Xie Haitao, Shen Le, Yu Peng, Wang Shi, Sun Tong, Liu Xueqian, Wang Mengxi, Qian Li, Hua Jiayi, Chen Nan, Chen Xiaohu, Tang Shuhua
First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China.
Department of Cardiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China.
Front Endocrinol (Lausanne). 2024 Dec 5;15:1432200. doi: 10.3389/fendo.2024.1432200. eCollection 2024.
NT-proBNP (N-terminal pro-B-type natriuretic peptide), high-sensitivity cardiac troponin T (hs-troponin T), and high-sensitivity cardiac troponin I (hs-troponin I) have been widely recognized as significant cardiac biomarkers, and are increasingly being recommended for early risk identification in cardiovascular high-risk populations. The aim of our study was to evaluate the prevalence of elevated cardiac biomarkers (NT-proBNP, hs-troponin T, hs-troponin I) and their association with the risk of hyperuricemia in the general US adults without known cardiovascular disease. We further studied whether elevated cardiac biomarkers are associated with an increased risk of all-cause and cardiovascular mortality in individuals with or without hyperuricemia.
The study population came from the adults (age ≥20y) without prevalent cardiovascular disease in NHANES (National Health and Nutrition Examination Survey) 1999 to 2004. We evaluated the prevalence of elevated cardiac biomarkers among adults with or without hyperuricemia, and conducted a comprehensive multivariate logistic regression analysis to ascertain the association between elevated cardiac biomarkers and hyperuricemia risk. Multivariate Cox regression model and Kaplan-Meier curve, risk competition model and Cumulative Incidence Function(CIF) were used respectively to examine the associations between elevated cardiac biomarkers with all-cause and cardiovascular mortality.
In general US adults without known cardiovascular disease, the prevalence of hyperuricemia was 16.35%. The age-adjustd prevalence of elevated NT-proBNP (≥125 pg/mL), hs-troponin T (≥6 ng/L), and hs-troponin I (male ≥6, female ≥4 ng/L) was 16.70%, 49.80%, and 11.91%, respectively, among adults with hyperuricemia. Adjusted multivariable logistic regression analysis revealed a statistically significant association between elevated levels of NT-proBNP, hs-troponin T, and hs-troponin I and hyperuricemia, and different clinical categories observed grade differences on the same cardiac biomarker. Elevated NT-proBNP, hs-troponinT and hs-troponinI were each significantly positively associated with the cumulative incidence of all-cause and cardiovascular mortality in adults with or without hyperuricemia. Compared to those with elevated cardiac biomarkers only, adults with hyperuricemia and elevated cardiac biomarkers faced the highest risk of all-cause and cardiovascular mortality.
Our study identified that elevated cardiac biomarkers pose a high burden on hyperuricemia risk in the general population without known cardiovascular disease, and further provides important information on long-term mortality risk in these populations. Routine testing of cardiac biomarkers may be useful for early risk identification and prognostic assessment in adults with hyperuricemia.
N末端B型利钠肽原（NT-proBNP）、高敏心肌肌钙蛋白T（hs-肌钙蛋白T）和高敏心肌肌钙蛋白I（hs-肌钙蛋白I）已被广泛公认为重要的心脏生物标志物，并且越来越多地被推荐用于心血管高危人群的早期风险识别。我们研究的目的是评估在美国无已知心血管疾病的普通成年人中，心脏生物标志物（NT-proBNP、hs-肌钙蛋白T、hs-肌钙蛋白I）升高的患病率及其与高尿酸血症风险的关联。我们进一步研究了无论有无高尿酸血症，心脏生物标志物升高是否与全因死亡率和心血管死亡率增加相关。
研究人群来自1999年至2004年美国国家健康与营养检查调查（NHANES）中无心血管疾病病史的成年人（年龄≥20岁）。我们评估了有无高尿酸血症的成年人中心脏生物标志物升高的患病率，并进行了全面的多变量逻辑回归分析，以确定心脏生物标志物升高与高尿酸血症风险之间的关联。分别使用多变量Cox回归模型和Kaplan-Meier曲线、风险竞争模型和累积发病率函数（CIF）来检验心脏生物标志物升高与全因死亡率和心血管死亡率之间的关联。
在美国无已知心血管疾病的普通成年人中，高尿酸血症的患病率为16.35%。在患有高尿酸血症的成年人中，NT-proBNP（≥125 pg/mL）、hs-肌钙蛋白T（≥6 ng/L）和hs-肌钙蛋白I（男性≥6，女性≥4 ng/L）升高的年龄调整患病率分别为16.70%、49.80%和11.91%。校正后的多变量逻辑回归分析显示，NT-proBNP、hs-肌钙蛋白T和hs-肌钙蛋白I水平升高与高尿酸血症之间存在统计学显著关联，并且不同临床类别在同一心脏生物标志物上观察到分级差异。NT-proBNP、hs-肌钙蛋白T和hs-肌钙蛋白I升高均与有无高尿酸血症的成年人全因死亡率和心血管死亡率的累积发病率显著正相关。与仅心脏生物标志物升高的成年人相比，高尿酸血症且心脏生物标志物升高的成年人面临的全因死亡率和心血管死亡率风险最高。
我们的研究发现，在无已知心血管疾病的普通人群中，心脏生物标志物升高给高尿酸血症风险带来了沉重负担，并进一步提供了这些人群长期死亡风险的重要信息。心脏生物标志物的常规检测可能有助于高尿酸血症成年人的早期风险识别和预后评估。
