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Uric acid and cardiorenal risk


Authors: V. Monhart
Authors‘ workplace: Interní klinika 1. LF UK a ÚVN, Praha
Published in: Kardiol Rev Int Med 2009, 11(3): 123-128
Category: Nontraditional risk factors cardiovascular disease

Overview

Hyperuricemia has long been known to be associated with cardiovascular and kidney disease, but it is unclear whether uric acid has a causal role in these comorbid disease processes or whether it is a secondary phenomenon. This review summarizes relevant studies concerning uric acid and possible links to hypertension, cardiovascular and renal diseases. Recent animal studies and epidemiologic studies have identified serum uric acid elevations as an independent risk factor for cardiovascular disease, hypertension and metabolic syndrome. Hyperuricemia has also been found to be an independent risk factor for the development of new‑onset as well as progression of chronic kidney disease. According to the current views, there is no need to treat all patients with asymptomatic hyperuricemia. Further clinical trials, aimed at determining whether lowering of uric acid levels would be of clinical benefit in the prevention and treatment of cardiovascular and renal diseases, are needed.

Keywords:
uric acid – cardiovascular risk – hypertension – metabolic syndrome – kidney disease


Sources

1. Alderman M, Aiyer KJV. Uric Acid: Role in Cardiovascular Disease and Effects of Losartan. Curr Med Res Opin 2004; 20: 369–379.

2. Feig DI, Kang DH, Johnson RJ. Uric Acid and Cardiovascular Risk. N Engl J Med 2008; 359: 1811–1821.

3. Yusuf S, Hawken S, Ounpuu S et al. INTERHEART Study Investigators. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet 2004; 364: 937–952.

4. Vasan RS, Sullivan LM, Wilson PW et al. Relative importance of borderline and elevated levels of coronary heart disease risk factors. Ann Intern Med 2005; 142: 393–402.

5. Wilson PWF. Overview of the risk factors for cardiovascular disease. UpToDate® 2009 (version 17.1). [http://www.uptodate.com/patients/content/topic.do?topicKey=~QGsob5Yuvb].

6. Lippi G, Montagnana M, Franchini M et al. The paradoxical relationship between serum uric acid and cardiovascular disease. Clin Chim Acta 2008; 392: 1–7.

7. Edwards NL. The role of hyperuricemia and gout in kidney and cardiovascular disease. Cleve Clin J Med 2008; 75 (Suppl 5): S13–S16.

8. Freedman DS, Williamson DF, Gunter EW et al. Relation of aserum uric acid to mortality ischemic heart disease: the NHANES I Epidemiologic Follow‑up Study. Am J Epidemiol 1995; 141: 637–644.

9. Moriarity JT, Folsom AR, Iribarren C et al. Serum uric acid and risk of coronary heart disease: Atherosclerosis Risk in Communities (ARIC) Study. Ann Epidemiol 2000; 10: 136–143.

10. Verdecchia P, Schillaci G, Reboldi G et al. Relation between serum uric acid and risk of cardiovascular disease in essential hypertension. The PIUMA study. Hypertension 2000; 36: 1072–1078.

11. Fang J, Alderman MH. Serum uric acid and cardiovascular mortality: The NHANES I Epidemiologic Follow‑up Study, 1971–1992. National Health and Nutrition Examination Survey. JAMA 2000; 283: 2404–2410.

12. Culleton BF, Larson MG, Kannel WB et al. Serum uric acid and risk for cardiovascular disease and death: the Framingham Heart Study. Ann Intern Med 1999; 131: 7–13.

13. Ward HJ. Uric acid as a independent risk factor in the treatment of hypertension. Lancet 1998; 352: 670–671.

14. Alderman MH, Cohen H, Madhavan S. Distribution and determinants of cardiovascular events during 20 years of successful antihypertensive treatment. J Hypertens 1998; 16: 761–769.

15. Franse LV, Pahor M, Di Bari M et al. Serum uric acid, diuretic treatment and risk of cardiovascular events in the Systolic Hypertension in the Elderly Program (SHEP). J Hypertens 2000; 18: 1149–1154.

16. Anker SD, Doehner W, Rauchhaus M et al. Uric acid and survival in chronic heart failure: validation and application in metabolic, functional, and hemodynamic staging. Circulation 2003; 107: 1991–1997.

17. Bickel C, Rupprecht HJ, Blankenberg S et al. Serum uric acid as an independent predictor of mortality in patients with angiographically proven coronary artery disease. Am J Cardiol 2002; 89: 12–17.

