Research Article :
Mohammed Ahmed Bamashmos and Khaled Al-Aghbari Hyperuricemia is a metabolic problem that has
become increasingly common worldwide over the past several decades. Its
prevalence is increased in both advanced and developing countries including
Yemen. The aim of this cross sectional study was to investigate the prevalence
of hyperuricemia in sample of Yemeni adult individual and its relationship to
certain cardiovascular risk factors namely obesity, hypertension, serum
glucose, total cholesterol, high serum triglyceride, Low High Density
Lipoprotein (HDL-C) and high Low Density Lipoprotein (LDL-C). A sample of 600 adult
Yemeni people aged equal or over 18 years was randomly chosen to represent the
population living in Sanaa City during a period of two years from April 2017 to
August 2018. All the study groups undergo full clinical history and examination
includes measurement of BP and BMI, WC and the following laboratory
investigation (FBS, Basal serum uric acid level, total cholesterol, serum TG,
HDL and LDL). The prevalence of
hyperuricemia in this study was 8.8% (11,6% male and 6.4% female). The serum
uric acid level in this study was significantly correlated with age, Waist
Circumference (WC), SBP, DBP, FBS, T-cholesterol, TG and LDL but not with HDL. There is strong
relationship between serum uric acid level and other cardiovascular risk
factors. Hyperurecemia
is metabolic problem that has become increasingly worldwide over the past
several decades and its the most risk factor for gout [1]. Hyperurecimea is
defining as serum urate level greater than 6mg/dl in in women and 7mg/dl in
men, above this concentration serum urate supersaturates in body fluid and is
prone to crystallization and subsequent deposition in the tissue [2].The
association of hyperurecemia and gout with other medical condition such as
hypertension, chronic kidney diseases, dyslipidemia and other cardiovascular
diseases has been recognized for over 100 years [3]. The prevalence of
hyperurecemia has been increased in recent years, not only in advanced
countries but also in developing countries along with the development with
their economics [4]. Published population-based prevalence data of
hyperuricemia were reported in 13 of the 21 Global Burden of Diseases
(GBD) regions, and a total of 24 countries. In most part of Asia Hyperuricemia
is relatively prevalent, but in East Asia it found to be most prevalent. Lowest
percentage is seen in Papua New Guinea 1% and in Marshall Islands 85% is seen. In japan the high income Asian country Hyperuricemia has
increased by five folds in time of two decades. There is no published
population-based epidemiological studies on hyperuricemia were identified
during the specified systematic review period [5]. Hyperuricemia can be causes
by over production of urate which account of less than 10% of the cause such as
high cellular turnover, genetic error and tumor lysis syndrome or far more
commonly inefficient excretion by the kidney due to renal insufficiency of any
cause or medication that impair renal urate clearance [6]. In numerous
epidemiological studies since 1950 a positive association has been seen between
serum uric acid and cardiovascular
diseases such as ischemic heart disease and stroke [7,8]. However weather uric acid is independent risk factor for
cardiovascular disease is still disputed as several studies has suggested that
hyperurecemia is merely associated with cardiovascular disease because of
confounding factors such as obesity, hypertension, dyslipidemia, use of
diuretic and insulin resistance [9]. Obesity and central fat distribution were
associated with hyperurecemia. Patients with central obesity have greater risk
of hyperurecemia [4]. There are many researches was conducted to evaluate the
relationship between leptin hormone and the cluster of hyperurecemia in order
to identify the pathogenic mechanism associating obesity with hyperurecemia. It
