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Elevated uric acid and obesity-related cardiovascular disease risk factors among hypertensive youth

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Abstract

Background

Uric acid (UA) is associated with high blood pressure in adolescents and with left ventricular hypertrophy (LVH) and cardiovascular disease (CVD) in adults. We sought to determine if UA is independently associated with CVD risk factors and left ventricular mass (LVM) over time in hypertensive youth.

Methods

This was a 1-year prospective observational study of hypertensive children aged 3–19 years. Cross-sectional and longitudinal associations of serum UA with CVD risk factors and LVM were explored.

Results

Of the 49 children who completed both the baseline and 12-month assessments, at baseline the mean age was 13.8 years and mean UA was 5.5 mg/dL; 24 % had elevated UA, 51 % were overweight/obese and 39 % had LVH. Measures of adiposity, low high-density lipoprotein cholesterol, high-sensitivity C-reactive protein, LVM and LVH were all significantly associated with elevated UA at baseline, but not with change over time. Each 1 mg/dL increase in baseline UA was associated with a 2.5 g/m2.7 increase in the LVM index at follow-up (95 % confidence interval 0.64, 4.39; p = 0.01); after adjustment for age, sex, race, body mass index z-score, change in UA, time, blood pressure and medication use, this association was no longer significant.

Conclusions

Hypertensive children with elevated UA have a higher prevalence of obesity-related CVD risk factors. Among hypertensive children, UA may be a marker of adiposity and not an independent CVD risk factor.

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References

  1. World Health Organization (WHO) (2013) Cardiovascular diseases (CVDs). Fact sheet No. 317. Available at: http://www.who.int/mediacentre/factsheets/fs317/en/. Accessed 22 July 2014

  2. Weintraub WS, Daniels SR, Burke LE, Franklin BA, Goff DC Jr, Hayman LL, Lloyd-Jones D, Pandey DK, Sanchez EJ, Schram AP, Whitsel LP, American Heart Association Advocacy Coordinating Committee, Council on Cardiovascular Disease in the Young, Council on the Kidney in Cardiovascular Disease, Council on Epidemiology and Prevention, Council on Cardiovascular Nursing, Council on Arteriosclerosis, Thrombosis and Vascular Biology, Council on Clinical Cardiology, and Stroke Council (2011) Value of primordial and primary prevention for cardiovascular disease: a policy statement from the American Heart Association. Circulation 124:967–990

    Article  CAS  PubMed  Google Scholar 

  3. Nguyen S, Choi HK, Lustig RH, Hsu CY (2009) Sugar-sweetened beverages, serum uric acid, and blood pressure in adolescents. J Pediatr 154:807–813

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  4. 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  PubMed  Google Scholar 

  5. Niskanen LK, Laaksonen DE, Nyyssönen K, Alfthan G, Lakka HM, Lakka TA, Salonen JT (2004) Uric acid level as a risk factor for cardiovascular and all-cause mortality in middle-aged men: a prospective cohort study. Arch Intern Med 164:1546–1551

    Article  CAS  PubMed  Google Scholar 

  6. Iwashima Y, Horio T, Kamide K, Rakugi H, Ogihara T, Kawano Y (2006) Uric acid, left ventricular mass index, and risk of cardiovascular disease in essential hypertension. Hypertension 47:195–202

    Article  CAS  PubMed  Google Scholar 

  7. Kanbay M, Segal M, Afsar B, Kang DH, Rodriguez-Iturbe B, Johnson RJ (2013) The role of uric acid in the pathogenesis of human cardiovascular disease. Heart 99:759–766

    Article  CAS  PubMed  Google Scholar 

  8. Hill JA, Olson EN (2008) Cardiac plasticity. N Engl J Med 358:1370–1380

    Article  CAS  PubMed  Google Scholar 

  9. Mitsuhashi H, Yatsuya H, Matsushita K, Zhang H, Otsuka R, Muramatsu T, Takefuji S, Hotta Y, Kondo T, Murohara T, Toyoshima H, Tamakoshi K (2009) Uric acid and left ventricular hypertrophy in Japanese men. Circ J 73:667–672

    Article  CAS  PubMed  Google Scholar 

  10. Krishnan E, Hariri A, Dabbous O, Pandya BJ (2012) Hyperuricemia and the echocardiographic measures of myocardial dysfunction. Congest Heart Fail 18:138–143

    Article  CAS  PubMed  Google Scholar 

  11. Feig DI, Soletsky B, Johnson RJ (2008) Effect of allopurinol on blood pressure of adolescents with newly diagnosed essential hypertension: a randomized trial. JAMA 300:924–932

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  12. Centers for Disease Control and Prevention (2000) Centers for Disease Control and Prevention Clinical Growth Charts. Available at: http://www.cdc.gov/growthcharts/clinical_charts.htm. Accessed 15 Mar 2010

  13. Centers for Disease Control and Prevention (2009) Centers for Disease Control and Prevention growth charts and Z-score data files. Available at: http://www.cdc.gov/growthcharts/zscore.htm. Accessed 10 Sept 2012

