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Hyperuricemia: risk factor for thromboembolism in hypertrophic cardiomyopathy patients

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Abstract

Hyperuricemia has been regarded as a risk factor for various cardiovascular diseases. However, few studies have evaluated its influence on thromboembolism in hypertrophic cardiomyopathy (HCM) patients. The purpose of the present study is to investigate the association between hyperuricemia and thromboembolism in a retrospective HCM cohort. A total of 447 adult HCM patients were enrolled in this study from December 2008 to May 2016. Uric acid levels were measured at baseline. Hyperuricemia was defined as blood uric acid level > 360 µmol/L for female patients and > 420 µmol/L for male patients, respectively. The association between hyperuricemia and thromboembolism was analyzed. During the follow-up period of 1786.8 person-years, 31 patients (6.9%) developed thromboembolic events. There was a higher thromboembolism incidence in patients with hyperuricemia than those with normouricemia (8.9% vs. 5.6%; unadjusted HR 2.35, 95% CI 1.16–4.78, P = 0.018). The association slightly increased after adjusting for potential confounders (HR 2.67, 95% CI 1.24–5.76, P = 0.013). Atrial fibrillation (AF) and left ventricular outflow tract obstruction played an interactive role in the relationship between hyperuricemia and thromboembolism with P for interaction of 0.011 and 0.007, respectively. Adjusted HRs of hyperuricemia were 8.99 (95% CI 2.23–36.29, P = 0.002) for thromboembolism in HCM patients with AF and 6.89 (95% CI 2.23–21.24, P = 0.001) in non-obstructive HCM patients. The association lost statistical significance among patients without AF and obstructive ones. Hyperuricemia significantly predicts future thromboembolism in HCM patients, especially in HCM patients with AF and non-obstructive HCM patients. Future studies are warranted for further evaluation.

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References

  1. Maron BJ (1997) Hypertrophic cardiomyopathy. Lancet 350:127–133. https://doi.org/10.1016/S0140-6736(97)01282-8

    Article  CAS  PubMed  Google Scholar 

  2. Maron BJ (2002) Hypertrophic cardiomyopathy: a systematic review. JAMA 287:1308–1320. https://doi.org/10.1001/jama.287.10.1308

    Article  PubMed  Google Scholar 

  3. Maron BJ, Olivotto I, Bellone P et al (2002) Clinical profile of stroke in 900 patients with hypertrophic cardiomyopathy. J Am Coll Cardiol 39:301–307. https://doi.org/10.1016/S0735-1097(01)01727-2

    Article  PubMed  Google Scholar 

  4. Choi YJ, Choi EK, Do HK et al (2018) Temporal trends of the prevalence and incidence of atrial fibrillation and stroke among Asian patients with hypertrophic cardiomyopathy: a nationwide population-based study. Int J Cardiol 273:130–135. https://doi.org/10.1016/j.ijcard.2018.08.038

    Article  PubMed  Google Scholar 

  5. Haruki S, Minami Y, Hagiwara N (2016) Stroke and embolic events in hypertrophic cardiomyopathy: risk stratification in patients without atrial fibrillation. Stroke 47:936–942. https://doi.org/10.1161/STROKEAHA.115.012130

    Article  PubMed  Google Scholar 

  6. Bos MJ, Koudstaal PJ, Hofman A et al (2006) Uric acid is a risk factor for myocardial infarction and stroke: the Rotterdam Study. Stroke 37:1503–1507. https://doi.org/10.1161/01.STR.0000221716.55088.d4

    Article  CAS  PubMed  Google Scholar 

  7. Hozawa A, Folsom AR, Ibrahim H et al (2006) Serum uric acid and risk of ischemic stroke: the ARIC Study. Atherosclerosis 187:401–407. https://doi.org/10.1016/j.atherosclerosis.2005.09.020

    Article  CAS  PubMed  Google Scholar 

  8. Holme I, Aastveit AH, Hammar N et al (2009) Uric acid and risk of myocardial infarction, stroke and congestive heart failure in 417 734 men and women in the Apolipoprotein MOrtality RISk study (AMORIS). J Intern Med 266:558–570. https://doi.org/10.1111/j.1365-2796.2009.02133.x

    Article  CAS  PubMed  Google Scholar 

  9. Storhaug HM, Norvik JV, Toft I et al (2013) Uric acid is a risk factor for ischemic stroke and all-cause mortality in the general population: a gender specific analysis from The Tromsø Study. BMC Cardiovasc Disord. https://doi.org/10.1186/1471-2261-13-115

    Article  PubMed  PubMed Central  Google Scholar 

  10. Zamorano JL, Anastasakis A, Borger MA et al (2014) 2014 ESC guidelines on diagnosis and management of hypertrophic cardiomyopathy: the task force for the diagnosis and management of hypertrophic cardiomyopathy of the European Society of Cardiology (ESC). Eur Heart J 35:2733–2779. https://doi.org/10.1093/eurheartj/ehu284

    Article  Google Scholar 

  11. He S, Wang Z, Cheem TH et al (2019) External validation of the model of thrombo-embolic risk in hypertrophic cardiomyopathy patients. Can J Cardiol. https://doi.org/10.1016/j.cjca.2019.05.035