18. Short RA, Johnson RJ, Tuttle KR. Uric Acid, Microalbuminuria and Cardiovascular Events in High‑Risk Patients. Am J Nephrology 2005; 25: 36–44.

19. Bos MJ, Koudstaal PJ, Hofman A et al. Uric acid is a risk factor for myocardial infarction and stroke: the Rotterdam Study. Stroke 2006; 37: 1503–1507.

20. Lehto S, Niskanen L, Rönnemaa T et al. Serum uric acid is a strong predictor of stroke in patients with non‑insulin‑dependent diabetes mellitus. Stroke 1998; 29: 635–639.

21. Mazzali M, Hughes J, Kim YG et al. Elevated uric acid increases blood pressure in the rat by a novel crystal-independent mechanism. Hypertension 2001; 38: 1101–1106.

22. Mazzali M, Kanellis J, Han L et al. Hyperuricemia induces a primary renal arteriolopathy in rats by a blood pressure‑independent mechanism. Am J Physiol Renal Physiol 2002; 82: F991–F997.

23. Feig DI, Nakagawa T, Karumanchi SA et al. Hypothesis: Uric acid, nephron number, and the pathogenesis of essential hypertension. Kidney Int 2004; 66: 281–287.

24. Watanabe S, Kang DH, Feng L et al. Uric acid, hominoid evolution, and the pathogenesis of salt-sensitivity. Hypertension 2002; 40: 355–360.

25. Feig DI, Soletsky B, Johnson RJ. Effect of allopurinol on the blood pressure of adolescents with newly diagnosed essential hypertension: a randomized trial. JAMA 2008; 300: 924–932.

26. Feig DI, Johnson RJ. Hyperuricemia in child-hood primary hypertension. Hypertension 2003; 42: 247–252.

27. Brand FN, McGee DL, Kannel WB et al. Hyperuricemia as a risk factor of coronary heart disease: the Framingham Study. Am J Epidemiol 1985; 121: 11–18.

28. Nakanishi N, Okamoto M, Yoshida H et al. Serum uric acid and risk for development of hypertension and impaired fasting glucose or Type II diabetes in Japanese male office workers. Eur J Epidemiol 2003; 18: 523–530.

29. Alper AB jr, Chen W, Yau L et al. Childhood uric acid predicts adult blood pressure: the Bogalusa Heart Study. Hypertension 2005; 45: 34–38.

30. Masuo K, Kawaguchi H, Mikami H et al. Serum uric acid and plasma norepinephrine concentrations predict subsequent weight gain and blood pressure elevation. Hypertension 2003; 42: 474–480.

31. Nagahama K, Inoue T, Iseki K et al. Hyperuricemia as a predictor of hypertension in a screened cohort in Okinawa, Japan. Hypertens Res 2004; 27: 835–841.

32. Sundström J, Sullivan L, D’Agostino RB et al. Relations of serum uric acid to longitudinal blood pressure tracking and hypertension incidence. Hypertension 2005; 45: 28–33.

33. Perlstein TS, Gumieniak O, Williams GH et al. Uric acid and the development of Hypertension: the Normative Aging Study. Hypertension 2006; 48: 1031–1036.

34. Sarafidis PA, Nilsson PM. The metabolic syndrome: a glance at its history. J Hypertens 2006; 24: 621–626.

35. Puig JG, Martínez MA, Mora M et al. Serum urate, Metabolic Syndrome, and Cardiovascular Risk Factors: A Population-Based Study. Nucleos Nucleot Nucl Acids 2008; 27: 620–623.

36. Puig JG, Martínez MA. Hyperuricemia, gout, and the metabolic syndrome: serum urate and the metabolic syndrome. Curr Opin Rheumatol 2008; 20: 187–191.

37. Hjortnaes J, Algra A, Olijhoek J et al. Serum uric acid levels and risk for vascular diseases in patients with metabolic syndrome. J Rheumatol 2007; 34: 1882–1887.

38. Choi HK, Ford ES, Li C et al. Prevalence of the metabolic syndrome in patients with gout: the Third National Health and Nutrition Examination Survey. Arthritis Rheum 2007; 57: 109–115.

39. Strazzullo P, Barbato A, Galletti F et al. Abnormalities of renal sodium handling in the metabolic syndrome: results of the Olivetti Heart Study. J Hypertens 2006; 24: 1633–1639.

40. Strazzullo P, Puig JG. Uric acid and oxidative stress: relative impact on cardiovascular risk. Nutr Metab Cardiovasc Dis 2007; 17: 409–414.

