The association between hyperuricemia, left atrial size and new-onset atrial fibrillation

doi:10.1016/j.ijcard.2013.06.067

International Journal of Cardiology

Volume 168, Issue 4, 9 October 2013, Pages 4027-4032

https://doi.org/10.1016/j.ijcard.2013.06.067 Get rights and content

Abstract

Background

Although hyperuricemia was associated with several cardiovascular diseases, the role of uric acid (UA) in left atrial (LA) remodeling and new-onset atrial fibrillation (AF) has not been fully explored. The goal of the present study is to investigate the relationship between UA, LA diameter and the development of AF in the large-scale cohort.

Methods

The study consisted of 2 parts. First, we investigated the association between serum UA and LA diameter in a single-center database (n = 3043). Second, we studied and compared the risk of new-onset AF among patients with and without hyperuricemia in the nationwide longitudinal cohort in Taiwan (n = 122,524).

Results

Elevated serum level of UA was associated with an increased systemic inflammation, and insulin resistance. The LA diameter was significantly correlated with serum UA (r = 0.341, p value < 0.001). The linear correlation between LA dimension and UA level remained significant after the adjustment for clinical, biochemical and echocardiographic variables. In the nationwide cohort, there were 2339 patients (1.9% of the study population) developing AF during the follow-up of 6.3 ± 3.0 years. The AF occurrence rate was higher in patients with hyperuricemia than those without it (2.1% versus 1.7%; p value < 0.001). Hyperuricemia was a significant risk factor of new-onset AF with a hazard ratio of 1.191 (95% confidence interval = 1.098–1.292, p value < 0.001) in the multivariate Cox regression analysis.

Conclusions

Hyperuricemia was associated with a larger LA size and may be a novel risk factor for the development of AF.

Section snippets

Background

Atrial fibrillation (AF) is the most prevalent sustained cardiac arrhythmia, and its incidence is projected to rise continuously over the next few decades [1]. Several clinical risk factors for the development of AF have been identified, including old age, male gender, hypertension, congestive heart failure, chronic kidney disease and diabetes mellitus. Although the pathophysiology of AF remains incompletely understood, accumulative evidences suggested oxidative stress and inflammation were

Study design

The present study consisted of 2 parts. First, we investigated the association between serum level of UA and LA diameter in a single-center database. Second, we studied and compared the risk of new-onset AF among patients with and without hyperuricemia in the nationwide cohort in Taiwan.

Serum UA and LA diameter in the single-center cohort

In this retrospective analysis, echocardiography and blood tests were performed in 3043 subjects who participated in a healthy survey at a tertiary medical center in Taipei, Taiwan. The transthoracic

Baseline characteristics of patients divided by UA tertile

The 3043 subjects who participated in the healthy survey were divided into tertiles on the basis of serum level of UA. The mean UA levels of these 3 groups were 4.3 ± 0.7, 5.9 ± 0.4 and 7.7 ± 1.0 mg/dL, respectively. Patients' data about baseline characteristics, medical histories, biochemical markers and echocardiographic parameters were shown in Table 1. We observed that male gender and hypertension were more prevalent in patients with a higher UA level. With increasing UA tertile, there was a trend

Main findings

In this study, we investigated the association between UA and LA size in a total of 3043 participants in a single-center database. Furthermore, we studied the risk of AF in patients with and without hyperuricemia in a nationwide cohort enrolling 122,524 subjects. The main findings were as follows: (1) Elevated serum level of UA was associated with an increased systemic inflammation, insulin resistance and decreased eGFR. (2) Serum UA was positively correlated with LA size after the adjustment

Conclusion

In summary, we showed that the serum UA level was significantly correlated with LA diameter after the adjustment for other clinical, biochemical and echocardiographic factors. Furthermore, we demonstrated that hyperuricemia was an important risk factor of new-onset AF in the nationwide longitudinal cohort in Taiwan.

Acknowledgments

This work was supported in part by grants from the National Science Council (NSC98-2410-H-010-003-MY2), and Taipei Veterans General Hospital (V99C1-140, V99A-153, V100D-002-3, V101D-001-2, and V102B-025).

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¹: Dr Tze-Fan Chao and Dr Chung-Lieh Hung contributed equally to this study.

View full text

The association between hyperuricemia, left atrial size and new-onset atrial fibrillation

Abstract

Background

Methods

Results

Conclusions

Section snippets

Background

Study design

Serum UA and LA diameter in the single-center cohort

Baseline characteristics of patients divided by UA tertile

Main findings

Conclusion

Acknowledgments

Int J Cardiol

Am J Cardiol

Am J Cardiol

Am J Cardiol

Am Heart J

Lone atrial fibrillation: what is known and what is to come

Int J Clin Pract

Is atrial fibrillation an inflammatory disorder?

Eur Heart J

Echocardiographic predictors of nonrheumatic atrial fibrillation. The Framingham Heart Study

Circulation

Uric acid and inflammatory markers

Eur Heart J

Serum uric acid as an independent predictor of early death after acute stroke

Circ J