What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Essential hypertension (n=451). Intervention: Serum uric acid levels. Primary outcome: Presence of atrial fibrillation (OR 1.008, 95% CI 1.003-1.013, p=0.002).

January 1, 2011Internal MedicineOpen Access

Uric Acid Levels and Atrial Fibrillation in Hypertensive Patients

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Key result

Increased serum uric acid levels were independently associated with the presence of atrial fibrillation in hypertensive patients (OR 1.008).

Why the study?

Are elevated serum uric acid levels associated with the presence of atrial fibrillation in hypertensive patients?

Study Design

Type

Cross-Sectional (n=451)

Multicenter

Structured PICO

Are elevated serum uric acid levels associated with the presence of atrial fibrillation in hypertensive patients?

Population

451 patients with essential hypertension, free of significant comorbidities such as coronary artery disease and diabetes, evaluated cross-sectionally for the association between serum uric acid levels and atrial fibrillation.

Comparator

Patients without atrial fibrillation (n=401)

Outcome

Presence of atrial fibrillation

Main Result

Odds Ratio: 1.008 (95% CI 1.003–1.013)

p-value: p=0.002

Elevated serum uric acid levels and increased left atrial diameter are independently associated with the presence of atrial fibrillation in patients with essential hypertension.

Limitations

Did not exclude patients taking diuretics
Most AF patients had paroxysmal AF, preventing separate analysis for different types
Specific inflammatory and oxidative stress markers were not assessed
Observational design identifies only association, not causality
Only a single UA measurement was available
No data on specific indexes of ventricular diastolic function or BMI
No data on exact AF burden
Did not exclude patients taking diuretics, which affect uric acid metabolism
Most AF patients had paroxysmal AF (76%), preventing separate analysis by AF type
Observational design identifies only an association and not causality
Only a single uric acid measurement was available
No data on other specific indexes of ventricular diastolic function
No data on body mass index (BMI)
No data on the exact AF burden (number of episodes, duration)

Implication

Association of elevated uric acid with AF in hypertension is hypothesis-generating; prospective studies needed before any clinical consideration.

Abstract

OBJECTIVE: Uric acid (UA) is a cardiovascular risk marker associated with oxidative stress and inflammation. Recently, atrial fibrillation (AF) has been associated with inflammation and oxidative stress. The objective of this observational study was to investigate the association between UA levels and AF in hypertensive patients. METHODS: Consecutive patients with hypertension were screened. We excluded subjects with coronary artery disease, congestive heart failure, diabetes, valvular heart disease, congenital heart disease, cardiomyopathy, renal failure, inflammatory conditions, thyroid dysfunction, respiratory diseases, and those who were taking drugs that affect UA metabolism (apart from diuretics). The final study population consisted of 451 patients. Fifty of them (11%) had AF (paroxysmal: 38; persistent: 8; permanent: 4). Demographic, clinical, laboratory, and echocardiographic characteristics were carefully recorded. RESULTS: After univariate analysis, age, duration of hypertension, serum creatinine, serum UA, left atrial diameter (LAD), interventricular septum thickness, and left ventricular posterior wall thickness were significantly increased in patients with AF compared with non-AF patients, while the estimated glomerular filtration (eGFR) level was much lower in patients with AF than in those without AF. After multivariate logistic regression analysis, the independent predictors of AF were UA (OR: 1.008; 95% CI: 1.003-1.013, p=0.002) and LAD (OR: 1.160; 95% CI: 1.068-1.260; p<0.001). CONCLUSION: We demonstrated an independent association between increased serum UA levels and AF in hypertensive patients. Undoubtedly, larger studies in different populations should further examine this potential association as well as the underlying pathophysiological mechanisms.

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Cite This Study

Liu et al. (2011) conducted a cross-sectional in Essential hypertension (n=451). Serum uric acid levels was evaluated on Presence of atrial fibrillation (OR 1.008, 95% CI 1.003-1.013, p=0.002). Increased serum uric acid levels were independently associated with the presence of atrial fibrillation in hypertensive patients (OR 1.008).

synapsesocial.com/papers/6a7b37412eb3c7e469f442d8 https://doi.org/10.2169/internalmedicine.50.4587