Metabolites (Mar 2024)
Serum Uric Acid/Serum Creatinine Ratio and Cardiovascular Mortality in Diabetic Individuals—The Uric Acid Right for Heart Health (URRAH) Project
- Lanfranco D’Elia,
- Maria Masulli,
- Pietro Cirillo,
- Agostino Virdis,
- Edoardo Casiglia,
- Valerie Tikhonoff,
- Fabio Angeli,
- Carlo Maria Barbagallo,
- Michele Bombelli,
- Federica Cappelli,
- Rosario Cianci,
- Michele Ciccarelli,
- Arrigo F. G. Cicero,
- Massimo Cirillo,
- Raffaella Dell’Oro,
- Giovambattista Desideri,
- Claudio Ferri,
- Loreto Gesualdo,
- Cristina Giannattasio,
- Guido Grassi,
- Guido Iaccarino,
- Luciano Lippa,
- Francesca Mallamaci,
- Alessandro Maloberti,
- Stefano Masi,
- Alberto Mazza,
- Alessandro Mengozzi,
- Maria Lorenza Muiesan,
- Pietro Nazzaro,
- Paolo Palatini,
- Gianfranco Parati,
- Roberto Pontremoli,
- Fosca Quarti-Trevano,
- Marcello Rattazzi,
- Gianpaolo Reboldi,
- Giulia Rivasi,
- Elisa Russo,
- Massimo Salvetti,
- Giuliano Tocci,
- Andrea Ungar,
- Paolo Verdecchia,
- Francesca Viazzi,
- Massimo Volpe,
- Claudio Borghi,
- Ferruccio Galletti
Affiliations
- Lanfranco D’Elia
- Department of Clinical Medicine and Surgery, “Federico II” University of Naples, 80131 Naples, Italy
- Maria Masulli
- Department of Clinical Medicine and Surgery, “Federico II” University of Naples, 80131 Naples, Italy
- Pietro Cirillo
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, “Aldo Moro” University of Bari, 70122 Bari, Italy
- Agostino Virdis
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
- Edoardo Casiglia
- Studium Patavinum, Department of Medicine, University of Padua, 35100 Padua, Italy
- Valerie Tikhonoff
- Department of Medicine, University of Padua, 35100 Padua, Italy
- Fabio Angeli
- Department of Medicine and Technological Innovation (DiMIT), University of Insubria, 21100 Varese, Italy
- Carlo Maria Barbagallo
- Biomedical Department of Internal Medicine and Specialistics, University of Palermo, 90100 Palermo, Italy
- Michele Bombelli
- Internal Medicine, Pio XI Hospital of Desio, ASST Brianza, University of Milano-Bicocca, 20871 Vimercate, Italy
- Federica Cappelli
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
- Rosario Cianci
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Rome, Italy
- Michele Ciccarelli
- Department of Medicine and Surgery, University of Salerno, 84081 Salerno, Italy
- Arrigo F. G. Cicero
- Hypertension and Cardiovascular Disease Research Center, Medical and Surgical Sciences Department, Alma Mater Studiorum University of Bologna, 40126 Bologna, Italy
- Massimo Cirillo
- Department of Public Health, “Federico II” University of Naples, 80131 Naples, Italy
- Raffaella Dell’Oro
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
- Giovambattista Desideri
- Department of Clinical, Internal Medicine, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, 00161 Rome, Italy
- Claudio Ferri
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
- Loreto Gesualdo
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, “Aldo Moro” University of Bari, 70122 Bari, Italy
- Cristina Giannattasio
- Cardiology IV, “A.De Gasperi’s” Department, Niguarda Ca’ Granda Hospital, 20162 Milan, Italy
- Guido Grassi
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
- Guido Iaccarino
- Department of Clinical Medicine and Surgery, “Federico II” University of Naples, 80131 Naples, Italy
- Luciano Lippa
- Italian Society of General Medicine (SIMG), 67051 Avezzano, Italy
- Francesca Mallamaci
- Department of Nephrology, Dialysis and Transplantation GOM “Bianchi-Melacrino-Morelli”, 89133 Reggio Calabria, Italy
- Alessandro Maloberti
- Cardiology IV, “A.De Gasperi’s” Department, Niguarda Ca’ Granda Hospital, 20162 Milan, Italy
- Stefano Masi
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
- Alberto Mazza
- Department of Internal Medicine, Santa Maria Della Misericordia General Hospital, AULSS 5 Polesana, 45100 Rovigo, Italy
- Alessandro Mengozzi
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
- Maria Lorenza Muiesan
- Department of Clinical and Experimental Sciences, University of Brescia, 25121 Brescia, Italy
- Pietro Nazzaro
