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Xiao Y, Han L, Wang H, Ke H, Xu S, Huang Z, Lyu G, Li S. Uric Acid Inhibits Mice Pancreatic Steatosis via the Glycerophospholipid Pathway. ACS OMEGA 2024; 9:21829-21837. [PMID: 38799326 PMCID: PMC11112710 DOI: 10.1021/acsomega.3c08874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 04/26/2024] [Accepted: 04/30/2024] [Indexed: 05/29/2024]
Abstract
Background: despite evidence for mutually reinforcing effects of serum uric acid (SUA) and lipids, the effects of uric levels on pancreatic steatosis are not well-established. In this study, the relationship between low concentrations of uric acid and pancreatic steatosis was evaluated. Methods: forty C57BL/6J mice were fed a diet of high uric acid (HU), high fat (HF), high uric acid and high fat (HUHF), and normal control (NC) (10 mice in each group). Weight was measured weekly. Ultrasonography was performed to observe the pancreatic echo intensity of all mice before the end of feeding. Subsequently, peripheral blood was taken for biochemical examination. Intact pancreatic tissues were taken, part of which was used for pathological examination, part of which was used for PCR experiments and Western Blot experiments to obtain glycerophospholipid-associated mRNA data and protein levels. Results: body weight was significantly higher in the HF group than in the other three groups. Higher uric acid matched lower total cholesterol and triglyceride, matched higher low-density lipoprotein, and matched equal high-density lipoprotein. Ultrasound images and HE staining of pancreatic tissues of mice showed that higher uric acid matched lower fat content. The mRNA levels of phospholipase A2 group IB were highest in high uric acid group, while relative protein expression levels were lowest in high uric acid and control groups. Phospholipase A2 group IIA showed the opposite patterns. Conclusions: elevated serum uric acid at low concentrations can inhibit pancreatic steatosis, which is modulated via the glycerophospholipid metabolic pathway.
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Affiliation(s)
- Yang Xiao
- Department
of Ultrasonography, Second Affiliated Hospital
of Fujian Medical University, Quanzhou 362002, China
| | - Lina Han
- Department
of Ultrasonography, Second Affiliated Hospital
of Fujian Medical University, Quanzhou 362002, China
| | - Han Wang
- Department
of Ultrasonography, Second Affiliated Hospital
of Fujian Medical University, Quanzhou 362002, China
| | - Helin Ke
- Department
of Ultrasonography, Second Affiliated Hospital
of Fujian Medical University, Quanzhou 362002, China
| | - Shaodan Xu
- Department
of Ultrasonography, Second Affiliated Hospital
of Fujian Medical University, Quanzhou 362002, China
| | - Zhibin Huang
- Department
of Ultrasonography, Second Affiliated Hospital
of Fujian Medical University, Quanzhou 362002, China
| | - Guorong Lyu
- Department
of Ultrasonography, Second Affiliated Hospital
of Fujian Medical University, Quanzhou 362002, China
- Department
of Medicine, Quanzhou Medical College, Quanzhou 362002, China
| | - Shilin Li
- Department
of Ultrasonography, Second Affiliated Hospital
of Fujian Medical University, Quanzhou 362002, China
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Liu Y, Li S, Zhang X, Huang B, Fu Y, Li X, Cui J. Association between serum uric acid and deep venous thrombosis in European populations: A two-sample Mendelian randomization study. Nutr Metab Cardiovasc Dis 2024; 34:1021-1027. [PMID: 38402000 DOI: 10.1016/j.numecd.2024.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 10/28/2023] [Accepted: 01/14/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND AND AIM Previous experimental and observational studies showed that serum uric acid (SUA) was associated with deep venous thrombosis (DVT), but the causal relationship is unclear. This study aimed to explore the potential causal association between SUA and DVT. METHODS AND RESULTS We designed a two-sample Mendelian randomization (MR) analysis by using summary-level data from large genome-wide association studies performed in European individuals. A total of 14 SUA-related single-nucleotide polymorphisms (SNPs) (P value < 5 × 10-8) were identified as instrumental variables. The inverse variance weighted method was used as the primary method to compute the odds ratios (ORs) and 95 % confidence intervals (95 % CIs) for per standard deviation increase in SUA. MR Egger, weighted median, weighted mode, and simple mode were also applied to test the robustness of the results. We found no significant causal effects of serum uric acid on deep venous thrombosis (odds ratio [OR]: 1.000, 95 % confidence interval [CI]: 0.998-1.002, p = 0.78) by using inverse variance weighted. MR analyses based on other methods showed similar results. CONCLUSIONS There was no potential causal associations between higher genetically predicted SUA levels and increased risk of deep venous thrombosis. Further, MR studies with more valid SNPs and more DVT cases are needed. Validation of the findings is also recommended.
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Affiliation(s)
- Yue Liu
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China
| | - Shiwei Li
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China
| | - Xinxin Zhang
- Department of Nephropathy, Tianjin Medical University General Hospital, Tianjin, China
| | - Bo Huang
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China
| | - Yuhong Fu
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China
| | - Xin Li
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China
| | - Jingqiu Cui
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China.
