Objective To assess the predictive value of serum uric acid levels for cardiovascular and all-cause mortality in a large prospective population based study.Methods The study was based on 3648 participants in Shanghai ...Objective To assess the predictive value of serum uric acid levels for cardiovascular and all-cause mortality in a large prospective population based study.Methods The study was based on 3648 participants in Shanghai and Beijing,who were inpatients with high cardiovascular(CV) risk at baseLine (2004.7 to 2005.1),and blood was taken.Follow-up for death from cardiovascular disease and any cause was complete until January 1,2006.Results The mean follow-up was 1 years.There were 303 deaths during follow-up,of which 121 were cardiovascular.Crude mortality rates were 8.3 % for all patients,6.8% for female patients (116/1715),and 9.7% (187/1933) for male patients.Among men,patients in the lower and higher uric acid groups had increased cardiac and overall mortality risks compared with patients in the normal uric acid groups.Similar relation was found in women but not statistically significant.After adjusting for other conventional risk factors (age,diabetes,hypertension,diuretic use and smoking),baseline uric acid level was still associated with increased risk for death from cardiovascular disease (P=0.005),or death from all causes (P=0.014) Conclusion Our data suggest that abnormal serum uric acid levels are independently and significantly associated with risk of cardiovascular and all-cause mortality.(J Geriatr Cardiol 2008;5:15-20)展开更多
BACKGROUND Patients with chronic heart failure(CHF)frequently develop hyperuricemia,an elevated serum uric acid level,associated with adverse outcomes.Dapagliflozin,a sodium-glucose cotransporter-2 inhibitor,demonstra...BACKGROUND Patients with chronic heart failure(CHF)frequently develop hyperuricemia,an elevated serum uric acid level,associated with adverse outcomes.Dapagliflozin,a sodium-glucose cotransporter-2 inhibitor,demonstrates reduction in cardiovascular mortality and hospitalization in patients with CHF and ejection fraction(HFrEF),irrespective of diabetes.However,dapagliflozin’s effect on the uric acid levels in patients with CHF and hyperuricemia remain unclear.AIM To investigate the effects of dapagliflozin on uric acid levels in CHF patients with hyperuricemia.METHODS We conducted a randomized,double-blind,placebo-controlled trial in 200 patients with CHF and hyperuricemia,with HFrEF and serum uric acid levels≥7 mg/dL(≥416μmol/L).The participants were randomly assigned to receive a daily dose of 10 mg dapagliflozin or placebo for 24 months.The primary endpoint was the change in serum uric acid level from baseline to 24 months.Secondary endpoints included changes in left ventricular ejection fraction(LVEF),Nterminal pro-B-type natriuretic peptide(NT-proBNP),and quality of life(QoL)scores,as well as the incidence of cardiovascular death and hospitalization for heart failure.RESULTS At 24 months,dapagliflozin significantly reduced serum uric acid levels by 1.2 mg/dL(71μmol/L)compared with placebo(95%CI:-1.5 to-0.9;P<0.001).Dapagliflozin also significantly improved LVEF by 3.5%(95%CI:2.1-4.9;P<0.001),NT-proBNP by 25%(95%CI:18-32;P<0.001),and QoL scores by 10 points(95%CI:7-13;P<0.001)and reduced the risk of cardiovascular death and hospitalization for heart failure by 35%(95%CI:15–50;P=0.002)compared with the placebo.Adverse events were similar between the two groups,except for a higher rate of genital infections in the dapagliflozin group(10%vs 2%,P=0.01).CONCLUSION Dapagliflozin significantly lowered serum uric acid levels and improved the clinical outcomes in patients with CHF and hyperuricemia.Therefore,dapagliflozin may be a useful therapeutic option for this high-risk population.展开更多
Background The association between increased serum uric acid （SUA） levels and cardiovascular risk has been debated for decades. Several large studies have provided conflicting results regarding the clinical signific...Background The association between increased serum uric acid （SUA） levels and cardiovascular risk has been debated for decades. Several large studies have provided conflicting results regarding the clinical significance of elevated SUA levels in cardiovascular disease （CVD） or cerebrovascular disease. The aim of this study was to investigate the relationship between SUA and CVD and all-cause mortality and their potential diagnostic value. Methods A total of 3570 in-patients ranging in age from 56 to 95 years （mean （67.36_＋11.36） years） were selected from 20 hospitals in Beijing and Shanghai. A carefully designed questionnaire was used to gather baseline data of each patient All patients were divided into two main groups according to their SUA levels： high SUA and normal SUA groups. Serum indices and other important parameters were measured. Results Compared with normal SUA group, high SUA group had significant difference in systolic blood pressure （SBP）, total cholesterol （TC）, triglyceride （TG）, high density lipoprotein cholesterol （HDL-C）, body mass index （BMI）, and age （P 〈0.05 or P 〈0.01）. High SUA prevailed in female and patients with history of essential hypertension, while history of smoking and diabetes showed no significant difference between two groups. All-cause and CVD mortality occurred more frequently in high SUA group than in normal SUA group. In the accumulative survival analysis, high SUA group had lower survival rate than normal SUA group both in CVD and all-cause mortality. COX regression analysis indicated that the history of smoking, age and high SUA were independent risk factors for the development of CVD. Conclusions These preliminary observations suggest that patients with high SUA levels would face higher risk of mortality. SUA measurement may be applied as a routine predictor for clinical assessment.展开更多
