may be considered. Although specific studies are still lacking, it should be useful checking the variability of a risk factor, together with its magnitude out of the normal range, in clinical practice. This can lead to an improvement of the quality of care, which, in turn, could further hesitate in an improvement of risk factors variability.
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Affiliation(s)
- Antonio Ceriello
- IRCCS MultiMedica, Via Gaudenzio Fantoli, 16/15, 20138, Milan, Italy.
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22
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Demiray A, Afsar B, Covic A, Kuwabara M, Ferro CJ, Lanaspa MA, Johnson RJ, Kanbay M. The Role of Uric Acid in the Acute Myocardial Infarction: A Narrative Review. Angiology 2021; 73:9-17. [PMID: 33902350 DOI: 10.1177/00033197211012546] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Increased serum uric acid (SUA) levels have been associated with various pathologic processes such as increased oxidative stress, inflammation, and endothelial dysfunction. Thus, it is not surprising that increased SUA is associated with various adverse outcomes including cardiovascular (CV) diseases. Recent epidemiological evidence suggests that increased SUA may be related to acute myocardial infarction (AMI). Accumulating data also showed that elevated UA has pathophysiological role in the development of AMI. However, there are also studies showing that SUA is not related to the risk of AMI. In this narrative review, we summarized the recent literature data regarding SUA and AMI after providing some background information for the association between UA and coronary artery disease. Future studies will show whether decreasing SUA levels is beneficial for outcomes related to AMI and the optimum SUA levels for best outcomes in CV diseases.
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Affiliation(s)
- Atalay Demiray
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Baris Afsar
- Division of Nephrology, Department of Internal Medicine, Suleyman Demirel University School of Medicine, Isparta, Turkey
| | - Adrian Covic
- Department of Nephrology, Grigore T. Popa' University of Medicine, Iasi, Romania
| | - Masanari Kuwabara
- Intensive Care Unit and Department of Cardiology, Toranomon Hospital, Tokyo, Japan
| | - Charles J Ferro
- Department of Renal Medicine, University Hospitals Birmingham, Edgbaston, Birmingham, the United Kingdom
| | - Miguel A Lanaspa
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Richard J Johnson
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Mehmet Kanbay
- Department of Medicine, Division of Nephrology, Koc University School of Medicine, Istanbul, Turkey
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23
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Tian X, Wang A, Zuo Y, Chen S, Zhang L, Wu S, Luo Y. Visit-to-visit variability of serum uric acid measurements and the risk of all-cause mortality in the general population. Arthritis Res Ther 2021; 23:74. [PMID: 33663587 PMCID: PMC7931538 DOI: 10.1186/s13075-021-02445-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 02/11/2021] [Indexed: 11/16/2022] Open
Abstract
Background Evidence on longitudinal variability of serum uric acid (SUA) and risk of all-cause mortality in the general population is limited, as many prior studies focused on a single measurement of SUA. Methods A total of 53,956 participants in the Kailuan study who underwent three health examinations during 2006 to 2010 were enrolled. Variability of SUA was measured using the coefficient of variation (primary index), standard deviation, average real variability, and variability independent of the mean. Cox proportional hazard regressions were used to calculate the hazard ratio (HR) and 95% confidence interval (CI) for the association of variability of SUA with subsequent risk of all-cause mortality, considering its magnitude and the direction and across different baseline SUA categories. Results Over a median follow-up of 7.04 years, 2728 participants died. The highest variability of SUA was associated with an increased risk of all-cause mortality, the HR was 1.33 (95% CI, 1.20–1.49) compared with the lowest variability. In this group, both a large fall (HR, 1.28; 95% CI, 1.14–1.44) and rise (HR, 1.18; 95% 1.05–1.32) in SUA were related to risk of all-cause mortality. These associations were similar across different baseline SUA categories. Consistent results were observed in alternative measures of SUA variability. Moreover, individuals with higher variability in SUA were more related to common risk factors than those with stable SUA. Conclusions Higher variability in SUA was independently associated with the risk of all-cause mortality irrespective of baseline SUA and direction of variability in the general population.
