| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
From the Department of Medicine, University of Kuopio (Finland) (S.L.,
L.N., M.L.), the Department of Medicine, University of Turku (T.R.), and The
Social Insurance Institution (T.R.), Turku, Finland.
Correspondence to Markku Laakso, MD, Professor and Chair, Department of Medicine, University of Kuopio, SF-70210 Kuopio, Finland. E-mail markku.laakso{at}uku.fi
Background and
Purpose—Patients with non–insulin-dependent diabetes mellitus
(NIDDM) are at increased risk for stroke. Hyperuricemia is a common
finding in NIDDM, but its significance as an independent risk factor
for cardiovascular disease has remained uncertain.
Therefore, we investigated serum urate as a predictor of stroke in
NIDDM patients free of clinical nephropathy (ie, with a
serum creatinine level of
Methods—In this population-based study,
cardiovascular risk factors were determined in 1017
patients (551 men and 466 women) with NIDDM, aged 45 to 64 years at
baseline. The patients were followed up for 7 years with respect to
stroke events.
Results—During the follow-up period, 31 NIDDM patients (12
men [2.2%] and 19 women [4.1%]) died from stroke and 114 NIDDM
patients (55 men [10.0%] and 59 women [12.7%]) had a fatal or
nonfatal stroke. The incidence of stroke increased significantly by
quartiles of serum uric acid levels (P<.001). High uric
acid level (above the median value of >295 µmol/L) was
significantly associated with the risk of fatal and nonfatal stroke by
Cox regression analysis (hazard ratio, 1.93 [1.30 to 2.86];
P=.001). This association remained statistically
significant even after adjustment for all
cardiovascular risk factors (hazard ratio, 1.91 [1.24
to 2.94[; P=.003).
Conclusions—Our results indicate that hyperuricemia is a
strong predictor of stroke events in middle-aged patients with NIDDM
independently of other cardiovascular risk factors.
© 1998 American Heart Association, Inc.
Original Contributions
Serum Uric Acid Is a Strong Predictor of Stroke in Patients With Non–Insulin-Dependent Diabetes Mellitus
120 µmol/L).
Key Words: diabetes mellitus • mortality • uric acid • stroke onset
This article has been cited by other articles:
 |
|
 |
|
  S. D. Cohen, P. L. Kimmel, R. Neff, L. Agodoa, and K. C. Abbott Association of Incident Gout and Mortality in Dialysis Patients J. Am. Soc. Nephrol., November 1, 2008; 19(11): 2204 - 2210. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W T. Cade Diabetes-Related Microvascular and Macrovascular Diseases in the Physical Therapy Setting Physical Therapy, November 1, 2008; 88(11): 1322 - 1335. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. I. Feig, D.-H. Kang, and R. J. Johnson Uric Acid and Cardiovascular Risk N. Engl. J. Med., October 23, 2008; 359(17): 1811 - 1821. [Full Text] [PDF]
|
|
|
|
 |
|
 D. Sander, K. Sander, and H. Poppert Review: Stroke in type 2 diabetes The British Journal of Diabetes & Vascular Disease, September 1, 2008; 8(5): 222 - 229. [Abstract] [PDF]
|
|
|
|
 |
|
 C. Meisinger, W. Koenig, J. Baumert, and A. Doring Uric Acid Levels Are Associated With All-Cause and Cardiovascular Disease Mortality Independent of Systemic Inflammation in Men From the General Population: The MONICA/KORA Cohort Study Arterioscler. Thromb. Vasc. Biol., June 1, 2008; 28(6): 1186 - 1192. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. J. Schretlen, A. B. Inscore, T. D. Vannorsdall, M. Kraut, G. D. Pearlson, B. Gordon, and H. A. Jinnah Serum uric acid and brain ischemia in normal elderly adults Neurology, October 2, 2007; 69(14): 1418 - 1423. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. F. Baker, H. R. Schumacher, and E. Krishnan Serum Uric Acid Level and Risk for Peripheral Arterial Disease: Analysis of Data From the Multiple Risk Factor Intervention Trial Angiology, September 1, 2007; 58(4): 450 - 457. [Abstract] [PDF]
|
|
|
|
 |
|
