Date Published: June 30, 2017
Publisher: Public Library of Science
Author(s): Hoon Young Choi, Seok-hyung Kim, Ah Ran Choi, Seung Gyu Kim, Hyunwook Kim, Jung Eun Lee, Hyung Jong Kim, Hyeong Cheon Park, Cesare R. Sirtori.
Hyperuricemia is a risk factor for cardiovascular disease and is associated with increased arterial stiffness in high-risk populations. However, given the possible sex-related differences in the prevalence of hyperuricemia, the association between elevated serum uric acid (SUA) level and increased arterial stiffness has yielded conflicting results. We investigated the relationship between SUA and arterial stiffness in asymptomatic healthy subjects who underwent a health examination. Subjects who underwent a comprehensive health examination were enrolled. After exclusion of extensive confounding factors, 2,704 healthy subjects with coronary calcium score < 100 were evaluated in the final analysis. All subjects underwent brachial—ankle pulse wave velocity (baPWV) to detect arterial stiffness. The SUA was divided into quartiles for its association with arterial stiffness and was analyzed separately for men and women. The mean SUA level was significantly lower in women than in men. The baPWV was significantly elevated in subjects with the highest quartile of SUA in women, but not in men. After adjusting for age, smoking, systolic blood pressure, body mass index, estimated glomerular filtration rate, fasting plasma glucose, high-density lipoprotein-cholesterol, low-density lipoprotein-cholesterol, and coronary artery calcium score, the highest quartile of SUA in women was significantly associated with increased risk of high baPWV compared with the lowest quartile of SUA (OR = 1.7, p = 0.018), whereas in men, SUA level was not associated with high baPWV. Our study showed that elevated SUA is independently associated with increased baPWV in healthy Korean women, but not in men.
Elevated serum uric acid (SUA) levels are a common finding in patients with hypertension, metabolic syndrome, and renal disease . Studies in populations of patients at high risk for cardiovascular disease (CVD) have shown an association between high SUA levels and CVD . Furthermore, in patients with moderate-to-severe chronic heart failure, high SUA levels increase all-cause mortality independent of other risk factors , and this increase in risk seems to start at an SUA level above 7 mg/dL . Even in relatively healthy populations, high SUA levels are significantly associated with increased subclinical coronary atherosclerosis . Interestingly, a sex-dependent association, particularly in women, has been suggested between higher SUA level and the risk of adverse cardiovascular (CV) events [6, 7].
The results in this study showed that high normal or greater SUA (Q4: 291.61–517.7 μmol/L) was associated with increased baPWV in healthy Korean women. Previous observational data included subjects with risk factors for increased arterial stiffness. To our knowledge, this study is the first to carefully examine the traditional risk factors for CVD and exclude other possible confounding risk factors including coronary calcification to analyze the effects of SUA per se on arterial stiffness.
We found that elevated SUA level is associated with increased arterial stiffness in elderly healthy Korean women. However, the relationship between elevated SUA level and increased arterial stiffness was not significant in men.