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Aaramaa HK, Mars N, Helminen M, Kerola AM, Palomäki A, Eklund KK, Gracia-Tabuenca J, Sinisalo J, FinnGen, Isomäki P. Risk of cardiovascular comorbidities before and after the onset of rheumatic diseases. Semin Arthritis Rheum 2024; 65:152382. [PMID: 38308930 DOI: 10.1016/j.semarthrit.2024.152382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 12/27/2023] [Accepted: 01/09/2024] [Indexed: 02/05/2024]
Abstract
OBJECTIVES To elucidate the risk and temporal relationship of cardiovascular (CV) comorbidities in rheumatic diseases. METHODS Patients in the FinnGen study diagnosed between 2000 and 2014 with seropositive (n = 2368) or seronegative (n = 916) rheumatoid arthritis (RA), ankylosing spondylitis (AS, n = 715), psoriatic arthritis (PsA, n = 923), systemic lupus erythematosus (SLE, n = 190), primary Sjogren's syndrome (pSS, n = 412) or gout (n = 2034) were identified from healthcare registries. Each patient was matched based on age, sex, and birth region with twenty controls without any rheumatic conditions. Overall risk ratios (RR) were calculated by comparing the prevalence of seven CV diseases between patients and controls. Logistic regression models were used for estimating odds ratios (OR) for CV comorbidities before and after the onset of rheumatic diseases. RESULTS The RR for 'any CVD' varied from 1.14 (95 % confidence interval [CI] 1.02-1.26) in PsA to 2.05 (95 % CI 1.67-2.52) in SLE. Patients with SLE or gout demonstrated over two-fold risks for several CV comorbidities. Among CV comorbidities, venous thromboembolism (VTE) showed the highest effect sizes in several rheumatic diseases. The ORs for CV comorbidities were highest within one year before and/or after the onset of the rheumatic disease. However, in gout the excess risk of CV disease was especially high before gout diagnosis. CONCLUSIONS The risk of CV comorbidities was elevated in all studied rheumatic diseases, with highest risks observed in SLE and gout. The risk for CV diseases was highest immediately before and/or after rheumatic disease diagnosis, highlighting the increased risk for CV comorbidities across all rheumatic diseases very early on the disease course.
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Affiliation(s)
- Hanna-Kaisa Aaramaa
- Centre for Rheumatic Diseases, Tampere University Hospital, Elämänaukio 2, 33521 Tampere, Finland; Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön katu 34, 33520 Tampere, Finland.
| | - Nina Mars
- Institute for Molecular Medicine Finland, FIMM, HiLIFE, University of Helsinki, Tukholmankatu 8, 00290 Helsinki, Finland; Broad Institute of MIT and Harvard, 415 Main St, Cambridge, MA 02142, USA
| | - Mika Helminen
- Tays Research Services, Tampere University Hospital, Elämänaukio 2, 33521 Tampere, Finland; Faculty of Social Sciences, Health Sciences, Tampere University, Kalevantie 4, Tampere 33014, Tampere, Finland
| | - Anne M Kerola
- Inflammation Center, Rheumatology, Helsinki University Hospital, Topeliuksenkatu 5, 00260 Helsinki, Finland; Faculty of Medicine, University of Helsinki, Tukholmankatu 8, 00290 Helsinki, Finland
| | - Antti Palomäki
- Centre for Rheumatology and Clinical Immunology, Turku University Hospital, Kiinamyllynkatu 4-8, 20521 Turku, Finland; Department of Medicine, Turku University, 20014 Turku University, Finland
| | - Kari K Eklund
- Inflammation Center, Rheumatology, Helsinki University Hospital, Topeliuksenkatu 5, 00260 Helsinki, Finland
| | - Javier Gracia-Tabuenca
- Institute for Molecular Medicine Finland, FIMM, HiLIFE, University of Helsinki, Tukholmankatu 8, 00290 Helsinki, Finland
| | - Juha Sinisalo
- Heart and Lung Center, Helsinki University Hospital, Topeliuksenkatu 5, 00260 Helsinki, Finland
| | - FinnGen
- FinnGen consortium (see Supplementary Table S1)
| | - Pia Isomäki
- Centre for Rheumatic Diseases, Tampere University Hospital, Elämänaukio 2, 33521 Tampere, Finland; Molecular Immunology Group, Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön katu 34, 33520 Tampere, Finland
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4
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Ferguson LD, Molenberghs G, Verbeke G, Rahimi K, Rao S, McInnes IB, McMurray JJV, Sattar N, Conrad N. Gout and incidence of 12 cardiovascular diseases: a case-control study including 152 663 individuals with gout and 709 981 matched controls. THE LANCET. RHEUMATOLOGY 2024; 6:e156-e167. [PMID: 38383089 DOI: 10.1016/s2665-9913(23)00338-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 12/14/2023] [Accepted: 12/14/2023] [Indexed: 02/23/2024]
Abstract
BACKGROUND Gout, a common crystal arthropathy, is associated with increased risk of cardiovascular disease. We aimed to identify how this risk varies by individual cardiovascular disease across a broad spectrum of conditions. METHODS In this matched case-control study, we used linked primary and secondary electronic health records from the UK Clinical Practice Research Datalink to assemble a cohort of individuals with a first-time diagnosis of gout between Jan 1, 2000 and Dec 31, 2017, who were aged 80 years or younger at diagnosis, and free of cardiovascular diseases up to 12 months after diagnosis. The control cohort comprised up to five control individuals per patient with gout, matched on age, sex, socioeconomic status, geographical region, and calendar time, randomly selected among individuals free of gout at any time before and during the study period. The cohorts were followed up until June 30, 