 V. F. Panoulas, H. J. Milionis, K. M. J. Douglas, P. Nightingale, M. D. Kita, R. Klocke, M. S. Elisaf, and G. D. Kitas Association of serum uric acid with cardiovascular disease in rheumatoid arthritis Rheumatology, September 1, 2007; 46(9): 1466 - 1470. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. H. Alderman Podagra, Uric Acid, and Cardiovascular Disease Circulation, August 21, 2007; 116(8): 880 - 883. [Full Text] [PDF]
|
|
|
|
 |
|
 V. G. Athyros, D. P. Mikhailidis, E. N. Liberopoulos, A. I. Kakafika, A. Karagiannis, A. A. Papageorgiou, K. Tziomalos, E. S. Ganotakis, and M. Elisaf Effect of statin treatment on renal function and serum uric acid levels and their relation to vascular events in patients with coronary heart disease and metabolic syndrome: A subgroup analysis of the GREek Atorvastatin and Coronary heart disease Evaluation (GREACE) Study Nephrol. Dial. Transplant., January 1, 2007; 22(1): 118 - 127. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Papazafiropoulou, N. Tentolouris, I. Moyssakis, D. Perrea, and N. Katsilambros The Potential Effect of Some Newer Risk Factors for Atherosclerosis on Aortic Distensibility in Subjects With and Without Type 2 Diabetes Diabetes Care, August 1, 2006; 29(8): 1926 - 1928. [Full Text] [PDF]
|
|
|
|
 |
|
 M. J. Bos, P. J. Koudstaal, A. Hofman, J. C.M. Witteman, and M. M.B. Breteler Uric Acid Is a Risk Factor for Myocardial Infarction and Stroke: The Rotterdam Study Stroke, June 1, 2006; 37(6): 1503 - 1507. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Zoccali, R. Maio, F. Mallamaci, G. Sesti, and F. Perticone Uric Acid and Endothelial Dysfunction in Essential Hypertension J. Am. Soc. Nephrol., May 1, 2006; 17(5): 1466 - 1471. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Kikura, T. Takada, and S. Sato Preexisting Morbidity as an Independent Risk Factor for Perioperative Acute Thromboembolism Syndrome Arch Surg, December 1, 2005; 140(12): 1210 - 1217. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E Suresh Diagnosis and management of gout: a rational approach Postgrad. Med. J., September 1, 2005; 81(959): 572 - 579. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. J. Milionis, E. Rizos, J. Goudevenos, K. Seferiadis, D. P. Mikhailidis, and M. S. Elisaf Components of the Metabolic Syndrome and Risk for First-Ever Acute Ischemic Nonembolic Stroke in Elderly Subjects Stroke, July 1, 2005; 36(7): 1372 - 1376. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. Ishizaka, Y. Ishizaka, E.-I. Toda, R. Nagai, and M. Yamakado Association Between Serum Uric Acid, Metabolic Syndrome, and Carotid Atherosclerosis in Japanese Individuals Arterioscler. Thromb. Vasc. Biol., May 1, 2005; 25(5): 1038 - 1044. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. Viazzi, D. Parodi, G. Leoncini, A. Parodi, V. Falqui, E. Ratto, S. Vettoretti, G. P. Bezante, M. Del Sette, G. Deferrari, et al. Serum Uric Acid and Target Organ Damage in Primary Hypertension Hypertension, May 1, 2005; 45(5): 991 - 996. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. K. Niskanen, D. E. Laaksonen, K. Nyyssonen, G. Alfthan, H.-M. Lakka, T. A. Lakka, and J. T. Salonen Uric Acid Level as a Risk Factor for Cardiovascular and All-Cause Mortality in Middle-aged Men: A Prospective Cohort Study Arch Intern Med, July 26, 2004; 164(14): 1546 - 1551. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S.-P. Hsu, M.-F. Pai, Y.-S. Peng, C.-K. Chiang, T.-I Ho, and K.-Y. Hung Serum uric acid levels show a 'J-shaped' association with all-cause mortality in haemodialysis patients Nephrol. Dial. Transplant., February 1, 2004; 19(2): 457 - 462. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W S Waring, S H Adwani, O Breukels, D J Webb, and S R J Maxwell Hyperuricaemia does not impair cardiovascular function in healthy adults Heart, February 1, 2004; 90(2): 155 - 159. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Chamorro, A. M. Planas, C. J. Weir, S. W. Muir, M. R. Walters, and K. R. Lees Yin and Yang of Uric Acid in Patients With Stroke * Response Stroke, January 1, 2004; 35 (1): e11 - e12. [Full Text] [PDF]
|
|
|
|
|
|