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Affiliation(s)
- Xue Tian
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No.10 Xitoutiao, You'anmen Wai, Fengtai District, Beijing, 100069, China.,Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Anxin Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yingting Zuo
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No.10 Xitoutiao, You'anmen Wai, Fengtai District, Beijing, 100069, China.,Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Shuohua Chen
- Department of Cardiology, Kailuan Hospital, North China University of Science and Technology, 57 Xinhua East Rd, Tangshan, 063000, China
| | - Licheng Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No.10 Xitoutiao, You'anmen Wai, Fengtai District, Beijing, 100069, China.,Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Shouling Wu
- Department of Cardiology, Kailuan Hospital, North China University of Science and Technology, 57 Xinhua East Rd, Tangshan, 063000, China.
| | - Yanxia Luo
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No.10 Xitoutiao, You'anmen Wai, Fengtai District, Beijing, 100069, China. .,Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China.
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24
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Mozzini C, Girelli D, Setti A, Croce J, Stefanoni F, Castagna A, Pizzolo F, Friso S, Olivieri O, Martinelli N. Serum Uric Acid Levels, but Not rs7442295 Polymorphism of SCL2A9 Gene, Predict Mortality in Clinically Stable Coronary Artery Disease. Curr Probl Cardiol 2021; 46:100798. [PMID: 33540324 DOI: 10.1016/j.cpcardiol.2021.100798] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 01/14/2021] [Indexed: 10/22/2022]
Abstract
Serum uric acid (SUA) has been associated with cardiovascular disease, but up to now whether SUA is an independent cardiovascular risk factor or merely a disease-related epiphenomenon remains still controversial. within the framework of the Verona Heart Study, we prospectively followed 703 subjects with angiographically demonstrated and clinically stable coronary artery disease between May 1996 and March 2007. At baseline, SUA levels were measured in all the patients. Genotype data of SCL2A9 rs7442295 polymorphism, which has been associated with SUA by genome-wide association studies, were available for 686 subjects (97.6%). After a median follow-up of 57 months, 116 patients (16.5%) had died, 83 (11.8%) because of cardiovascular causes. Patients with hyperuricemia, defined by SUA levels above the 75th percentile (≥0.41 mmol/L), had an increased total and cardiovascular mortality rate than those with SUA below this threshold level (23.3% vs 14.1%, P = 0.048 and 19.4% vs 9.2%, P = 0.001, respectively, by Kaplan-Meier with Log-Rank test). These associations were confirmed by Cox regression after adjustment for sex, age, other predictors of mortality, coronary revascularization, and drug therapies at discharge (hazard ratio for total mortality 1.87 [1.05-3.34], P = 0.033; hazard ratio for cardiovascular mortality 2.09 [1.03-4.25], P = 0.041). Although associated with SUA levels, rs7442295 polymorphism did not predict total or cardiovascular mortality. our data support that SUA may be a prognostic cardiovascular biomarker, predicting total and cardiovascular mortality in the setting of secondary prevention of coronary artery disease. On the other hand, SCL2A9 gene polymorphism, notwithstanding a clear influence on SUA levels, was not associated with mortality.
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Affiliation(s)
- Chiara Mozzini
- Department of Medicine, Section of Internal Medicine, University of Verona, Verona, Italy.
