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An examination of the relationship between serum uric acid level, a clinical history of gout, and cardiovascular outcomes among patients with acute coronary syndrome.
Pagidipati, Neha J; Hess, Connie N; Clare, Robert M; Akerblom, Axel; Tricoci, Pierluigi; Wojdyla, Daniel; Keenan, Robert T; James, Stefan; Held, Claes; Mahaffey, Kenneth W; Klein, Alyssa B; Wallentin, Lars; Roe, Matthew T.
Afiliación
  • Pagidipati NJ; Duke University Health System, Duke Clinical Research Institute, Durham, NC. Electronic address: neha.pagidipati@dm.duke.edu.
  • Hess CN; University of Colorado School of Medicine, Aurora, CO.
  • Clare RM; Duke University Health System, Duke Clinical Research Institute, Durham, NC.
  • Akerblom A; Uppsala University, Uppsala Clinical Research Center, Uppsala, Sweden.
  • Tricoci P; Duke University Health System, Duke Clinical Research Institute, Durham, NC.
  • Wojdyla D; Duke University Health System, Duke Clinical Research Institute, Durham, NC.
  • Keenan RT; Duke University Health System, Durham, NC.
  • James S; Uppsala University, Uppsala Clinical Research Center, Uppsala, Sweden.
  • Held C; Uppsala University, Uppsala Clinical Research Center, Uppsala, Sweden.
  • Mahaffey KW; Stanford University Medical Center, Stanford, CA.
  • Klein AB; AstraZeneca, Gaithersburg, MD.
  • Wallentin L; Uppsala University, Uppsala Clinical Research Center, Uppsala, Sweden.
  • Roe MT; Duke University Health System, Duke Clinical Research Institute, Durham, NC.
Am Heart J ; 187: 53-61, 2017 May.
Article en En | MEDLINE | ID: mdl-28454808
ABSTRACT

BACKGROUND:

Studies have suggested a relationship between higher baseline serum uric acid (sUA) levels and an elevated risk of subsequent ischemic cardiovascular outcomes among acute coronary syndrome (ACS) patients; this relationship may be modified by a clinical history of gout and has not been studied in large patient cohorts. We sought to understand the effect of sUA and gout on ACS outcomes.

METHODS:

Using PLATO and TRACER data on 27,959 ACS patients, we evaluated baseline sUA levels in relation to a composite of cardiovascular death, myocardial infarction (MI), or stroke. We assessed interaction terms to determine if a baseline clinical diagnosis of gout modified this putative relationship; 46% (n=12,882) had sUA levels elevated >6.0 mg/dL.

RESULTS:

Patients with elevated levels were more often male with a history of prior MI, diabetes, and heart failure compared with those with sUA <6.0 mg/dL. The unadjusted risk of the composite endpoint increased with corresponding elevations in sUA levels (per 1 mg/dL increase) (HR=1.23 [95% CI 1.20-1.26]) above the statistical inflection point of 5.0 mg/dL. After adjustment, the association between sUA level and the composite outcome remained significant (HR=1.07 [95% CI 1.04-1.10]), and baseline gout did not modify this relationship.

CONCLUSIONS:

In patients with ACS, increasing levels of sUA are associated with an elevated risk of cardiovascular events, regardless of a clinical diagnosis of gout. Further investigation is warranted to determine the mechanism behind this relationship and to delineate whether sUA is an appropriate therapeutic target to reduce cardiovascular risk.
Asunto(s)

Texto completo: 1 Banco de datos: MEDLINE Asunto principal: Ácido Úrico / Enfermedades Cardiovasculares / Síndrome Coronario Agudo / Gota Tipo de estudio: Etiology_studies / Risk_factors_studies Límite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Am Heart J Año: 2017 Tipo del documento: Article

Texto completo: 1 Banco de datos: MEDLINE Asunto principal: Ácido Úrico / Enfermedades Cardiovasculares / Síndrome Coronario Agudo / Gota Tipo de estudio: Etiology_studies / Risk_factors_studies Límite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Am Heart J Año: 2017 Tipo del documento: Article