Chao Tze-Fan, Hung Chung-Lieh, Chen Su-Jung, Wang Kang-Ling, Chen Tzeng-Ji, Lin Yenn-Jiang, Chang Shih-Lin, Lo Li-Wei, Hu Yu-Feng, Tuan Ta-Chuan, Chen Shih-Ann
Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taiwan.
Int J Cardiol. 2013 Oct 9;168(4):4027-32. doi: 10.1016/j.ijcard.2013.06.067. Epub 2013 Jul 17.
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.
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).
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.
Hyperuricemia was associated with a larger LA size and may be a novel risk factor for the development of AF.
尽管高尿酸血症与多种心血管疾病相关，但尿酸（UA）在左心房（LA）重构和新发心房颤动（AF）中的作用尚未得到充分研究。本研究的目的是在大规模队列中探讨UA、LA直径与AF发生之间的关系。
本研究包括两部分。首先，我们在一个单中心数据库（n = 3043）中研究血清UA与LA直径之间的关联。其次，我们在台湾全国纵向队列（n = 122,524）中研究并比较了高尿酸血症患者和非高尿酸血症患者新发AF的风险。
血清UA水平升高与全身炎症增加和胰岛素抵抗相关。LA直径与血清UA显著相关（r = 0.341，p值<0.001）。在调整临床、生化和超声心动图变量后，LA大小与UA水平之间的线性相关性仍然显著。在全国队列中，在6.3±3.0年的随访期间有2339例患者（占研究人群的1.9%）发生AF。高尿酸血症患者的AF发生率高于非高尿酸血症患者（2.1%对1.7%；p值<0.001）。在多变量Cox回归分析中，高尿酸血症是新发AF的显著危险因素，风险比为1.191（95%置信区间 = 1.098 - 1.292，p值<0.001）。
高尿酸血症与较大的LA大小相关，可能是AF发生的一个新危险因素。