| | - Domenico Girelli
- Department of Medicine, Section of Internal Medicine, University of Verona, Verona, Italy
| | - Angela Setti
- Department of Medicine, Section of Internal Medicine, University of Verona, Verona, Italy
| | - Jacopo Croce
- Department of Medicine, Section of Internal Medicine, University of Verona, Verona, Italy
| | - Filippo Stefanoni
- Department of Medicine, Section of Internal Medicine, University of Verona, Verona, Italy
| | - Annalisa Castagna
- Department of Medicine, Section of Internal Medicine, University of Verona, Verona, Italy
| | - Francesca Pizzolo
- Department of Medicine, Section of Internal Medicine, University of Verona, Verona, Italy
| | - Simonetta Friso
- Department of Medicine, Section of Internal Medicine, University of Verona, Verona, Italy
| | - Oliviero Olivieri
- Department of Medicine, Section of Internal Medicine, University of Verona, Verona, Italy
| | - Nicola Martinelli
- Department of Medicine, Section of Internal Medicine, University of Verona, Verona, Italy
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Gao K, Li Y, Su Y, Lin Z, Yang X, Xu M, Huang Y, Chen S, Xie Y, Li Z. High uric acid promotes mitophagy through the ROS/CaMKIIδ/Parkin pathway in cardiomyocytes in vitro and in vivo. Am J Transl Res 2021; 13:8754-8765. [PMID: 34539992 PMCID: PMC8430116 DOI: pmid/34539992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 06/13/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Increasing evidence has suggested that high uric acid (HUA) is closely related to cardiovascular disease (CVD). Mitophagy abnormalities have been reported to participate in multiple pathogenic processes of CVD. However, the potential molecular mechanisms remain unclear. Herein, we investigated the effect of HUA-induced mitophagy and its potential molecular mechanism in cardiomyocytes. METHODS We established a model of cardiomyocytes induced by HUA in vitro and in vivo. Mitochondrial membrane potential (MMP), reactive oxygen species (ROS) production and adenosine triphosphate (ATP) content were measured. The mitophagy-related protein expression of LC3B-II, Parkin, Ca2+/calmodulin-dependent protein kinase II δ (CaMKIIδ) and P62 was measured by Western blot. Based on the colocalization of lysosomes and mitochondria, a confocal microscope was used to detect mitophagy. Additionally, we established a mitophagy inhibitor group (3-MA) and CaMKIIδ inhibitor group (KN-93) to verify the pathway. RESULTS In the HUA stimulation model, ROS production was increased, and mitochondrial injury indexes (MMP and ATP contents) were decreased. Moreover, these indicators were reversed by 3-MA and KN-93. Under HUA stimulation, the expression of LC3B-II, Parkin, CaMKIIδ and P62 increased significantly. Furthermore, these protein levels were reduced by 3-MA and KN-93. CONCLUSION HUA can promote cardiomyocyte mitophagy activation through the ROS/CaMKIIδ/parkin pathway axis. This study may provide a new target and theoretical basis for the prevention and treatment of HUA-related metabolic heart disease in the future.
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Affiliation(s)
- Kai Gao
- Emergency Department, The Second Affiliated Hospital of Shantou University Medical CollegeShantou, Guangdong Province, China
| | - Yanbing Li
- Department of Cardiology, Beijing Youan Hospital, Capital Medical UniversityBeijing, China
| | - Yiwan Su
- Department of Cardiology, The Second Affiliated Hospital of Shantou University Medical CollegeShantou, Guangdong Province, China
| | - Zhishan Lin
- Department of Cardiology, The Second Affiliated Hospital of Shantou University Medical CollegeShantou, Guangdong Province, China
| | - Xiangbin Yang
- Department of Cardiology, The Second Affiliated Hospital of Shantou University Medical CollegeShantou, Guangdong Province, China
| | - Meiling Xu
- Emergency Department, The Second Affiliated Hospital of Shantou University Medical CollegeShantou, Guangdong Province, China
| | - Yanting Huang
- Department of Cardiology, The Second Affiliated Hospital of Shantou University Medical CollegeShantou, Guangdong Province, China
| | - Shuqin Chen
- Department of Cardiology, The Second Affiliated Hospital of Shantou University Medical CollegeShantou, Guangdong Province, China
| | - Yang Xie
- Emergency Department, The Second Affiliated Hospital of Shantou University Medical CollegeShantou, Guangdong Province, China
| | - Zhi Li