J. Kanellis and R. J. Johnson Editorial Comment--Elevated Uric Acid and Ischemic Stroke: Accumulating Evidence That It Is Injurious and Not Neuroprotective Stroke, August 1, 2003; 34(8): 1956 - 1957. [Full Text] [PDF]
|
|
|
|
|
|
R. J. Johnson, D.-H. Kang, D. Feig, S. Kivlighn, J. Kanellis, S. Watanabe, K. R. Tuttle, B. Rodriguez-Iturbe, J. Herrera-Acosta, and M. Mazzali Is There a Pathogenetic Role for Uric Acid in Hypertension and Cardiovascular and Renal Disease? Hypertension, June 1, 2003; 41(6): 1183 - 1190. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W.S. WARING Uric acid: an important antioxidant in acute ischaemic stroke QJM, October 1, 2002; 95(10): 691 - 693. [Full Text] [PDF]
|
|
|
|
|
|
G. Seghieri, D. Moruzzo, S. Fascetti, C. Bambini, R. Anichini, A. De Bellis, L. Alviggi, and F. Franconi Increase in Serum Uric Acid Is Selectively Associated With Stroke in Type 2 Diabetes Diabetes Care, June 1, 2002; 25(6): 1095 - 1095. [Full Text] [PDF]
|
|
|
|
 |
|
 K.Y.K. Wong, R.S. Macwalter, H.W. Fraser, I. Crombie, S.A. Ogston, and A.D. Struthers Urate predicts subsequent cardiac death in stroke survivors Eur. Heart J., May 2, 2002; 23(10): 788 - 793. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Chamorro, V. Obach, A. Cervera, M. Revilla, R. Deulofeu, and J. H. Aponte Prognostic Significance of Uric Acid Serum Concentration in Patients With Acute Ischemic Stroke Stroke, April 1, 2002; 33(4): 1048 - 1052. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H.U. HINK and T. FUKAI Extracellular Superoxide Dismutase, Uric Acid, and Atherosclerosis Cold Spring Harb Symp Quant Biol, January 1, 2002; 67(0): 483 - 490. [Abstract] [PDF]
|
|
|
|
|
|
J.-G. Wang, J. A. Staessen, R. H. Fagard, W. H. Birkenhager, L. Gong, and L. Liu Prognostic Significance of Serum Creatinine and Uric Acid in Older Chinese Patients With Isolated Systolic Hypertension Hypertension, April 1, 2001; 37(4): 1069 - 1074. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. I. McFarlane, M. Banerji, and J. R. Sowers Insulin Resistance and Cardiovascular Disease J. Clin. Endocrinol. Metab., February 1, 2001; 86(2): 713 - 718. [Full Text]
|
|
|
|
|
|
P. Verdecchia, G. Schillaci, G. Reboldi, F. Santeusanio, C. Porcellati, and P. Brunetti Relation Between Serum Uric Acid and Risk of Cardiovascular Disease in Essential Hypertension : The PIUMA Study Hypertension, December 1, 2000; 36(6): 1072 - 1078. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W.S. Waring, D.J. Webb, and S.R.J. Maxwell Uric acid as a risk factor for cardiovascular disease QJM, November 1, 2000; 93(11): 707 - 713. [Full Text] [PDF]
|
|
|
|
 |
|
 C. K. M. Choy, I. F. F. Benzie, and P. Cho Ascorbic Acid Concentration and Total Antioxidant Activity of Human Tear Fluid Measured Using the FRASC Assay Invest. Ophthalmol. Vis. Sci., October 1, 2000; 41(11): 3293 - 3298. [Abstract] [Full Text]
|
|
|
|
|
|
A. Cherubini, M. C. Polidori, M. Bregnocchi, S. Pezzuto, R. Cecchetti, T. Ingegni, A. di Iorio, U. Senin, and P. Mecocci Antioxidant Profile and Early Outcome in Stroke Patients Stroke, October 1, 2000; 31(10): 2295 - 2300. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. J. Johnson, K. R. Tuttle, B. Culleton, and D. Levy Much Ado About Nothing, or Much to Do About Something? The Continuing Controversy Over the Role of Uric Acid in Cardiovascular Disease Hypertension, March 1, 2000; 35 (3): e10 - e10. [Full Text]
|
|
|
|
|
|
J. Syrjanen, J. Mustonen, and A. Pasternack Hypertriglyceridaemia and hyperuricaemia are risk factors for progression of IgA nephropathy Nephrol. Dial. Transplant., January 1, 2000; 15(1): 34 - 42. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. F. Culleton, M. G. Larson, W. B. Kannel, and D. Levy Serum Uric Acid and Risk for Cardiovascular Disease and Death: The Framingham Heart Study Ann Intern Med, July 6, 1999; 131(1): 7 - 13. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. H. Alderman, H. Cohen, S. Madhavan, and S. Kivlighn Serum Uric Acid and Cardiovascular Events in Successfully Treated Hypertensive Patients Hypertension, July 1, 1999; 34(1): 144 - 150. [Abstract] [Full Text] [PDF]
|
|