    Article  PubMed  Google Scholar 

  12. Fang J, Alderman MH (2000) Serum uric acid and cardiovascular mortality the NHANES I epidemiologic follow-up study, 1971–1992. National Health and Nutrition Examination Survey. JAMA 283:2404–2410

    Article  CAS  Google Scholar 

  13. Lang RM, Badano LP, Mor-Avi V et al (2015) Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American society of echocardiography and the European association of cardiovascular imaging. Eur Heart J Cardiovasc Imaging 16:233–271. https://doi.org/10.1093/ehjci/jev014

    Article  PubMed  Google Scholar 

  14. Zhu L, Wang J, Wang Y et al (2015) Plasma uric acid as a prognostic marker in patients with hypertrophic cardiomyopathy. Can J Cardiol 31:1252–1258. https://doi.org/10.1016/j.cjca.2015.02.018

    Article  PubMed  Google Scholar 

  15. Zhang C, Liu R, Yuan J et al (2016) Gender-related differences in the association between serum uric acid and left ventricular mass index in patients with obstructive hypertrophic cardiomyopathy. Biol Sex Differ. https://doi.org/10.1186/s13293-016-0074-x

    Article  PubMed  PubMed Central  Google Scholar 

  16. Ozylmaz S, Satlmolu MH, Gül M et al (2018) Evaluation of the association between serum uric acid level and the predicted risk score of sudden cardiac death in five years in patients with hypertrophic cardiomyopathy. Turk Kardiyol Dern Ars 46:111–120. https://doi.org/10.5543/tkda.2017.60094

    Article  Google Scholar 

  17. Chao TF, Liu CJ, Chen SJ et al (2014) Hyperuricemia and the risk of ischemic stroke in patients with atrial fibrillation—could it refine clinical risk stratification in AF? Int J Cardiol 170:344–349. https://doi.org/10.1016/j.ijcard.2013.11.011

    Article  PubMed  Google Scholar 

  18. Su HM, Lin TH, Hsu PC et al (2014) Association of hyperuricemia with cardiac events in patients with atrial fibrillation. Int J Cardiol 172:464–465. https://doi.org/10.1016/j.ijcard.2013.12.263

    Article  PubMed  Google Scholar 

  19. Tamariz L, Agarwal S, Soliman EZ et al (2011) Association of serum uric acid with incident atrial fibrillation (from the Atherosclerosis Risk in Communities [ARIC] study). Am J Cardiol 108:1272–1276. https://doi.org/10.1016/j.amjcard.2011.06.043

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Nyrnes A, Toft I, Njølstad I et al (2014) Uric acid is associated with future atrial fibrillation: an 11-year follow-up of 6308 men and women—the Tromsø study. Europace 16:320–326. https://doi.org/10.1093/europace/eut260

    Article  PubMed  Google Scholar 

  21. Kuwabara M, Niwa K, Nishihara S et al (2017) Hyperuricemia is an independent competing risk factor for atrial fibrillation. Int J Cardiol 231:137–142. https://doi.org/10.1016/j.ijcard.2016.11.268

    Article  PubMed  Google Scholar 

  22. Maharani N, Kuwabara M, Hisatome I (2016) Hyperuricemia and atrial fibrillation. Int Heart J 57:395–399. https://doi.org/10.1536/ihj.16-192

    Article  CAS  PubMed  Google Scholar 

  23. Maron BJ, Rowin EJ, Maron MS, Braunwald E (2017) Nonobstructive hypertrophic cardiomyopathy out of the shadows: known from the beginning but largely ignored … until now. Am J Med 130:119–123. https://doi.org/10.1016/j.amjmed.2016.09.015

    Article  PubMed  Google Scholar 

  24. Pelliccia F, Pasceri V, Limongelli G et al (2017) Long-term outcome of nonobstructive versus obstructive hypertrophic cardiomyopathy: a systematic review and meta-analysis. Int J Cardiol 243:379–384. https://doi.org/10.1016/j.ijcard.2017.06.071

    Article  PubMed  Google Scholar 

  25. Lu DY, Pozios I, Haileselassie B et al (2018) Clinical outcomes in patients with nonobstructive, labile, and obstructive hypertrophic cardiomyopathy. J Am Heart Assoc 7:1–12. https://doi.org/10.1161/JAHA.117.006657

    Article  Google Scholar 

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Acknowledgements

This study was supported by the National Natural Science Foundation of China (Grant Number: 81600299).

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  1. Ziqiong Wang and Hang Liao contributed equally to this work.

Authors and Affiliations

  1. Department of Cardiology, West China Hospital, Sichuan University, Sichuan, 37 Guo Xue Xiang, Chengdu, 610041, People’s Republic of China

    Ziqiong Wang, Hang Liao, Xiaoping Chen & Sen He

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  1. Ziqiong Wang
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Correspondence to Sen He.

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Wang, Z., Liao, H., Chen, X. et al. Hyperuricemia: risk factor for thromboembolism in hypertrophic cardiomyopathy patients. Intern Emerg Med 15, 1231–1237 (2020). https://doi.org/10.1007/s11739-020-02275-6

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