2019. We investigated the incidence of 12 cardiovascular diseases and used Cox proportional hazards models to examine differences in people with and without gout, overall and by subgroups of sex, age, socioeconomic status, and year of study inclusion. We further adjusted models for known cardiovascular risk factors (blood pressure, BMI, smoking status, cholesterol, type 2 diabetes, chronic kidney disease, and history of hypertension). FINDINGS We identified 152 663 individuals with gout (mean age 56·2 years [SD 13·3]; 120 324 [78·8%] men and 32 339 [21·2%] women) and 709 981 matched controls (mean age 56·5 years [13·2]; 561 002 [79·0%] men and 148 979 [21·0%] women). Of these individuals, 31 479 (20·6%) with gout and 106 520 (15·0%) without gout developed cardiovascular disease during a median follow-up of 6·5 years (IQR 3·1-10·5). Patients with gout had higher risk of cardiovascular diseases than matched controls (hazard ratio [HR] 1·58 [95% CI 1·52-1·63]). Excess risk of cardiovascular disease in gout was greater in women than men (women: HR 1·88 [1·75-2·02]; men: HR 1·49 [1·43-1·56]), and, among all age groups, was highest in younger individuals (HR in people aged <45 years: 2·22 [1·92-2·57]). Excess risk was observed across all 12 cardiovascular diseases investigated. Patients with gout had higher BMI than matched controls (mean difference 2·90 kg/m2 [95% CI 2·87-2·93]) and higher prevalence of chronic kidney disease, dyslipidaemia, history of hypertension, obesity, and type 2 diabetes. Adjusting for known cardiovascular risk factors attenuated but did not eliminate the excess risk of cardiovascular disease related to gout (adjusted HR 1·31 [1·27-1·36]). INTERPRETATION Patients with gout had an excess risk of developing a broad range of cardiovascular diseases that extend beyond atherosclerotic diseases and include heart failure, arrhythmias, valve disease, and thromboembolic diseases. Excess risk was highest in women and younger individuals. These findings suggest that strategies to reduce cardiovascular risk in patients with gout need to evolve and be implemented in clinical practice. FUNDING Research Foundation Flanders.
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Affiliation(s)
- Lyn D Ferguson
- School of Cardiovascular and Metabolic Health, University of Glasgow, UK
| | - Geert Molenberghs
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics, Hasselt University and KU Leuven, Leuven, Belgium
| | - Geert Verbeke
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics, Hasselt University and KU Leuven, Leuven, Belgium
| | - Kazem Rahimi
- Deep Medicine, Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | - Shishir Rao
- Deep Medicine, Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | - Iain B McInnes
- College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - John J V McMurray
- School of Cardiovascular and Metabolic Health, University of Glasgow, UK
| | - Naveed Sattar
- School of Cardiovascular and Metabolic Health, University of Glasgow, UK
| | - Nathalie Conrad
- School of Cardiovascular and Metabolic Health, University of Glasgow, UK; Deep Medicine, Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK; Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium.
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5
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Cai W, Zhang R, Wang Y, Li Z, Liu L, Gu H, Yang K, Yang X, Wang C, Wang A, Sun W, Xiong Y. Predictors and outcomes of deep venous thrombosis in patients with acute ischemic stroke: results from the Chinese Stroke Center Alliance. INT ANGIOL 2023; 42:503-511. [PMID: 38226943 DOI: 10.23736/s0392-9590.23.05077-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2024]
Abstract
BACKGROUND No large-scale, multicenter studies have explored the incidence rate and predictors of deep vein thrombosis (DVT) in patients with acute ischemic stroke (AIS). We aimed to determine the risk factors of DVT, and assess the association between DVT and clinical outcomes in AIS patients. METHODS In total, 106,612 patients with AIS enrolled in the Chinese Stroke Center Alliance between August 2015 and July 2019 were included. The predictors of DVT in AIS patients were screened based on the logistic regression analysis for the comparison of the characteristics and clinical outcomes of patients with and without DVT. RESULTS The overall incidence of DVT after AIS was 4.7%. Factors associated with increased incidence of DVT included advanced age, female sex, high admission National Institutes of Health Stroke Scale score, history of cerebral hemorrhage, transient ischemic attack (TIA), dyslipidemia, atrial fibrillation, and peripheral vascular disease, International Normalized Ratio (INR) <0.8 or >1.5, and blood uric acid >420 μmol/L. Ambulation and early antithrombotic therapy were associated with a lower incidence of DVT. Patients with DVT was associated with longer hospital stay (OR=1.44, 95% CI: 1.35-1.54), and higher in-hospital mortality (OR=1.68, 95% CI: 1.25-2.27). CONCLUSIONS This large-scale, multi-center study showed that the occurrence of DVT in AIS patients is associated with various modifiable and objective indicators, such as abnormal INR and uric acid >420 μmol/L. Ambulatory status and early antithrombotic therapy can reduce the occurrence of DVT in AIS patients. In AIS patients, DVT may prolong the hospital stay and increase the risk of in-hospital mortality. Future research should focus on the clinical implementation of existing evidence on DVT prevention in AIS patients.