- Department of Cardiology, The Second Affiliated Hospital of Shantou University Medical CollegeShantou, Guangdong Province, China
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Abstract
OBJECTIVES Uric acid(UA) is related with cardiovascular disease, but the association of UA variability with all-cause mortality is rarely known. This study aimed to investigate the relationship between UA variability and all-cause mortality in Kailuan cohort study in northern China. DESIGN Cohort study. SETTING Kailuan community hospitals in Tangshan, Hebei province, Northern China. PARTICIPANTS A total of 55717 participants from Kailuan Study were enrolled, and our study followed up biennially from 2006 to 2010. MEASUREMENTS Clinical records of the participants enrolled were analyzed. UA variation independent of mean (UAVIM) values were calculated and all the participants were quartile grouped into four groups as: Q1(UAVIM<0.68), Q2(0.68≤UAVIM<1.10), Q3(1.10≤UAVIM<1.67) and Q4(UAVIM≥1.67). The endpoint event was all-cause death. Cox regression model was performed to evaluate the hazard ratios(HRs) of all-cause mortality based on UAVIM groups. RESULTS During a median follow-up of 6.83 years, 2926 deaths occurred. The accumulated mortality rates were 4.6%, 4.8%, 5.4% and 6.1% in group Q1, Q2, Q3 and Q4 respectively. When adjusted potential confounders, the highest risk for all-cause mortality was in group Q4 and the adjusted HRs and 95% confidence intervals(CIs) of group Q2-Q4 for all-cause death were 1.044(0.937, 1.164), 1.182(1.064, 1.314) and 1.353(1.220, 1.501) compared with group Q1, respectively. Further analysis showed that the risk for all-cause death increased as UAVIM value increased. Sensitive analysis still showed the similar results when excluding participants with hyperuricemia or severe chronic kidney diseases. Sub-group analysis by age, gender, BMI or hypertension history also indicated analogous results. CONCLUSION Elevated UAVIM was related with increased all-cause mortality and UAVIM was an independent risk factor for all-cause mortality in the community cohort study.
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Affiliation(s)
- M Wang
- Shouling Wu, Department of Cardiology, Kailuan Hospital, Hebei United University, Tangshan, China, E-mail: ; Hao Xue, Department of Cardiology, Chinese People's Liberation Army General Hospital, Beijing, China, E-mail:
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27
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Wang C, Cui T, Wang L, Zhu Q, Wang A, Yuan Y, Hao Z, Wu B. Prognostic significance of uric acid change in acute ischemic stroke patients with reperfusion therapy. Eur J Neurol 2020; 28:1218-1224. [PMID: 33176022 DOI: 10.1111/ene.14643] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 10/26/2020] [Accepted: 11/04/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Uric acid (UA) is an important endogenous free radical scavenger that has been found to have a neuroprotective effect. However, there is uncertainty about the relationship between UA change and outcome in acute ischemic stroke (AIS) patients with reperfusion therapy. METHODS We consecutively enrolled AIS patients with reperfusion therapy. UA was measured upon admission and during hospitalization. The change in UA levels (ΔUA) was determined by calculating the difference between admission UA and the lowest UA among all follow-up measurements, with a positive ΔUA suggesting a decrease in UA levels. Functional outcome was assessed by modified Rankin Scale (mRS) at 3 months. Poor outcome was defined as mRS >2. RESULTS A total of 361 patients were included (mean age 68.7 ± 13.9 years, 54.3% males). The mean UA on admission was 355 ± 96.1 μmol/L. The median ΔUA was 121 μmol/L (IQR 50-192 μmol/L) and 18 (5%) patients had increased UA levels. UA on admission was positively associated with good outcome (p for trend = 0.017). When patients were classified into quartiles by ΔUA, patients with the largest decrease in UA (Q4: 199-434 μmol/L) had a higher risk of poor outcome at 3 months compared to patients with the least decrease in UA (Q1: 0-57 μmol/L) (OR 2.55, 95% CI 1.09-5.98, p = 0.031). The risk of poor outcome increased with ΔUA (p for trend = 0.048). CONCLUSIONS In patients with reperfusion therapy, high UA on admission was associated with a good 3-month outcome, while a greater decrease in UA was associated with poor outcome.