was suggested that leptin could be a pathogenic factor responsible for
hyperurecemia in obese patients [10]. The strong association between hypertension and
hyperurecemia has been recognized for more than century. More than one large
epidemiological studies published over the past 7 years have found that serum
urate level predict later development of hypertension [11,12]. Experimental studies have reported that hyperurecemia induces
systemic hypertension and renal injury via activation of renin angiotensin
system and direct intery of uric acid into both endothelial and vascular smooth
muscle cells, decreased neuronal nitric oxide synthase in the juxtaglomerular
apparatus resulting in local inhibition of endothelial nitric oxide level,
stimulation of vascular smooth muscle cell proliferation and stimulation of
vasoactive and inflammatory mediators [13,14]. There is strong association
between hypertriglycemia and hyperurecemia this association could be explained
by insulin resistance as hypertriglyceridemia and hyperurecemia are suggested to
be associated with insulin
resistance syndrome [15]. The association of hypertriglyceridemia and hyperurecemia in
patients with insulin resistance syndrome could be explained by accumulation of
glycolytic intermediate and release of free fatty acid from adipose tissue
[16]. The resemblance of hyperurecemia and the metabolic syndrome has led to
the suggestion that the metabolic syndrome can be further expanded to include
hyperurecemia [17]. A prospective study in Korea suggested that higher uric
acid concentration predicted the incidence of hypertension and the development
of metabolic syndrome and hyperurecemia has been considered as component of
metabolic syndrome [18,19]. This was across sectional population based study conducted in
Sanaa city for a period of 2 years between September 2016 and September 2018 a
sample of 600 adult Yemeni people (275 male and 325 female aged ≥ 18 years) was
randomly selected from those attending Al-Kuwait University Hospital and
Consultation Clinic. All the participants in this study undergo complete clinical
history (regarding their age, occupation, habit, any history of hypertension,
diabetes mellitus, dyslipidemia and medication) Anthropometric measurement
includes measurement of height, weight, waist circumference and systolic and diastolic
blood pressure. Height was measured with tapeline to the nearest.5cm and
weight was measured with beam scale balance. Participants wore light clothing
and were asked to remove shoes, heavy outer garments Body Mass Index (BMI:
kg/m2) was calculated from measured weight and height. BMI was classified as
underweight (<18.5 kg/m2), normal (18.5-25 kg/m2), overweight (25-30 kg/m2)
and obese (>30 kg/m2) by WHO criteria [20]. Waist circumference was manually
measured on standing subjects with soft tape midway between the lowest rib and
the iliac crest. Abdominal obesity was defined as WC ≥ 90 cm (male) or WC ≥ 80
cm (female) by IDF consensus [21]. Two blood pressure recording were obtained from the right arm
of patients with slandered mercury sphygmomanometer
in a sitting position after 10 min. of rest measurement were taken in 3-5
minutes interval and the mean values were calculated. Blood pressure was
classified as normotensive (SBP<120 mmHg and DBP<80 mmHg),
pre-hypertensive (SBP: 120-139 mmHg and/or DBP: 80-89 mmHg) and hypertensive
(SBP ≥ 140 mmHg and/or DBP ≥ 90 mmHg) by the Seventh Report of the Joint
National Committee on the Prevention, Detection, Evaluation, and Treatment of
High Blood Pressure (JNC-7) [22]. The American Diabetes Association criteria
was used to classify FBG as normal glucose (FBG<5.6 mmol/L), Impaired
Fasting Glucose (IFG) (FBG ≥ 5.6 mmol/L ≤ FBG<7.0 mmol/L), and diabetic (FBG
≥ 7.0 mmol/L, Serum uric acid were measured [23]. Hyperurecemia is defined as
serum uric acid level greater than 6.0mg/|dl in women and 7.0 mg/dl in men.