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Affiliation(s)
- Weixin Cai
- Department of Nursing, Beijing Tiantan Hospital, Capital Medical University, Beijing, China -
| | - Ran Zhang
- Department of Nursing, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
- National Center for Healthcare Quality Management in Neurological Diseases, Beijing, China
| | - Zixiao Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
- National Center for Healthcare Quality Management in Neurological Diseases, Beijing, China
| | - Liping Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
- National Center for Healthcare Quality Management in Neurological Diseases, Beijing, China
| | - Hongqiu Gu
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
- National Center for Healthcare Quality Management in Neurological Diseases, Beijing, China
| | - Kaixuan Yang
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
- National Center for Healthcare Quality Management in Neurological Diseases, Beijing, China
| | - Xin Yang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
- National Center for Healthcare Quality Management in Neurological Diseases, Beijing, China
| | - Chunjuan Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
- National Center for Healthcare Quality Management in Neurological Diseases, Beijing, China
| | - Anxin Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Weige Sun
- Department of Nursing, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yunyun Xiong
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
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Cipolletta E, Tata LJ, Nakafero G, Avery AJ, Mamas MA, Abhishek A. Risk of Venous Thromboembolism With Gout Flares. Arthritis Rheumatol 2023; 75:1638-1647. [PMID: 36808284 DOI: 10.1002/art.42480] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 02/07/2023] [Accepted: 02/14/2023] [Indexed: 02/23/2023]
Abstract
OBJECTIVE Previous studies demonstrated that the risk of venous thromboembolism (VTE) is increased in patients with gout, but not whether there was a temporal association between gout flare and VTE. This study was undertaken to evaluate potential temporal associations between gout flare and VTE. METHODS Data were obtained from electronic primary-care records from the UK's Clinical Practice Research Datalink, which links data from hospitalization and mortality registers. Using self-controlled case series analysis adjusted for season and age, we evaluated the temporal association between gout flare and VTE. The 90 days after primary-care consultation or hospitalization for gout flare was designated the exposed period. This was divided into three 30-day intervals. The baseline period was up to 2 years before the start of and up to 2 years after the end of the exposed period. The association between gout flare and VTE was measured using adjusted incidence rate ratios (IRRs) with 95% confidence intervals (95% CIs). RESULTS In total, 314 patients met the inclusion criteria (age ≥18 years, incident gout, no presence of VTE or use of a primary-care anticoagulant prescription before the start of the pre-exposure period). Among the 314 patients, VTE incidence was significantly higher in the exposed period than in the baseline period (adjusted IRR 1.83, 95% CI 1.30-2.59). The adjusted IRR of VTE during the first 30 days after gout flare was 2.31 (95% CI 1.39-3.82) relative to the baseline period. No increase in the adjusted IRRs was observed in days 31-60 (adjusted IRR 1.49, 95% CI 0.79-2.81) and days 61-90 (adjusted IRR 1.67, 95% CI 0.91-3.06) relative to baseline. Results were consistent across sensitivity analyses. CONCLUSION Among patients with gout, there was a transient increase in the rate of VTE within 30 days after primary-care consultation or hospitalization for gout flare.
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Affiliation(s)
- Edoardo Cipolletta
- Academic Rheumatology, University of Nottingham, Nottingham, UK, and Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Laila J Tata
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | | | - Anthony J Avery
- Centre for Academic Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Keele University, Keele, UK
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Zhang WZ. Uric acid en route to gout. Adv Clin Chem 2023; 116:209-275. [PMID: 37852720 DOI: 10.1016/bs.acc.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
Gout and hyperuricemia (HU) have generated immense attention due to increased prevalence. Gout is a multifactorial metabolic and inflammatory disease that occurs when increased uric acid (UA) induce HU resulting in monosodium urate (MSU) crystal deposition in joints. However, gout pathogenesis does not always involve these events and HU does not always cause a gout flare. Treatment with UA-lowering therapeutics may not prevent or reduce the incidence of gout flare or gout-associated comorbidities. UA exhibits both pro- and anti-inflammation functions in gout pathogenesis. HU and gout share mechanistic and metabolic connections at a systematic level, as shown by studies on associated comorbidities. Recent studies on the interplay between UA, HU, MSU and gout as well as the development of HU and gout in association with metabolic syndromes, non-alcoholic fatty liver disease (NAFLD), and cardiovascular, renal and cerebrovascular diseases are discussed. This review examines current and potential therapeutic regimens and illuminates the journey from disrupted UA to gout.
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Affiliation(s)
- Wei-Zheng Zhang
- VIDRL, The Peter Doherty Institute, Melbourne, VIC, Australia.
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8
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Misra DP, Ahmed S, Goyal M, Sharma A, Agarwal V. Venous Thromboembolism in the Inflammatory Rheumatic Diseases. Rheum Dis Clin North Am 2023; 49:97-127. [PMID: 36424029 DOI: 10.1016/j.rdc.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Venous thromboembolism (VTE), which includes deep venous thrombosis and pulmonary embolism, is a cardiovascular event whose risk is increased in most inflammatory rheumatic diseases (IRDs). Mechanisms that increase VTE risk include antiphospholipid antibodies (APLs), particularly anticardiolipin antibodies, anti-beta2glycoprotein I antibodies and lupus anticoagulant present together, and inflammation-mediated endothelial injury. Patients with IRDs should receive long-term anticoagulation drugs when the risk of VTE recurrence is high. In the light of recent warnings from regulatory agencies regarding heightened VTE risk with Janus kinase inhibitors, these drugs should be initiated only after a careful assessment of VTE risk in those with IRDs.
