Cargando…

U‐Shaped Association Between Serum Uric Acid Levels With Cardiovascular and All‐Cause Mortality in the Elderly: The Role of Malnourishment

BACKGROUND: The link between elevated serum uric acid (SUA) levels and cardiovascular disease (CVD)–related mortality in the elderly population remains inconclusive. Nutritional status influences both SUA and CVD outcomes. Therefore, we investigated whether SUA‐predicted mortality and the effect‐mod...

Descripción completa

Detalles Bibliográficos
Autores principales: Tseng, Wei‐Cheng, Chen, Yung‐Tai, Ou, Shuo‐Ming, Shih, Chia‐Jen, Tarng, Der‐Cherng
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5850189/
https://www.ncbi.nlm.nih.gov/pubmed/29440009
http://dx.doi.org/10.1161/JAHA.117.007523
_version_ 1783306186781622272
author Tseng, Wei‐Cheng
Chen, Yung‐Tai
Ou, Shuo‐Ming
Shih, Chia‐Jen
Tarng, Der‐Cherng
author_facet Tseng, Wei‐Cheng
Chen, Yung‐Tai
Ou, Shuo‐Ming
Shih, Chia‐Jen
Tarng, Der‐Cherng
author_sort Tseng, Wei‐Cheng
collection PubMed
description BACKGROUND: The link between elevated serum uric acid (SUA) levels and cardiovascular disease (CVD)–related mortality in the elderly population remains inconclusive. Nutritional status influences both SUA and CVD outcomes. Therefore, we investigated whether SUA‐predicted mortality and the effect‐modifying roles of malnourishment in older people. METHODS AND RESULTS: A longitudinal Taiwanese cohort including 127 771 adults 65 years and older participating in the Taipei City Elderly Health Examination Program from 2001 to 2010 were stratified by 1‐mg/dL increment of SUA. Low SUA (<4 mg/dL) strata was categorized by malnourishment status defined as Geriatric Nutritional Risk Index <98, serum albumin <38 g/L, or body mass index <22 kg/m(2). Study outcomes were all‐cause and CVD‐related mortality. Cox models were used to estimate hazard ratios (HRs) of mortality, after adjusting for 20 demographic and comorbid covariates. Over a median follow‐up of 5.8 years, there were 16 439 all‐cause and 3877 CVD‐related deaths. Compared with the reference SUA strata of 4 to <5 mg/dL, all‐cause mortality was significantly higher at SUA <4 mg/dL (HR, 1.16; 95% confidence interval, 1.07–1.25) and ≥8 mg/dL (HR, 1.13; confidence interval, 1.06–1.21), with progressively elevated risks at both extremes. Similarly, increasingly higher CVD‐related mortality was found at the SUA level <4 mg/dL (HR, 1.19; confidence interval, 1.00–1.40) and ≥7 mg/dL (HR, 1.17; confidence interval, 1.04–1.32). Remarkably, among the low SUA (<4 mg/dL) strata, only malnourished participants had greater all‐cause and CVD‐related mortality. This modifying effect of malnourishment remained consistent across subgroups. CONCLUSIONS: SUA ≥8 or <4 mg/dL independently predicts higher all‐cause and CVD‐related mortality in the elderly, particularly in those with malnourishment.
format Online
Article
Text
id pubmed-5850189
institution National Center for Biotechnology Information
language English
publishDate 2018
publisher John Wiley and Sons Inc.
record_format MEDLINE/PubMed
spelling pubmed-58501892018-03-21 U‐Shaped Association Between Serum Uric Acid Levels With Cardiovascular and All‐Cause Mortality in the Elderly: The Role of Malnourishment Tseng, Wei‐Cheng Chen, Yung‐Tai Ou, Shuo‐Ming Shih, Chia‐Jen Tarng, Der‐Cherng J Am Heart Assoc Original Research BACKGROUND: The link between elevated serum uric acid (SUA) levels and cardiovascular disease (CVD)–related mortality in the elderly population remains inconclusive. Nutritional status influences both SUA and CVD outcomes. Therefore, we investigated whether SUA‐predicted mortality and the effect‐modifying roles of malnourishment in older people. METHODS AND RESULTS: A longitudinal Taiwanese cohort including 127 771 