Background:Whether there is an association between serum uric acid(SUA)level and risk of mortality in the general population remains unclear.Based on the China National Survey of Chronic Kidney Disease linked to morta...Background:Whether there is an association between serum uric acid(SUA)level and risk of mortality in the general population remains unclear.Based on the China National Survey of Chronic Kidney Disease linked to mortality data,a population-based cohort study was performed to investigate the association between SUA level and all-cause mortality,cardiovascular disease(CVD)mortality,and cancer mortality in China.Methods:The survival status of participants in the cross-sectional survey was identified from January 1,2006 to December 31,2017.Only 33,268 individuals with complete SUA data among the 47,204 participants were included in the analysis.We determined the rates of all-cause mortality,CVD mortality,and cancer mortality.We used Cox proportional hazards regression models to evaluate the effect of the SUA level on mortality.Results:During a total of 297,538.4 person-years of follow-up,1282 deaths occurred.In the Cox proportional hazards regression model,the rate of all-cause mortality,CVD mortality,and cancer mortality had a U-shaped association with SUA levels only in men,whereas no significant associations were detected in women.For all-cause mortality in men,the multivariable-adjusted hazard ratios(HRs)in the first,second,and fourth quartiles compared with the third quartile were 1.31(95%confidence interval[CI]1.04–1.67),1.17(95%CI 0.92–1.47),and 1.55(95%CI 1.24–1.93),respectively.For CVD mortality,the corresponding HRs were 1.47(95%CI 1.00–2.18),1.17(95%CI 0.79–1.75),and 1.67(95%CI 1.16–2.43),respectively.For the cancer mortality rate,only a marginally significant association was detected in the fourth quartile compared with the third quartile with an HR of 1.43(95%CI 0.99–2.08).Conclusions:The association between SUA and mortality differed by sex.We demonstrated a U-shaped association with SUA levels for all-cause and CVD mortalities among men in China.展开更多
文摘Objective To assess the predictive value of serum uric acid levels for cardiovascular and all-cause mortality in a large prospective population based study.Methods The study was based on 3648 participants in Shanghai and Beijing,who were inpatients with high cardiovascular(CV) risk at baseLine (2004.7 to 2005.1),and blood was taken.Follow-up for death from cardiovascular disease and any cause was complete until January 1,2006.Results The mean follow-up was 1 years.There were 303 deaths during follow-up,of which 121 were cardiovascular.Crude mortality rates were 8.3 % for all patients,6.8% for female patients (116/1715),and 9.7% (187/1933) for male patients.Among men,patients in the lower and higher uric acid groups had increased cardiac and overall mortality risks compared with patients in the normal uric acid groups.Similar relation was found in women but not statistically significant.After adjusting for other conventional risk factors (age,diabetes,hypertension,diuretic use and smoking),baseline uric acid level was still associated with increased risk for death from cardiovascular disease (P=0.005),or death from all causes (P=0.014) Conclusion Our data suggest that abnormal serum uric acid levels are independently and significantly associated with risk of cardiovascular and all-cause mortality.(J Geriatr Cardiol 2008;5:15-20)
基金Supported by General Medical Research Fund Project,No.TYYLKYJJ-2022-025.
文摘BACKGROUND Patients with chronic heart failure(CHF)frequently develop hyperuricemia,an elevated serum uric acid level,associated with adverse outcomes.Dapagliflozin,a sodium-glucose cotransporter-2 inhibitor,demonstrates reduction in cardiovascular mortality and hospitalization in patients with CHF and ejection fraction(HFrEF),irrespective of diabetes.However,dapagliflozin’s effect on the uric acid levels in patients with CHF and hyperuricemia remain unclear.AIM To investigate the effects of dapagliflozin on uric acid levels in CHF patients with hyperuricemia.METHODS We conducted a randomized,double-blind,placebo-controlled trial in 200 patients with CHF and hyperuricemia,with HFrEF and serum uric acid levels≥7 mg/dL(≥416μmol/L).The participants were randomly assigned to receive a daily dose of 10 mg dapagliflozin or placebo for 24 months.The primary endpoint was the change in serum uric acid level from baseline to 24 months.Secondary endpoints included changes in left ventricular ejection fraction(LVEF),Nterminal pro-B-type natriuretic peptide(NT-proBNP),and quality of life(QoL)scores,as well as the incidence of cardiovascular death and hospitalization for heart failure.RESULTS At 24 months,dapagliflozin significantly reduced serum uric acid levels by 1.2 mg/dL(71μmol/L)compared with placebo(95%CI:-1.5 to-0.9;P<0.001).Dapagliflozin also significantly improved LVEF by 3.5%(95%CI:2.1-4.9;P<0.001),NT-proBNP by 25%(95%CI:18-32;P<0.001),and QoL scores by 10 points(95%CI:7-13;P<0.001)and reduced the risk of cardiovascular death and hospitalization for heart failure by 35%(95%CI:15–50;P=0.002)compared with the placebo.Adverse events were similar between the two groups,except for a higher rate of genital infections in the dapagliflozin group(10%vs 2%,P=0.01).CONCLUSION Dapagliflozin significantly lowered serum uric acid levels and improved the clinical outcomes in patients with CHF and hyperuricemia.Therefore,dapagliflozin may be a useful therapeutic option for this high-risk population.