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Affiliation(s)
- Durga Prasanna Misra
- Department of Clinical Immunology and Rheumatology, C block, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Rae Bareli Road, Lucknow 226014, India.
| | - Sakir Ahmed
- Department of Clinical Immunology and Rheumatology, Kalinga Institute of Medical Sciences (KIMS), Bhubaneswar 751024, India. https://twitter.com/sakir_rheum
| | - Mohit Goyal
- Department of Rheumatology and Clinical Immunology, CARE Pain and Arthritis Centre, Udaipur 313002, Rajasthan, India. https://twitter.com/drmohitgoyal
| | - Aman Sharma
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India. https://twitter.com/Amansharmapgi
| | - Vikas Agarwal
- Department of Clinical Immunology and Rheumatology, C block, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Rae Bareli Road, Lucknow 226014, India. https://twitter.com/vikasagrIMMUNO
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9
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Guo Y, Zhou F, Xu H. Gout and risk of venous thromboembolism: A systematic review and meta-analysis of cohort studies. Int J Rheum Dis 2023; 26:344-353. [PMID: 36549889 DOI: 10.1111/1756-185x.14524] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 08/02/2022] [Accepted: 11/22/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND The association between gout and venous thromboembolism (VTE) remains ambiguous, and the results of current studies are inconsistent. A systematic review and meta-analysis of cohort studies were conducted to comprehensively assess the associations between gout and VTE and its subtypes, deep venous thrombosis (DVT) and pulmonary embolism (PE). METHODS PubMed, Web of Science, Embase, Scopus, and the Cochrane Library databases were searched up to June 2021, to identify eligible cohort studies, reporting the association of gout with VTE and its subtypes. We pooled hazard ratios (HRs) with 95% confidence intervals (CIs). Subgroup analysis, sensitivity analysis, and publication bias tests were also conducted. RESULTS Five studies involving 642 632 individuals were included. Patients with gout had a statistically significantly higher risk of VTE (HR: 1.33; 95% CI: 1.21, 1.46; P < .001) compared with non-gout controls, and significant associations were also found between gout and DVT (HR: 1.40; 95% CI: 1.22, 1.62; P < .001) and PE (HR: 1.18; 95% CI: 1.07, 1.30; P = .001). Subgroup analysis showed this association in men (HR: 1.37; 95% CI: 1.14, 1.65; P = .001) and women (HR: 1.36; 95% CI: 1.21, 1.53; P < .001) were consistent (P = .980). Meta-regression analysis revealed publication year (P = .005) and quality of study (P = .006) contributed to heterogeneity. CONCLUSIONS In conclusion, our study provided evidence that gout was associated with the risk of VTE and its subtypes DVT and PE. However, more prospective and high-quality clinical evidence is required to confirm our findings.
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Affiliation(s)
- Yicong Guo
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
| | - Feixiang Zhou
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
| | - Huilan Xu
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
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Choi HG, Kim SY, Chung J. The Risk of BPPV, Meniere's Disease, and Vestibular Neuronitis in Patients with Gout: A Longitudinal Follow-Up Study Using a National Health Screening Cohort. J Clin Med 2022; 12:jcm12010185. [PMID: 36614986 PMCID: PMC9821089 DOI: 10.3390/jcm12010185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 12/21/2022] [Accepted: 12/24/2022] [Indexed: 12/28/2022] Open
Abstract
This study evaluated the impact of pre-existing gout on the occurrence of benign paroxysmal positional vertigo (BPPV), Meniere’s disease, and vestibular neuronitis, with the goal of identifying novel associations of gout with other comorbid diseases. The 2002−2019 Korean National Health Insurance Service Health Screening Cohort data were retrospectively analyzed. 23,827 patients with gout were matched to 95,268 controls without gout for age, sex, income, region of residence, and index date. The occurrence of BPPV, Meniere’s disease, and vestibular neuronitis was evaluated in both groups. The hazard ratios (HRs) of gout for BPPV, Meniere’s disease, and vestibular neuronitis were calculated using a stratified Cox proportional hazard model. Participants with gout demonstrated a 1.13-fold higher risk of BPPV (95% CI, 1.06−1.21, p < 0.001) and a 1.15-fold higher risk of Meniere’s disease (95% CI, 1.15−1.37, p < 0.001) than the matched control group. However, the HR for vestibular neuronitis was not significantly higher in the gout group (adjusted HR = 1.06, 95% CI, 0.93−1.21, p = 0.391). A previous history of gout was related to a higher risk of BPPV and Meniere’s disease. Additional studies are necessary to elucidate the mechanism underlying the relationship between gout and comorbid diseases such as BPPV and Meniere’s disease.