  14. Centers for Disease Control and Prevention (2000) Centers for Disease Control and Prevention body mass index-for-age percentiles; 2 to 20 years: girls. Available at: http://www.cdc.gov/growthcharts/data/set2clinical/cj41c074.pdf. Accessed 29 Sept 2012

  15. Fernandez JR, Redden DT, Pietrobelli A, Allison DB (2004) Waist circumference percentiles in nationally representative samples of African-American, European-American, and Mexican-American children and adolescents. J Pediatr 145:439–444

    Article  PubMed  Google Scholar 

  16. Urbina E, Alpert B, Flynn J, Hayman L, Harshfield GA, Jacobson M, Mahoney L, McCrindle B, Mietus-Snyder M, Steinberger J, Daniels S, American Heart Association Atherosclerosis, Hypertension, and Obesity in Youth Committee (2008) Ambulatory blood pressure monitoring in children and adolescents: recommendations for standard assessment: a scientific statement from the American heart association atherosclerosis, hypertension, and obesity in youth committee of the council on cardiovascular disease in the young and the council for high blood pressure research. Hypertension 52:433–451

    Article  CAS  PubMed  Google Scholar 

  17. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents (2004) The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 114:555–576, 2 Suppl 4th report

  18. Tschudy MM, Arcara KM (eds) (2012) The Harriet Lane handbook a manual for pediatric house officers, 19th edn. Elsevier Mosby, Philadelphia, p 647

  19. Shatat IF, Abdallah RT, Sas DJ, Hailpern SM (2012) Serum uric acid in U.S. adolescents: distribution and relationship to demographic characteristics and cardiovascular risk factors. Pediatr Res 72:95–100

    Article  CAS  PubMed  Google Scholar 

  20. Devereux RB, Alonso DR, Lutas EM, Gottlieb GJ, Campo E, Sachs I, Reichek N (1986) Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol 57:450–458

  21. Khoury PR, Mitsnefes M, Daniels SR, Kimball TR (2009) Age-specific reference intervals for indexed left ventricular mass in children. J Am Soc Echocardiogr 22:709–714

    Article  PubMed  Google Scholar 

  22. Feig DI, Johnson RJ (2003) Hyperuricemia in childhood primary hypertension. Hypertension 42:247–252

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  23. Greenland S, Finkle WD (1995) A critical look at methods for handling missing covariates in epidemiologic regression analyses. Am J Epidemiol 142:1255–1264

    CAS  PubMed  Google Scholar 

  24. Grayson PC, Kim SY, LaValley M, Choi HK (2011) Hyperuricemia and incident hypertension: a systematic review and meta-analysis. Arthritis Care Res (Hoboken) 63:102–110

    Article  CAS  Google Scholar 

  25. Feig DI (2012) The role of uric acid in the pathogenesis of hypertension in the young. J Clin Hypertens (Greenwich) 14:346–352

    Article  CAS  Google Scholar 

  26. Loeffler LF, Navas-Acien A, Brady TM, Miller ER 3rd, Fadrowski JJ (2012) Uric acid level and elevated blood pressure in US adolescents: national health and nutrition examination survey, 1999–2006. Hypertension 59:811–817

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  27. Feig DI, Kang DH, Johnson RJ (2008) Uric acid and cardiovascular risk. N Engl J Med 359:1811–1821

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  28. Yang Q, Zhang Z, Kuklina EV, Fang J, Ayala C, Hong Y, Loustalot F, Dai S, Gunn JP, Tian N, Cogswell ME, Merritt R (2012) Sodium intake and blood pressure among US children and adolescents. Pediatrics 130:611–619

    Article  PubMed  Google Scholar 

  29. Forman JP, Scheven L, de Jong PE, Bakker SJ, Curhan GC, Gansevoort RT (2012) Association between sodium intake and change in uric acid, urine albumin excretion, and the risk of developing hypertension. Circulation 125:3108–3116

    Article  PubMed Central  CAS  PubMed  Google Scholar 

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Acknowledgments

This study is supported by grants from by the American Society of Nephrology, National Kidney Foundation of MD, American Heart Association, Thomas Wilson Sanitarium for Children of Baltimore City, the National Heart, Lung, and Blood Institute of the National Institutes of Health under Award Number K23HL119622. It was also made possible by Grant Number UL1 RR 025005 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of the NCRR or NIH.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Lauren D. Reschke

  2. Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD, USA

    Edgar R. Miller III & Lawrence J. Appel

  3. Division of Pediatric Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Jeffrey J. Fadrowski, Lauren F. Loeffler & Tammy M. Brady

  4. Division of Pediatric Cardiology, Oregon Health and Science University, Portland, OR, USA

    Kathryn W. Holmes

Authors
  1. Lauren D. Reschke
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  2. Edgar R. Miller III
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  4. Lauren F. Loeffler
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  6. Lawrence J. Appel
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  7. Tammy M. Brady
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Corresponding author

Correspondence to Tammy M. Brady.

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Reschke, L.D., Miller, E.R., Fadrowski, J.J. et al. Elevated uric acid and obesity-related cardiovascular disease risk factors among hypertensive youth. Pediatr Nephrol 30, 2169–2176 (2015). https://doi.org/10.1007/s00467-015-3154-y

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  • DOI: https://doi.org/10.1007/s00467-015-3154-y

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