41. Nakagawa T, Tuttle K, Short RA et al. Hypothesis: fructose‑induced hyperuricemia as a causal mechanism for the epidemic of the metabolic syndrome. Nat Clin Pract Nephrol 2005; 1: 80–86.

42. Nakagawa T, Mazzali M, Kang DH et al. Hyperuricemia cause glomerular hypertrophy in the rat. Am J Nephrol 2003; 23: 2–7.

43. Kang DH, Nakagawa T, Feng L et al. A role of uric acid in the progression of renal disease. J Am Soc Nephrol 2002; 13: 2888–2897.

44. Kang DH, Nakagawa T. Uric acid and chronic renal disease: possible implication of hyperuricemia on progression of renal disease. Semin Nephrol 2005; 25: 43–49.

45. Nakagawa T, Mazzali M, Kang HD et al. Uric acid: A uremic toxin? Blood Purif 2006; 24: 67–70.

46. Sánchez-Lozada LG, Tapia E, Avila-Casado C et al. Mild hyperuricemia induces glomerular hypertension in normal rats. Am J Physiol Renal Physiol 2002; 283: F1105–F1110.

47. Kang DH, Park SK, Lee IK et al. Uric acid‑induced C‑reactive protein expression: implication on cell proliferation and nitric oxide production of human vascular cells. J Am Soc Nephrol 2005; 16: 3553–3562.

48. Kanellis J, Watanabe S, Li JH et al. Uric acid stimulates monocyte chemoattractant protein‑1 production in vascular smooth Musile cells via mitogen‑activated protein kinase and cyclooxygenase-2. Hypertension 2003; 41: 1287–1293.

49. Tomita M, Mizuno S, Yamanaka H et al. Does hyperuricemia affect mortality? A prospective cohort study of Japanese male workers. J Epidemiol 2000; 10: 403–409.

50. Iseki K, Ikemiya Y, Inoue T et al. Significance of hyperuricemia as a risk factor for developing ESRD in a screened cohort. Am J Kidney Dis 2004; 44: 642–650.

51. Obermayr RP, Temml C, Gutjahr G et al. Elevated uric acid increases the risk for kidney disease. J Am Soc Nephrol 2008; 19: 2407–2413.

52. Weiner DE, Tighiouart H, Elsayed EF et al. Uric acid and incident kidney disease in the community. J Am Soc Nephrol 2007; 18: 287–292.

53. Hsu CY, Iribarren C, McCulloch CE et al. Risk factors for end‑stage renal disease: 25-year follow‑up. Arch Intern Med 2009; 169: 342–350.

54. Syrjänen J, Mustonen J, Pasternack A. Hypertriglyceridaemia and hyperuricaemia are risk factors for progression of IgA nephropathy. Nephrol Dial Transplant 2000; 15: 34–42.

55. Talaat KM, el-Sheikh AR. The effect of mild hyperuricemia on urinary transforming growth factor beta and the progression of chronic kidney disease. Am J Nephrol 2007; 27: 435–440.

56. Sturm G, Kollerits B, Neyer U et al. Uric acid as a risk factor for progression of non‑diabetic chronic kidney disease? The Mild to Moderate Kidney Disease (MMKD) Study. Exper Gerontol 2008; 43: 347–352.

57. Mazzali M. Uric acid and transplantation. Semin Nephrol 2005; 25: 50–55.

58. Toprak O, Cirit M, Esi E et al. Hyperuricemia as a risk factor for contrast‑induced nephropathy in patients with chronic kidney disease. Catheter Cardiovasc Interv 2006; 67: 227–235.

59. Ruilope LM. The renal effects of losartan. Recep Cardiovasc Dis 1998; 5: 1–3.

60. Baker JF, Krishnan E, Chen L et al. Serum uric acid and cardiovascular disease: recent developments, and where do they leave us? Am J Med 2005; 118: 816–826.

61. Wannamethee SG. Serum uric acid and risk of coronary heart disease. Curr Pharm Des 2005; 11: 4125–4132.

62. Krishnan E, Baker JF, Furst DE et al. Gout and the risk of acute myocardial infarction. Arthritis Rheum 2006; 54: 2688–2696.

63. Choi HK, Curhan G. Independent impact of gout on mortality and risk for coronary heart disease. Circulation 2007; 116: 894–900.

64. Siu YP, Leung KT, Tong MK et al. Use of allopurinol in slowing the progression of renal disease through its ability to lower serum uric acid level. Am J Kidney Dis 2006; 47: 51–59.

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Paediatric cardiology Internal medicine Cardiac surgery Cardiology
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