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Affiliation(s)
- Hyo Geun Choi
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University College of Medicine, Anyang 14068, Republic of Korea
| | - So Young Kim
- Department of Otorhinolaryngology-Head & Neck Surgery, CHA Bundang Medical Center, CHA University, Seongnam 13488, Republic of Korea
| | - Juyong Chung
- Department of Otorhinolaryngology, Wonkwang University School of Medicine, 895 Muwang-ro, Iksan 54538, Republic of Korea
- Correspondence: ; Tel.: +82-63-859-1489; Fax: +82-63-858-3922
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11
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Yu CW, Wu SC, Li TH, Wei JCC. Comment on: Association between serum urate, gout and comorbidities: a case-control study using data from the UK Biobank. Rheumatology (Oxford) 2021; 61:e80-e81. [PMID: 34747451 DOI: 10.1093/rheumatology/keab836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 09/08/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Chin-Wei Yu
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Shao-Ci Wu
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Tsung-Hao Li
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - James Cheng-Chung Wei
- Department of Allergy, Immunology & Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan.,Institute of Medicine, College of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
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12
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Yu H, Wang Z, Li Z, An Y, Yan M, Ji S, Xu M, Wang L, Dong W, Shi J, Gao C. Hyperuricemia enhances procoagulant activity of vascular endothelial cells through TMEM16F regulated phosphatidylserine exposure and microparticle release. FASEB J 2021; 35:e21808. [PMID: 34390515 DOI: 10.1096/fj.202100426r] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 06/12/2021] [Accepted: 07/06/2021] [Indexed: 12/15/2022]
Abstract
The link between serum uric acid (SUA) and the risk of venous thromboembolism (VTE) is well established. Recent data suggested a causative role of UA in endothelial cells (ECs) dysfunction. However, the molecular mechanism of high UA on thrombogenesis is unknown. We investigate whether high UA induce phosphatidylserine (PS) externalization and microparticle (MP) shedding in cultured EC, and contribute to UA-induced hypercoagulable state. In the present study, we demonstrate that UA induces PS exposure and EMP release of EC in a concentration- and time-dependent manner, which enhances the procoagulant activity (PCA) of EC and inhibited over 90% by lactadherin in vitro. Furthermore, hyperuricemic rat model was used to evaluate the development of thrombi following by flow stasis in the inferior vena cava (IVC). Hyperuricemia group is more likely to form large and hard thrombi compared with control. Importantly, we found that TMEM16F expression is significantly upregulated in UA-treated EC, which is crucial for UA-induced PS exposure and MP formation. Additionally, UA increases the generation of reactive oxygen species (ROS), lipid peroxidation, and cytosolic Ca2+ concentration in EC, which might contribute to increased TMEM16F expression. Using confocal microscopy, we also observed disruption of the actin cytoskeleton, suggesting that depolymerization of actin filaments might be required for TMEM16F activation and followed by PS exposure and membrane blebbing in UA-treated EC. Our results demonstrate a thrombotic role of EC in hyperuricemia through TMEM16F-mediated PS exposure and MPs release.
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Affiliation(s)
- Hongyin Yu
- Department of Medical Laboratory Science and Technology, Harbin Medical University-Daqing, Daqing, China
| | - Zelong Wang
- Department of Medical Laboratory Science and Technology, Harbin Medical University-Daqing, Daqing, China
| | - Zhanni Li
- Department of Medical Laboratory Science and Technology, Harbin Medical University-Daqing, Daqing, China
| | - Yao An
- Department of Medical Laboratory Science and Technology, Harbin Medical University-Daqing, Daqing, China
| | - Meishan Yan
- Department of Medical Laboratory Science and Technology, Harbin Medical University-Daqing, Daqing, China
| | - Shuting Ji
- Department of Medical Laboratory Science and Technology, Harbin Medical University-Daqing, Daqing, China
| | - Minghui Xu
- Department of Medical Laboratory Science and Technology, Harbin Medical University-Daqing, Daqing, China
| | - Liqiu Wang
- Department of Clinical Laboratory, The Fifth Hospital, Harbin Medical University, Daqing, China
| | - Weijun Dong
- Department of General Surgery, The Fifth Hospital, Harbin Medical University, Daqing, China
| | - Jialan Shi
- Department of Hematology, The First Hospital, Harbin Medical University, Harbin, China
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Chunyan Gao
- Department of Medical Laboratory Science and Technology, Harbin Medical University-Daqing, Daqing, China
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13
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Ren W, Huang Q, Fan K, Hu J, Cheng Q, Xu M, Xu R, Liu Y, Wang L, Chen S, Zhang W, Zhu Z, Wu C, Xue L, Dai Y, Yan F, Huang G, He J. Uric acid played a role in the association between gender and deep vein thrombosis in patients with stroke. Nutr Metab Cardiovasc Dis 2021; 31:2700-2706. [PMID: 34218986 DOI: 10.1016/j.numecd.2021.05.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 05/07/2021] [Accepted: 05/29/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIMS Gender-specific differences were found in serum uric acid (SUA) levels and the risk of isolated distal deep vein thrombosis (IDDVT). This study aimed to explore the association among gender, SUA, and IDDVT in stroke patients. METHODS AND RESULTS Finally, 3404 patients were recruited and divided into two groups: IDDVT (n = 1233) and Non-IDDVT (n = 2171) groups. Propensity score matching (PSM) was conducted to match the patients. Binary logistic regression was adopted to explore the association between SUA and IDDVT, with the SUA divided into quartiles. After PSM, 975 patients were included in each group. Non-IDDVT group had a larger proportion of male than IDDVT group (64.9% vs. 52.7%, p < 0.001). Moreover, males showed higher SUA levels than females (316.7 ± 102.1 vs. 261.8 ± 94.0 μmol/L, t = 12.1, p < 0.001). The highest quartile of SUA (≥346 μmol/L) showed a lower risk of IDDVT (OR = 0.629, p = 0.001), while the lowest quartile (≤225 μmol/L) showed a higher risk of IDDVT (OR = 1.361, p = 0.022). CONCLUSION In patients with stroke, SUA played a protective role in IDDVT. Females had a higher risk of IDDVT, which may be owing to the lower SUA levels than males. In clinical practice, more attention should be paid to the risk of IDDVT in females, especially those with lower SUA levels.