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Affiliation(s)
- Changyi Wang
- Center of Cerebrovascular Diseases, Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ting Cui
- Center of Cerebrovascular Diseases, Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Lu Wang
- Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qiange Zhu
- The Second Department of Neurology, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China
| | - Anmo Wang
- Center of Cerebrovascular Diseases, Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ye Yuan
- Center of Cerebrovascular Diseases, Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zilong Hao
- Center of Cerebrovascular Diseases, Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Bo Wu
- Center of Cerebrovascular Diseases, Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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28
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Dong Y, Shi H, Chen X, Fu K, Li J, Chen H, Teng W, Tian L. Serum uric acid and risk of stroke: a dose-response meta-analysis. J Clin Biochem Nutr 2020; 68:221-227. [PMID: 34025024 PMCID: PMC8129984 DOI: 10.3164/jcbn.20-94] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 07/19/2020] [Indexed: 01/11/2023] Open
Abstract
The relationship between serum uric acid and risk of stroke is still controversial. Therefore, we conducted a meta-analysis based on the cohort study to explore the relationship between serum uric acid and risk of stroke, and further illuminate whether there is a linear or non-linear relationship between them. We manually searched the database including Cochrane, PubMed, Embase, Web of Science, and selected cohort studies focusing on the relationship between serum uric acid and stroke risk. Random effect model was used for statistical analysis. Twenty-one cohort studies involving 818,098 participants were included. The pooled relative risk for the high-vs-low categories was 1.22 (95% CI: 1.15-1.30). In addition, there was a non-linear dose-response relationship between uric acid and stroke risk. Serum uric acid was in the range of 3-5 mg/dl, with the lowest risk of stroke. In conclusion, high serum uric acid level increases the risk of stroke, with a non-linear dose-response relationship.
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Affiliation(s)
- Yunan Dong
- Department of Geriatrics, Shengjing Hospital of China Medical University, No. 36, San Hao Street, Heping District, Shenyang 110004, China
| | - Han Shi
- The First Clinical Department, China Medical University, No. 77, Puhe Road, Shenyang North Area, Shenyang, Liaoning Province, 110122, China
| | - Xinxin Chen
- Department of Neurology, The First Hospital of China Medical University, No. 155, North Nanjing Street, Heping District, Shenyang 110001, China
| | - Kailei Fu
- Department of Neurology, The First Hospital of China Medical University, No. 155, North Nanjing Street, Heping District, Shenyang 110001, China
| | - Jinwei Li
- Department of Neurology, The First Hospital of China Medical University, No. 155, North Nanjing Street, Heping District, Shenyang 110001, China
| | - Hanze Chen
- Department of Neurology, The First Hospital of China Medical University, No. 155, North Nanjing Street, Heping District, Shenyang 110001, China
| | - Weiyu Teng
- Department of Neurology, The First Hospital of China Medical University, No. 155, North Nanjing Street, Heping District, Shenyang 110001, China
| | - Li Tian
- Department of Geriatrics, Shengjing Hospital of China Medical University, No. 36, San Hao Street, Heping District, Shenyang 110004, China
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Sakane N, Okuno A, Nomaguchi K, Tanaka M, Abe F, Kakiuchi I, Kiyosawa K, Miyasaka M, Nakamura M. Diagnostic Accuracy of Single Spot Urine for Detecting Renal Uric Acid Underexcretion in Men. J Clin Med Res 2020; 12:443-447. [PMID: 32655739 PMCID: PMC7331867 DOI: 10.14740/jocmr4250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 06/16/2020] [Indexed: 11/18/2022] Open
Abstract
Background The uric acid (UA) clearance test to evaluate the hyperuricemia phenotype requires a great deal of time. However, the utility of single spot urine is scarce. The study aimed to determine the diagnostic accuracy of single spot urine for predicting renal UA underexcretion (the decreased UA excretion) in men. Methods A total of 73 male participants aged 20 - 74 years with a UA level of 6.0 - 7.9 mg/dL were enrolled in the study. Renal UA underexcretion was defined as < 7.3 mL/min using the 60-min method. Urinary UA to creatinine ratio (UACR), fractional clearance of urate (FCU), and the Simkin index were calculated. A receiver operating characteristic (ROC) analysis was performed to compare the diagnostic utility of these parameters for predicting UA underexcretion. Results In the ROC analysis, the area under the curve values of the UACR, FCU, and the Simkin index for predicting UA underexcretion were 0.903 (95% confidence interval (CI): 0.830 - 0.976), 0.841 (95% CI: 0.749 - 0.933), and 0.779 (95% CI: 0.673 - 0.885), respectively. An optimal UACR cutoff of 0.460 (sensitivity 89.2%, specificity 80.6%, overall diagnostic accuracy 84.9%, positive predictive value 82.5%, and negative predictive value 87.9%) was identified. Conclusions These results suggest that the UACR is a simple and efficient test with high sensitivity and specificity levels for predicting renal UA underexcretion in men.