文摘Background The association between increased serum uric acid （SUA） levels and cardiovascular risk has been debated for decades. Several large studies have provided conflicting results regarding the clinical significance of elevated SUA levels in cardiovascular disease （CVD） or cerebrovascular disease. The aim of this study was to investigate the relationship between SUA and CVD and all-cause mortality and their potential diagnostic value. Methods A total of 3570 in-patients ranging in age from 56 to 95 years （mean （67.36_＋11.36） years） were selected from 20 hospitals in Beijing and Shanghai. A carefully designed questionnaire was used to gather baseline data of each patient All patients were divided into two main groups according to their SUA levels： high SUA and normal SUA groups. Serum indices and other important parameters were measured. Results Compared with normal SUA group, high SUA group had significant difference in systolic blood pressure （SBP）, total cholesterol （TC）, triglyceride （TG）, high density lipoprotein cholesterol （HDL-C）, body mass index （BMI）, and age （P 〈0.05 or P 〈0.01）. High SUA prevailed in female and patients with history of essential hypertension, while history of smoking and diabetes showed no significant difference between two groups. All-cause and CVD mortality occurred more frequently in high SUA group than in normal SUA group. In the accumulative survival analysis, high SUA group had lower survival rate than normal SUA group both in CVD and all-cause mortality. COX regression analysis indicated that the history of smoking, age and high SUA were independent risk factors for the development of CVD. Conclusions These preliminary observations suggest that patients with high SUA levels would face higher risk of mortality. SUA measurement may be applied as a routine predictor for clinical assessment.
基金This study was supported by grants from the National Natural Science Foundation of China(Nos.91846101,81771938,81900665,82003529,82090021)Beijing Nova Programme Interdisciplinary Cooperation Project(No.Z191100001119008)+4 种基金National Key R&D Program of the Ministry of Science and Technology of China(No.2019YFC2005000)Chinese Scientific and Technical Innovation Project 2030(No.2018AAA0102100)the University of Michigan Health System-Peking University Health Science Center Joint Institute for Translational and Clinical Research(Nos.BMU2018JI012,BMU2019JI005)CAMS Innovation Fund for Medical Sciences(No.2019-I2M-5-046)PKU-Baidu Fund(No.2019BD017).
文摘Background:Whether there is an association between serum uric acid(SUA)level and risk of mortality in the general population remains unclear.Based on the China National Survey of Chronic Kidney Disease linked to mortality data,a population-based cohort study was performed to investigate the association between SUA level and all-cause mortality,cardiovascular disease(CVD)mortality,and cancer mortality in China.Methods:The survival status of participants in the cross-sectional survey was identified from January 1,2006 to December 31,2017.Only 33,268 individuals with complete SUA data among the 47,204 participants were included in the analysis.We determined the rates of all-cause mortality,CVD mortality,and cancer mortality.We used Cox proportional hazards regression models to evaluate the effect of the SUA level on mortality.Results:During a total of 297,538.4 person-years of follow-up,1282 deaths occurred.In the Cox proportional hazards regression model,the rate of all-cause mortality,CVD mortality,and cancer mortality had a U-shaped association with SUA levels only in men,whereas no significant associations were detected in women.For all-cause mortality in men,the multivariable-adjusted hazard ratios(HRs)in the first,second,and fourth quartiles compared with the third quartile were 1.31(95%confidence interval[CI]1.04–1.67),1.17(95%CI 0.92–1.47),and 1.55(95%CI 1.24–1.93),respectively.For CVD mortality,the corresponding HRs were 1.47(95%CI 1.00–2.18),1.17(95%CI 0.79–1.75),and 1.67(95%CI 1.16–2.43),respectively.For the cancer mortality rate,only a marginally significant association was detected in the fourth quartile compared with the third quartile with an HR of 1.43(95%CI 0.99–2.08).Conclusions:The association between SUA and mortality differed by sex.We demonstrated a U-shaped association with SUA levels for all-cause and CVD mortalities among men in China.