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Affiliation(s)
- Wenwei Ren
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Qiqi Huang
- Department of Cardiovascular, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Kaili Fan
- School of Mental Health, Wenzhou Medical University, Wenzhou, 325000, China
| | - Jingjie Hu
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Qianqian Cheng
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Minjie Xu
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Ruoting Xu
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Yuntao Liu
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Liping Wang
- Department of Ultrasound, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Siyan Chen
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Wanli Zhang
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Zhenguo Zhu
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Chunxue Wu
- Department of Neurology, Wencheng County People's Hospital, Wenzhou, 325000, China
| | - Langlang Xue
- Intensive Care Unit, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Yanman Dai
- Department of Psychiatry, Wenzhou Seventh People's Hospital, Wenzhou, 325000, China
| | - Feifan Yan
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Guiqian Huang
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China.
| | - Jincai He
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China.
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14
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Cox P, Gupta S, Zhao SS, Hughes DM. The incidence and prevalence of cardiovascular diseases in gout: a systematic review and meta-analysis. Rheumatol Int 2021; 41:1209-1219. [PMID: 33987709 PMCID: PMC8164620 DOI: 10.1007/s00296-021-04876-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 04/21/2021] [Indexed: 02/07/2023]
Abstract
The aims of this systematic review and meta-analysis were to describe prevalence of cardiovascular disease in gout, compare these results with non-gout controls and consider whether there were differences according to geography. PubMed, Scopus and Web of Science were systematically searched for studies reporting prevalence of any cardiovascular disease in a gout population. Studies with non-representative sampling, where a cohort had been used in another study, small sample size (< 100) and where gout could not be distinguished from other rheumatic conditions were excluded, as were reviews, editorials and comments. Where possible meta-analysis was performed using random-effect models. Twenty-six studies comprising 949,773 gout patients were included in the review. Pooled prevalence estimates were calculated for five cardiovascular diseases: myocardial infarction (2.8%; 95% confidence interval (CI)s 1.6, 5.0), heart failure (8.7%; 95% CI 2.9, 23.8), venous thromboembolism (2.1%; 95% CI 1.2, 3.4), cerebrovascular accident (4.3%; 95% CI 1.8, 9.7) and hypertension (63.9%; 95% CI 24.5, 90.6). Sixteen studies reported comparisons with non-gout controls, illustrating an increased risk in the gout group across all cardiovascular diseases. There were no identifiable reliable patterns when analysing the results by country. Cardiovascular diseases are more prevalent in patients with gout and should prompt vigilance from clinicians to the need to assess and stratify cardiovascular risk. Future research is needed to investigate the link between gout, hyperuricaemia and increased cardiovascular risk and also to establish a more thorough picture of prevalence for less common cardiovascular diseases.
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Affiliation(s)
- Peter Cox
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Biosciences Building, Crown Street, Liverpool, L69 7BE, UK.
| | - Sonal Gupta
- School of Medicine, University of Liverpool, Liverpool, UK
| | - Sizheng Steven Zhao
- Musculoskeletal Biology, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - David M Hughes
- Department of Health Data Science, University of Liverpool, Liverpool, UK
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15
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Uric Acid-An Emergent Risk Marker for Thrombosis? J Clin Med 2021; 10:jcm10102062. [PMID: 34065792 PMCID: PMC8150596 DOI: 10.3390/jcm10102062] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/07/2021] [Accepted: 05/11/2021] [Indexed: 12/22/2022] Open
Abstract
Hyperuricemia is nowadays an established cardiovascular risk factor. Experimental studies linked elevated serum uric acid (SUA) levels with endothelial dysfunction (ED), inflammation, and prothrombotic state. The purpose of this review is to summarize the current evidence that emphasizes the possible role of uric acid as a biomarker for a prothrombotic state. A large number of clinical trials correlated SUA levels with both incident and recurrent cases of venous thromboembolism (VTE), independent of other confounding risk factors. Moreover, increased SUA levels may be an important tool for the risk stratification of patients with pulmonary embolism (PE). Left atrial thrombosis was correlated with high SUA levels in several studies and its addition to classical risk scores improved their predictive abilities. In patients with acute myocardial infarction (MI), hyperuricemia was associated with increased mortality, and the idea that hyperuricemia may be able to act as a surrogate to unstable coronary plaques was advanced. Finally, SUA was correlated with an increased risk of thromboembolic events in different systemic diseases. In conclusion, uric acid has been considered a marker of a thrombotic milieu in several clinical scenarios. However, this causality is still controversial, and more experimental and clinical data is needed.