Dyslipidemia was classified according to ATP III, TG: Normal<1.69 mmol/L,
Borderline high 1.69-2.26 mmol/L, High 2.26-5.65 mmol/L, Very high ≥ 5.65
mmol/L; TC: Desirable<5.17 mmol/L, Borderline high 5.17-6.24 mmol/L, High ≥
6.24 mmol/L; HDL-C: High 1.56 mmol/L, Optimal 1.03-1.56 mmol/L, Low The results were analyzed by using (Social Package of
Statistical Science) SPSS V.15 from LEAD Technologies Inc., USA. Basic
characteristics of subjects are presented as mean and slandered deviation for
quantities variables and as frequency and percent for qualitative variable. The
total participants were divided into two groups according to the sex then there
were divided into two mean groups according to serum uric acid level. The
prevalence of cardiovascular diseases risk factors among two groups were
calculated and Chi-square
test was used to detect the significance /The mean of uric acid in
different categories of separated variable were determined and the comparison
between the mean was achieved by independent t-test and one way ANOVA test. The
relationships between parameters were examined by calculating persons
correlation coefficient. For investigating for most effective factors on
hyperurecemia such as blood pressure anthropometrical and biochemical (except
UC) measurement were considered for Binary logistic regression P-value less
than 0.05 was considered statistically significant. A study sample includes 600 person aged between 18-83 of them
275 (45.4%) were male and 325 (54.6%) were female. The prevalence of high serum
uric acid level in the study group was 53 (8.8%) with no significant difference
between male and female (Table 1) regarding the clinical and laboratory
parameters in the study group BMI. WS, serum cholesterol, high TG, low high
density lipoprotein, high LDL and high FBS were significantly higher in women
than in men (17.2%, 35%, 43.3%, 41.2%, 19.3%, 53.8% and 26.4% vs 13.8%, 14.5%,
27.6%. 27.2%, 8.7%, 38.1% and 19.2% respectively, while the BP was
significantly higher in men than women, also there was no significant
difference between male and female regarding serum uric acid level. Hyperurecemia is increasingly common medical problem not only
in the advanced countries, but also in the developing countries. The incidence
of high serum uric acid is increased word wide with average of 20% of
population having hyperurecemia and the serum uric acid level is increased with
age. It has been described that hyperurecemia is associated with other
cardiovascular risk factors such as obesity, dyslipidemia,
hyperglycemia and hypertension [1-3]. Elevated serum uric acid levels are
commonly seen in association with glucose intolerance, hypertension and
dyslipidemia, a cluster of metabolic and hemodynamic disorders
which characterize the so-called metabolic syndrome [25-29]. To our knowledge
there is no data about the prevalence of hyperurecemia in Yemen so we decided
to carry out this research in order to know the prevalence of hyperurecemia and
its association with other cardiovascular risk factors in Yemeni population. Note: SUA-Serum
Uric Acid, FBS- Fasting Blood Sugar, IFG- Impaired Fasting Glucose, T.Ch- Total
Cholesterol, TG- Triglyceride, HDL- High Density Lipoprotein, LDL- Low Density
Lipoprotein. Table 1: Shows the clinical and laboratory characteristics of
the study group. Note: Table 2
present comparing the mean of selected study parameters in relation to the uric
acid level, it shows the mean of age, SBP, WS, fasting blood glucose, total
cholesterol, TG and LDL were significantly higher within hyperurecemic study
population in comparing to those with normal serum uric acid level, there were
no significant difference in DBP, BMI and HDL between the two groups. Note: Table 3
shows the simple correlation coefficients between serum uric acid levels and
the various cardiovascular risk factors in the population. Uric acid was
significantly positively correlated with age, SBP, FBS, TG, total cholesterol,
LDL (P-value ≤ 0.01) and weak positive correlated with DBP, BMI and WC (P-value
≤ 0.05 ) while it was insignificantly correlated with HDL (P-value 0.411). The mean observations of the present study are the following;
firstly the prevalence of hyperurecemia present in a good proportion in Yemeni
peoples and it was insignificantly high in women than in men. Secondly
significant correlation between serum uric acid the various cardiovascular risk
factors were found. The prevalence of hyperurecemia in the present study was
8.8%, which is mainly near to that reported in Saudi Arabia (9.3%), Iran (8%),
Thailand (9-11%), Mexico (11%) and in Turkish (12%) which may be reflected to
similar race and environmental factors. while its lower than that found in
Columbia (26.3%). Indian (25.8%), Taiwan (30.4%) and USA (21-22%) which may be
attributed to the high economic state of this countries. Hyperurecemia was
insignificantly higher in women (7.9%) than men (6.3%) which may be explained
by high prevalence of obesity in women (BMI and WC was 17.2%, 35% in women VS
13.8% and 14.1% in in men respectively. This finding was supported by study
done in Saudi Arabia and but other studies are against this observation.