adults 65 years and older participating in the Taipei City Elderly Health Examination Program from 2001 to 2010 were stratified by 1‐mg/dL increment of SUA. Low SUA (<4 mg/dL) strata was categorized by malnourishment status defined as Geriatric Nutritional Risk Index <98, serum albumin <38 g/L, or body mass index <22 kg/m(2). Study outcomes were all‐cause and CVD‐related mortality. Cox models were used to estimate hazard ratios (HRs) of mortality, after adjusting for 20 demographic and comorbid covariates. Over a median follow‐up of 5.8 years, there were 16 439 all‐cause and 3877 CVD‐related deaths. Compared with the reference SUA strata of 4 to <5 mg/dL, all‐cause mortality was significantly higher at SUA <4 mg/dL (HR, 1.16; 95% confidence interval, 1.07–1.25) and ≥8 mg/dL (HR, 1.13; confidence interval, 1.06–1.21), with progressively elevated risks at both extremes. Similarly, increasingly higher CVD‐related mortality was found at the SUA level <4 mg/dL (HR, 1.19; confidence interval, 1.00–1.40) and ≥7 mg/dL (HR, 1.17; confidence interval, 1.04–1.32). Remarkably, among the low SUA (<4 mg/dL) strata, only malnourished participants had greater all‐cause and CVD‐related mortality. This modifying effect of malnourishment remained consistent across subgroups. CONCLUSIONS: SUA ≥8 or <4 mg/dL independently predicts higher all‐cause and CVD‐related mortality in the elderly, particularly in those with malnourishment. John Wiley and Sons Inc. 2018-02-10 /pmc/articles/PMC5850189/ /pubmed/29440009 http://dx.doi.org/10.1161/JAHA.117.007523 Text en © 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs (http://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Original Research
Tseng, Wei‐Cheng
Chen, Yung‐Tai
Ou, Shuo‐Ming
Shih, Chia‐Jen
Tarng, Der‐Cherng
U‐Shaped Association Between Serum Uric Acid Levels With Cardiovascular and All‐Cause Mortality in the Elderly: The Role of Malnourishment
title U‐Shaped Association Between Serum Uric Acid Levels With Cardiovascular and All‐Cause Mortality in the Elderly: The Role of Malnourishment
title_full U‐Shaped Association Between Serum Uric Acid Levels With Cardiovascular and All‐Cause Mortality in the Elderly: The Role of Malnourishment
title_fullStr U‐Shaped Association Between Serum Uric Acid Levels With Cardiovascular and All‐Cause Mortality in the Elderly: The Role of Malnourishment
title_full_unstemmed U‐Shaped Association Between Serum Uric Acid Levels With Cardiovascular and All‐Cause Mortality in the Elderly: The Role of Malnourishment
title_short U‐Shaped Association Between Serum Uric Acid Levels With Cardiovascular and All‐Cause Mortality in the Elderly: The Role of Malnourishment
title_sort u‐shaped association between serum uric acid levels with cardiovascular and all‐cause mortality in the elderly: the role of malnourishment
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5850189/
https://www.ncbi.nlm.nih.gov/pubmed/29440009
http://dx.doi.org/10.1161/JAHA.117.007523
work_keys_str_mv AT tsengweicheng ushapedassociationbetweenserumuricacidlevelswithcardiovascularandallcausemortalityintheelderlytheroleofmalnourishment
AT chenyungtai ushapedassociationbetweenserumuricacidlevelswithcardiovascularandallcausemortalityintheelderlytheroleofmalnourishment
AT oushuoming ushapedassociationbetweenserumuricacidlevelswithcardiovascularandallcausemortalityintheelderlytheroleofmalnourishment
AT shihchiajen ushapedassociationbetweenserumuricacidlevelswithcardiovascularandallcausemortalityintheelderlytheroleofmalnourishment
AT tarngdercherng ushapedassociationbetweenserumuricacidlevelswithcardiovascularandallcausemortalityintheelderlytheroleofmalnourishment
AT ushapedassociationbetweenserumuricacidlevelswithcardiovascularandallcausemortalityintheelderlytheroleofmalnourishment