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16
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De Lucchi L, Nardin C, Sponchiado A, Raggi D, Faggin E, Martini E, Pagliara V, Callegari E, Caberlotto L, Plebani M, Pauletto P, Cinetto F, Agostini C, Villalta S, Rattazzi M. Serum uric acid levels and the risk of recurrent venous thromboembolism. J Thromb Haemost 2021; 19:194-201. [PMID: 33078502 DOI: 10.1111/jth.15139] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 10/06/2020] [Accepted: 10/09/2020] [Indexed: 08/31/2023]
Abstract
Essentials Increase in serum uric acid (SUA) levels has been widely associated with higher risk of cardiovascular disease. We investigated the link between SUA levels and the risk of venous thromboembolism (VTE) recurrence. Patients with SUA levels ≥ 4.38 mg/dL showed a three-fold increase in the risk of VTE recurrence. Elevated SUA levels are associated with increased risk of recurrent VTE independently from traditional risk factors. ABSTRACT: Background The link between serum uric acid (SUA) and the risk of cardiovascular disease is well established. However, the impact of SUA levels on the risk of venous thromboembolism (VTE) recurrence is unknown. Objectives To investigate the association between SUA and the risk of VTE recurrence. Patients and Methods We performed a monocenter, prospective study on 280 patients with a previous episode of VTE that completed the oral anticoagulant period. SUA levels at enrollment were correlated with the risk of VTE recurrence (mean follow-up 71.1 ± 29.2 months). Results Patients were stratified according to SUA tertiles distribution at baseline (tertiles cut-off: I ≤ 4.37 mg/dL, II 4.38--5.54 mg/dL, III ≥ 5.55 mg/dL). Fifty episodes of VTE recurrence occurred during the follow-up and Kaplan-Meier survival analysis showed that subjects in the lower tertile of SUA distribution had significantly lower risk of future VTE recurrence (P = .003). No differences were seen among patients belonging to the second and the third tertile of SUA distribution. A multivariate Cox regression analysis showed that higher tertiles of SUA distribution had about three-fold increase in the risk of VTE recurrence as compared to subjects with SUA ≤ 4.37, independently from potential confounders (hazard ratio [HR] 3.04, 95% confidence interval [CI] 1.15--8.05 P = .025). Moreover, we observed that the adjusted hazard of VTE recurrence increased by 30% for each additional unit of SUA (mg/dL; HR 1.30, 95% CI 1.01--1.22, P = .040). Conclusion Elevated SUA levels are associated with increased risk of future VTE recurrence independently from traditional risk factors.
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Affiliation(s)
- Lara De Lucchi
- Medicina Generale I^, Ca' Foncello University Hospital, Treviso, Italy
| | - Chiara Nardin
- Medicina Generale I^, Ca' Foncello University Hospital, Treviso, Italy
| | | | - Davide Raggi
- Department of Economics, University of Bologna, Bologna, Italy
| | | | - Elena Martini
- Medicina Generale I^, Ca' Foncello University Hospital, Treviso, Italy
| | - Valeria Pagliara
- Medicina Generale I^, Ca' Foncello University Hospital, Treviso, Italy
| | - Elena Callegari
- Medicina Generale I^, Ca' Foncello University Hospital, Treviso, Italy
| | - Livio Caberlotto
- Laboratory Medicine, Ca' Foncello University Hospital, Treviso, Italy
| | - Mario Plebani
- Department of Medicine - DIMED, University of Padova, Padova, Italy
| | - Paolo Pauletto
- ORAS Rehabilitation Hospital, Motta di Livenza, Treviso, Italy
| | - Francesco Cinetto
- Medicina Generale I^, Ca' Foncello University Hospital, Treviso, Italy
- Department of Medicine - DIMED, University of Padova, Padova, Italy
| | - Carlo Agostini
- Medicina Generale I^, Ca' Foncello University Hospital, Treviso, Italy
- Department of Medicine - DIMED, University of Padova, Padova, Italy
| | - Sabina Villalta
- Medicina Generale, Castelfranco Veneto Hospital, Castelfranco Veneto, Italy
| | - Marcello Rattazzi
- Medicina Generale I^, Ca' Foncello University Hospital, Treviso, Italy
- Department of Medicine - DIMED, University of Padova, Padova, Italy
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17
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Dehlin M, Jacobsson L, Roddy E. Global epidemiology of gout: prevalence, incidence, treatment patterns and risk factors. Nat Rev Rheumatol 2020; 16:380-390. [PMID: 32541923 DOI: 10.1038/s41584-020-0441-1] [Citation(s) in RCA: 455] [Impact Index Per Article: 113.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2020] [Indexed: 12/12/2022]
Abstract
Gout is the most common inflammatory arthritis and occurs when hyperuricaemia, sustained elevation of serum urate levels resulting in supersaturation of body tissues with urate, leads to the formation and deposition of monosodium urate crystals in and around the joints. Recent reports of the prevalence and incidence of gout vary widely according to the population studied and methods employed but range from a prevalence of <1% to 6.8% and an incidence of 0.58-2.89 per 1,000 person-years. Gout is more prevalent in men than in women, with increasing age, and in some ethnic groups. Despite rising prevalence and incidence, suboptimal management of gout continues in many countries. Typically, only a third to half of patients with gout receive urate-lowering therapy, which is a definitive, curative treatment, and fewer than a half of patients adhere to treatment. Many gout risk factors exist, including obesity, dietary factors and comorbid conditions. As well as a firmly established increased risk of cardiovascular disease and chronic kidney disease in those with gout, novel associations of gout with other comorbidities have been reported, including erectile dysfunction, atrial fibrillation, obstructive sleep apnoea, osteoporosis and venous thromboembolism. Discrete patterns of comorbidity clustering in individuals with gout have been described. Increasing prevalence and incidence of obesity and comorbidities are likely to contribute substantially to the rising burden of gout.
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Affiliation(s)
- Mats Dehlin
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lennart Jacobsson
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Edward Roddy
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Keele, UK. .,Haywood Academic Rheumatology Centre, Haywood Hospital, Midlands Partnership NHS Foundation Trust, Stoke-on-Trent, UK.
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