- Department of Precision and Regenerative Medicine and Jonic Area (DiMePRe-J), Neurosciences and Sense Organs, University of Bari Medical School, 70122 Bari, Italy
- Paolo Palatini
- Studium Patavinum, Department of Medicine, University of Padua, 35100 Padua, Italy
- Gianfranco Parati
- San Luca Hospital, IRCCS, Istituto Auxologico Italiano, 20149 Milan, Italy
- Roberto Pontremoli
- Dipartimento di Medicina Interna e Specialità Mediche, Università degli Studi di Genova, 16132 Genova, Italy
- Fosca Quarti-Trevano
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
- Marcello Rattazzi
- Medicina Interna 1°, Ca’ Foncello, Department of Medicine—DIMED, University of Padova Hospital, 31100 Treviso, Italy
- Gianpaolo Reboldi
- Department of Medicine and Surgery, University of Perugia, 06100 Perugia, Italy
- Giulia Rivasi
- Department of Geriatric and Intensive Care Medicine, Careggi Hospital, University of Florence, 50121 Florence, Italy
- Elisa Russo
- Dipartimento di Medicina Interna e Specialità Mediche, Università degli Studi di Genova, 16132 Genova, Italy
- Massimo Salvetti
- Department of Clinical and Experimental Sciences, University of Brescia, 25121 Brescia, Italy
- Giuliano Tocci
- Department of Clinical and Molecular Medicine, University of Rome Sapienza, 00189 Rome, Italy
- Andrea Ungar
- Department of Geriatric and Intensive Care Medicine, Careggi Hospital, University of Florence, 50121 Florence, Italy
- Paolo Verdecchia
- Hospital S. Maria della Misericordia, 06100 Perugia, Italy
- Francesca Viazzi
- Dipartimento di Medicina Interna e Specialità Mediche, Università degli Studi di Genova, 16132 Genova, Italy
- Massimo Volpe
- Department of Clinical and Molecular Medicine, University of Rome Sapienza, 00189 Rome, Italy
- Claudio Borghi
- Hypertension and Cardiovascular Disease Research Center, Medical and Surgical Sciences Department, Alma Mater Studiorum University of Bologna, 40126 Bologna, Italy
- Ferruccio Galletti
- Department of Clinical Medicine and Surgery, “Federico II” University of Naples, 80131 Naples, Italy
- DOI
- https://doi.org/10.3390/metabo14030164
- Journal volume & issue
-
Vol. 14,
no. 3
p. 164
Abstract
Several studies have detected a direct association between serum uric acid (SUA) and cardiovascular (CV) risk. In consideration that SUA largely depends on kidney function, some studies explored the role of the serum creatinine (sCr)-normalized SUA (SUA/sCr) ratio in different settings. Previously, the URRAH (URic acid Right for heArt Health) Study has identified a cut-off value of this index to predict CV mortality at 5.35 Units. Therefore, given that no SUA/sCr ratio threshold for CV risk has been identified for patients with diabetes, we aimed to assess the relationship between this index and CV mortality and to validate this threshold in the URRAH subpopulation with diabetes; the URRAH participants with diabetes were studied (n = 2230). The risk of CV mortality was evaluated by the Kaplan–Meier estimator and Cox multivariate analysis. During a median follow-up of 9.2 years, 380 CV deaths occurred. A non-linear inverse association between baseline SUA/sCr ratio and risk of CV mortality was detected. In the whole sample, SUA/sCr ratio > 5.35 Units was not a significant predictor of CV mortality in diabetic patients. However, after stratification by kidney function, values > 5.35 Units were associated with a significantly higher mortality rate only in normal kidney function, while, in participants with overt kidney dysfunction, values of SUA/sCr ratio > 7.50 Units were associated with higher CV mortality. The SUA/sCr ratio threshold, previously proposed by the URRAH Study Group, is predictive of an increased risk of CV mortality in people with diabetes and preserved kidney function. While, in consideration of the strong association among kidney function, SUA, and CV mortality, a different cut-point was detected for diabetics with impaired kidney function. These data highlight the different predictive roles of SUA (and its interaction with kidney function) in CV risk, pointing out the difference in metabolic- and kidney-dependent SUA levels also in diabetic individuals.
Keywords
