A Cohort Study of Hyperuricemia in Middle-aged South Korean Men
Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, 2024 East Monument Street, Baltimore, MD 21205, USA.American journal of epidemiology (Impact Factor: 5.23). 12/2011; 175(2):133-43. DOI: 10.1093/aje/kwr291
Few prospective studies have assessed the incidence and determinants of asymptomatic hyperuricemia in free-living populations. The authors' goals in this study were to estimate the incidence of hyperuricemia and quantify the dose-response relations of specific risk factors with hyperuricemia in middle-aged South Korean male workers. The authors followed a cohort of 10,802 hyperuricemia-free men aged 30-59 years, examining them annually or biennially at a university hospital in Seoul, South Korea, from 2002 to 2009. A parametric Cox model and a pooled logistic regression model were used to estimate adjusted hazard ratios for incident hyperuricemia (defined as serum uric acid level ≥7.0 mg/dL) according to prespecified risk factors. During 51,210.6 person-years of follow-up, 2,496 men developed hyperuricemia (incidence rate = 48.7 per 1,000 person-years, 95% confidence interval: 46.8, 50.7). The incidence of hyperuricema increased across baseline categories of age, body mass index, alcohol intake, blood pressure, metabolic syndrome, high-sensitivity C-reactive protein, triglycerides, gamma-glutamyltransferase, and fatty liver, whereas fasting glucose, estimated glomerular filtration rate, and high density lipoprotein cholesterol levels were inversely associated with incident hyperuricemia. Development of hyperuricemia, a very common outcome among apparently healthy South Korean men, was predicted by a variety of cardiovascular and metabolic risk factors, suggesting that lifestyle modification may help reduce the incidence of hyperuricemia.
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ABSTRACT: Objective: To determine the prevalence of gout associated with progressive degrees of kidney disease in the US population. Methods: We performed a cross-sectional analysis among non-institutionalized adults (age 20 and older) of the National Health and Nutrition Examination Surveys in 1988-1994 and 2007-2010. Gout status was ascertained by self-report of physician-diagnosed gout. Chronic kidney disease (CKD) was defined in stages based on estimated glomerular filtration rate (GFR) and single albuminuria measurements (albumin-to-creatinine ratio). Prevalence ratios comparing successive categories of GFR, albuminuria, and CKD as well as temporal trends over a 22-year interval were determined via Poisson regression. Results: In the US, the crude prevalence of gout was 2-3% among participants without CKD, 4% among participants with CKD stage 1, 6-10% for stage 2, 11-13% for stage 3, and over 30% for stage 4. The adjusted prevalence ratio comparing the CKD stage 4 stratum to participants without CKD was 3.20 (95% CI: 1.96, 5.24) in 2007-2010 and remained significant even after adjustment for serum uric acid. Notably, there was a statistically significant, progressively greater adjusted prevalence ratio of gout associated with successively lower categories of GFR and higher categories of albuminuria. Conclusions: Among US adults, there exists a strong dose-response association between impaired renal function and prevalent gout. Health providers should be aware of the elevated burden of gout among patients with CKD especially when evaluating new onset joint pain and swelling.Seminars in arthritis and rheumatism 01/2013; 42(6). DOI:10.1016/j.semarthrit.2012.09.009 · 3.93 Impact Factor
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ABSTRACT: First-line therapy of hypertension includes diuretics, known to exert a multiplicative increase on the risk of gout. Detailed insight into the underlying prevalence of hyperuricemia and gout in persons with uncontrolled blood pressure (BP) and common comorbidities is informative to practitioners initiating antihypertensive agents. We quantify the prevalence of hyperuricemia and gout in persons with uncontrolled BP and additional cardiovascular disease (CVD) risk factors. We performed a cross-sectional study of non-institutionalized US adults, 18 years and older, using the National Health and Nutrition Examination Surveys in 1988-1994 and 1999-2010. Hyperuricemia was defined as serum uric acid >6.0 mg/dL in women; >7.0 mg/dL in men. Gout was ascertained by self-report of physician-diagnosed gout. Uncontrolled BP was based on measured systolic BP≥140 mmHg and diastolic BP≥90 mmHg. Additional CVD risk factors included obesity, reduced glomerular filtration rate, and dyslipidemia. The prevalence of hyperuricemia was 6-8% among healthy US adults, 10-15% among adults with uncontrolled BP, 22-25% with uncontrolled BP and one additional CVD risk factor, and 34-37% with uncontrolled BP and two additional CVD risk factors. Similarly, the prevalence of gout was successively greater, at 1-2%, 4-5%, 6-8%, and 8-12%, respectively, across these same health status categories. In 2007-2010, those with uncontrolled BP and 2 additional CVD risk factors compared to those without CVD risk factors had prevalence ratios of 4.5 (95% CI 3.5-5.6) and 4.5 (95% CI: 3.1-6.3) for hyperuricemia and gout respectively (<0.01). Health care providers should be cognizant of the incrementally higher prevalence of hyperuricemia and gout among patients with uncontrolled BP and additional CVD risk factors. With one in three people affected by hyperuricemia among those with several CVD risk factors, physicians should consider their anti-hypertensive regimens carefully and potentially screen for hyperuricemia or gout.PLoS ONE 02/2013; 8(2):e56546. DOI:10.1371/journal.pone.0056546 · 3.23 Impact Factor
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ABSTRACT: The objective of this study was to assess the longitudinal relationship of weight change on incidence and remission of insulin resistance (IR). We performed a cohort study in apparently healthy Korean men, 30 to 59 years of age, who underwent a health checkup and were followed annually or biennially between 2002 and 2009. The computer model of homeostasis model assessment, HOMA2-IR, was obtained at each visit, and IR was defined as HOMA2-IR ≥75th percentile. For IR development, 1,755 of the 6,612 IR-free participants at baseline developed IR (rate 5.1 per 100 person-years) during 34,294.8 person-years of follow-up. The hazard ratios (95% confidence intervals) for incident IR with weight changes of <-0.9 kg, 0.6-2.1 kg and ≥2.2 kg from visit 1 to visit 2 (average 1.8 years) compared to weight change of -0.9-0.5 kg (reference) were 0.78 (0.68-0.90), 1.19 (1.04-1.35) and 1.26 (1.11-1.44), respectively. This association persisted in normal-weight individuals or those without any metabolic syndrome traits and remained significant after introducing weight categories and confounders as time-dependent exposures (P-trend <0.001). For IR remission, 903 of 1,696 IR participants had no IR (remission rate 10.3 per 100 person-years) during 8,777.4 person-years of follow-up. IR remission decreased with increasing quartiles of weight change (P-trend <0.001) and this association persisted in normal-weight individuals. Weight gain was associated with increased IR development and decreased IR remission regardless of baseline BMI status. Preventing weight gain, even in healthy and normal-weight individuals, is an important strategy for reducing IR and its associated consequences.PLoS ONE 05/2013; 8(5):e63690. DOI:10.1371/journal.pone.0063690 · 3.23 Impact Factor
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