Uric acid, left ventricular mass index, and risk of cardiovascular disease in essential hypertension
Uric acid, left ventricular mass index, and risk of cardiovascular disease in essential hypertension
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DOI：
10.1161/01.hyp.0000200033.14574.14
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发表时间：
2006-02-01
期刊：
影响因子：
8.3
通讯作者：
Kawano, Y
中科院分区：
文献类型：
--
作者：
Iwashima, Y;Horio, T;Kawano, Y
高血压患者常出现血尿酸（UA）升高，但UA与心血管事件之间的关系是间接的还是因果关系仍有待回答。我们检测了血清UA和左心室质量指数（LVMI）之间的关系，并前瞻性地研究了UA和LVMI的组合是否可以预测无症状原发性高血压患者心血管疾病（CVD）的发生率。本研究共纳入了619例既往无CVD的受试者（平均年龄61岁; 52%为女性）。多元回归分析显示UA与LVMI有显著相关性（男性：F = 4.29，P < 0.04;女性：F = 4.24，P < 0.05）。在随访期间（平均34个月），28名受试者（14名女性）发生CVD，包括心肌梗死、心绞痛、充血性心力衰竭、脑梗死和短暂性脑缺血。性别特异性中位数用于区分UA和LVMI较高组与较低组。Kaplan-Meier曲线显示UA和LVMI高的患者生存率明显降低（LVMI，男性：> 126.9，女性：> 112.0 g/m2; UA，男性：> 374.7，女性：> 303.3 μ mol/L; log-rank chi（2）= 13.18; P < 0.01）。多因素考克斯回归分析显示，UA和LVMI的联合升高是CVD事件的独立预测因子（危险比，2.38; P < 0.03）。我们的研究结果表明UA与LVMI独立相关，并提示高尿酸血症合并左心室肥厚是CVD的独立和强有力的预测因子。UA和CVD事件之间的关联可能部分是由于UA与LVMI的直接关联。
Elevated serum uric acid (UA) is frequently encountered in individuals with hypertension, but whether the relationship between UA and cardiovascular events is circumstantial or causal remains to be answered. We examined the association between serum UA and left ventricular mass index (LVMI) and investigated prospectively whether the combination of UA and LVMI can predict the incidence of cardiovascular disease (CVD) in asymptomatic subjects with essential hypertension. A total of 619 subjects ( mean age, 61 years; 52% female) free of prior CVD were included in this study. A significant association between UA and LVMI was also confirmed in multiple regression analysis ( male: F = 4.29, P < 0.04; female: F = 4.24, P < 0.05). During follow-up ( mean, 34 months), 28 subjects ( 14 female) developed CVD including myocardial infarction, angina pectoris, congestive heart failure, cerebral infarction, and transient cerebral ischemia. Sex-specific median values were used to separate the higher group from the lower group of UA and LVMI. Kaplan - Meier curves showed a significantly poorer survival rate in the group with higher UA and LVMI ( LVMI, male: > 126.9, female: > 112.0 g/m(2); UA, male: > 374.7, female: > 303.3 mu mol/L; log-rank chi(2) = 13.18; P < 0.01). Multivariate Cox regression analysis showed that the combination of higher UA and LVMI was an independent predictor for CVD events ( hazard ratio, 2.38; P < 0.03). Our findings demonstrate that UA is independently associated with LVMI and suggest that the combination of hyperuricemia combined with left ventricular hypertrophy is an independent and powerful predictor for CVD. The association between UA and CVD events may be introduced in part because of a direct association of UA with LVMI.