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Affiliation(s)
- Naoki Sakane
- Division of Preventive Medicine, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Ayana Okuno
- Food Ingredients & Technology Institute, R&D Division, Moringa Milk Insustry Co., Ltd. Kanagawa, Japan
| | - Kouji Nomaguchi
- Food Ingredients & Technology Institute, R&D Division, Moringa Milk Insustry Co., Ltd. Kanagawa, Japan
| | - Miyuki Tanaka
- Food Ingredients & Technology Institute, R&D Division, Moringa Milk Insustry Co., Ltd. Kanagawa, Japan
| | - Fumiaki Abe
- Food Ingredients & Technology Institute, R&D Division, Moringa Milk Insustry Co., Ltd. Kanagawa, Japan
| | - Izumi Kakiuchi
- Department of Nursing, Matsumoto Junior College, Matsumoto, Nagano, Japan
| | - Kyoko Kiyosawa
- Department of Nursing, Matsumoto Junior College, Matsumoto, Nagano, Japan
| | - Mitsunaga Miyasaka
- Department of Nursing, Matsumoto Junior College, Matsumoto, Nagano, Japan
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Chen SC, Yang YL, Wu CH, Huang SS, Chan WL, Lin SJ, Chou CY, Chen JW, Pan JP, Charng MJ, Chen YH, Wu TC, Lu TM, Hsu PF, Huang PH, Cheng HM, Huang CC, Sung SH, Lin YJ, Leu HB. Association between Preoperative Nutritional Status and Clinical Outcomes of Patients with Coronary Artery Disease Undergoing Percutaneous Coronary Intervention. Nutrients 2020; 12:E1295. [PMID: 32370130 DOI: 10.3390/nu12051295] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 04/29/2020] [Accepted: 04/30/2020] [Indexed: 01/11/2023] Open
Abstract
Background: Malnutrition is associated with poor outcomes in patients with cancer, heart failure and chronic kidney disease. This study aimed to investigate the predictive value of the Controlling Nutritional Status (CONUT) score in coronary artery disease (CAD) patients. Methods: We recruited a cohort of 3118 patients with CAD undergoing percutaneous coronary intervention (PCI) from 2005 to 2015. Nutritional status was evaluated using the CONUT score, with higher scores reflecting worse nutritional status. Results: After adjustment for comorbidities and medication, an increased CONUT score was independently associated with a higher risk of acute myocardial infarction (AMI) (HR: 1.13; 95% CI: 1.03–1.24), cardiovascular (CV) death (HR: 1.18; 95% CI: 1.07–1.30), congestive heart failure (CHF) (HR: 1.11; 95% CI: 1.04–1.18), a major adverse cardiovascular event (MACE) (HR: 1.14; 95% CI: 1.07–1.22), and total CV events (HR: 1.11; 95% CI: 1.07–1.15). The subgroup analyses demonstrated that the association of the CONUT score existed independently of other established cardiovascular risk factors. In addition, CONUT significantly improved risk stratification for myocardial infarction (MI), cardiac death, CHF, MACEs and total CV events compared to conventional risk factors in CAD patients by the significant increase in the C-index (p < 0.05) and reclassification risk categories in cardiac death and MACEs. Conclusions: The CONUT score improved the risk prediction of adverse events compared to traditional risk factors in CAD patients after percutaneous coronary intervention (PCI).
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