Comparing hyperurecemic subject with those with normal serum uric acid level,
those with hyperurecemia are older centrally obese, had high systolic blood
pressure, high FBS, total cholesterol, triglyceride, and LDL
[30-36] (Table 2). In this study, multiple logistic regression results have
further confirmed the association between metabolic abnormalities and high
serum uric acid, and have conducted further stratified analysis on each
metabolic abnormality-related indicator. Table 3 shows the simple correlation
coefficients between serum
uric acid levels and the various cardiovascular risk factors in the
population. Our results have shown that high serum uric acid was significantly
positively correlated with age, SBP, FBS,TG, total cholesterol, LDL (P-value ≤
0.01) and weak positive correlated with DBP, BMI and WC (P-value ≤ 0.05 ) while
it was insignificantly correlated with HDL (P-value 0.411) [35]. Elevation of the serum uric acid level has been known
associated with major cardiovascular risk factors, such as hypertension,
insulin resistance, dyslipidemia and obesity, which are hallmarks of metabolic
syndrome [36-39]. Similar to other studies, in this study, individuals with
hyperuricemia had higher prevalence of major cardiovascular risk factors,
including dyslipidemia, hypertension and overweight. Uric Acid (UA) is a known
endogenous scavenger, which provides a major part of the antioxidant capacity
against oxidative and radical injury. However, at high levels, UA can shift
from an antioxidant to a pro-oxidant factor (shuttle capacity),
depending on the characteristic of the surrounding microenvironment (e.g., UA
levels, acidity, depletion of other antioxidants, reduced Nitric Oxide (NO),
availability) [40,41]. Accordingly, high UA values have been associated with
metabolic syndrome, Cardiovascular Disease (CVD), and renal dysfunction,
involving mechanisms that favor oxidative stress, inflammation, and endothelial dysfunction.
The result of this study showed significant positive correlation were found
between serum uric acid and several component of the metabolic syndrome such as
higher WS, BP, TG and FBS (p-value ≤ 0.005) but there was insignificant
negative correlation with HDL. Several possible pathophysiological mechanisms
have been evoked to explain these associations including insulin resistance,
the use of diuretics or impaired renal function accompanying hypertension
[42-49]. Indeed the kidney seems to play an important role in the
development of the metabolic syndrome. Insulin-resistant individuals secrete
larger amounts of insulin in order to maintain an adequate glucose metabolism.
The kidney which is not insulin-resistant responds to these high insulin levels
by decreasing uric acid clearance, probably linked to insulin-induced urinary
sodium retention. Insulin resistance may increase blood pressure directly via
enhanced proximal tubular sodium reabsorption or indirectly by the sympatho-adrenal system
[43-45]. Thereby, the kidney has been implicated as the potential link between
muscle insulin resistance and compensatory hyperinsulinemia and the development
of hyperuricemia and eventually hypertension. Our study demonstrates an alarming high prevalence of
hyperurecemia among Yemeni patients that increases the burden on overstrained
Yemeni health system with uprising CVDs and other hyperurecemia related health
problems e.g. hypertension, dyslipidemia DM. There is also an urgent need to
develop strategies for prevention, detection, and treatment of hyperurecemia
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internal medicine and Endocrinology, Sanaa University, Yemen, E-mail: mohbamashmoos@yahoo.com Bamashmos AM and
Al-Aghbari K. Prevalence of hyperuricemia and its association with other
cardiovascular risk factors in adult Yemeni people of Sanaa city (2019)
Clinical Cardiol Cardiovascular Med 3: 10-14. Hyperurecemia, Dyslipidemia, BMI, FBS.Prevalence of Hyperuricemia and its Association with Other Cardiovascular Risk Factors in Adult Yemeni People of Sana City
Abstract
Objective: Full-Text
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