Hyperuricemia (HU) has been shown to be associated with an adverse impact on cardiovascular and metabolic risk. Scanty data are available in the general population on the longitudinal changes in ...serum uric acid (SUA), the occurrence of HU and their potential predictors. We examined during a 25-year follow-up the SUA changes and the factors associated with HU development in the Pressioni Arteriose Monitorate E loro Associazioni (PAMELA) study.
We analyzed data collected in 561 subjects of the PAMELA study evaluated during an average follow-up time amounting to 25.4 ± 1.0 years (mean ± SD). HU was defined by the Uric Acid Right for Heart Health (URRAh) cutoff (5.1 for females and 5.6 mg/dl for males). Mean SUA values during follow-up increased from 4.7 ± 1.1 to 5.0 ± 1.2 mg/dl (P<0.001), the average SUA elevation amounting to of 0.3 ± 1.1 mg/dl 26.7 % of the subjects displayed HU at the follow-up. This was associated at the multivariable analysis with female gender, office, home and 24-h blood pressure, diuretic treatment, serum triglycerides and baseline SUA, as well as the increase in waist circumference and the reduction in renal function.
The present study provides longitudinal evidence that in the general population during a 25 year follow-up there is a progressive increase in SUA and HU development. Baseline SUA represents the most important factor associated with these modifications. Gender, renal dysfunction, triglycerides, obesity, diuretic treatment and blood pressure represent other variables capable to predict future occurrence of HU.
•Scanty data are available in the general population on the longitudinal changes in serum uric acid (SUA), on development of new hyperuricemia (HU) and on potential predictors of these modifications.•In 561 subjects belonging to the Pressioni Arteriose E Loro Monitorate E Loro Associazioni (PAMELA) study the changes in SUA, occurrence on new HU during a 25 year follow-up. Data were also analyzed to examine the potential predictors of these metabolic alterations.•Mean SUA values during follow-up increased from 4.7 ± 1.1 to 5.0 ± 1.2 mg/dl (P<0.001), the average SUA elevation amounting to 0.3 ± 1.1 mg/dl. The percentage of subjects displaying HU at the follow-up amounted to 26.7 %.•At the multivariable analysis female gender, office, home and 24-h blood pressure, diuretic treatment, serum triglycerides and baseline SUA, the increase in waist circumference and the reduction in renal function were the most important predictors of the SUA increase and HU.
Congestive heart failure (CHF) is characterized not only by profound abnormalities in the haemodynamic profile but also by changes in sympathetic cardiovascular function. These neurogenic ...abnormalities are important features of the disease that can affect the prognosis of CHF and to become a target for therapeutic intervention. This article addresses 4 major issues. It will first examine the evidence that a hyperadrenergic state is a hallmark of CHF, based on data collected via indirect (plasma norepinephrine, power spectral analysis of the heart rate signal) and direct (microneurography, norepinephrine spillover, radioimaging techniques visualizing myocardial neural network) approaches. It will then provide an overview on the central, reflex and metabolic factors potentially responsible for the phenomenon. The review also analyses the clinical consequences of the adrenergic alteration, with particular emphasis on the effects of the sympathetic overdrive on disease progression, arrhythmogenic threshold, adverse clinical outcomes as well as sudden death. The final part of the review will examine the therapeutic implications of the above mentioned findings and discuss the effects of pharmacological and non- pharmacological interventions on the sympathetic abnormalities of the heart failure state.
Several lines of evidence show that blood pressure (BP) control in treated hypertensive patients is largely unsatisfactory and that this depends on a variety of factors, such as the poor patient's ...compliance, insufficient use of combination drug treatment as well as true difficulties in achieving well controlled BP. This review article will be focused on the main features of BP control by discussing the data obtained in clinical trials as well as the results available in clinical practice. The paper will also discuss the possible factors responsible for these findings as well as the favourable outcome on cardiovascular risk profile of an effective control of elevated BP. The possible approaches for controlling elevated BP values will be highlighted.
To review the sympathetic abnormalities occurring in heart failure, their pathophysiological importance and clinical relevance, and the effects of drug treatment, with particular reference to calcium ...antagonists.
Indirect and direct approaches to study sympathetic function in humans have documented conclusively that sympathetic activation represents a hallmark of cardiac failure syndrome. Evidence indicates that sympathetic overactivity is associated with, and probably caused by, a baroreflex impairment and that it has adverse effects on patients' prognosis and survival.
In the past, drug treatment in heart failure was aimed at improving patients' survival by ameliorating cardiac hemodynamics. It is now established that a major goal of therapeutic intervention is also to reduce sympathetic activation characterizing heart failure.
Studies with short-acting calcium antagonists show that they enhance sympathetic activation and that this has an adverse effect on patients' survival. In contrast, third generation calcium antagonists such as amlodipine, which have a slow onset and long duration of action, do not adversely affect sympathetic function and reflex cardiovascular control. Indeed, evidence suggests calcium antagonists with this profile may exert favorable clinical effects.
