Elevated serum uric acid was an independent predictor of severe valvular calcification (OR 1.001; 95% CI 1.000-1.003; P=0.014) and 1-year mortality in patients with aortic stenosis.
Cohort (n=685)
Do elevated serum uric acid levels predict severe valvular calcification and mortality in patients with aortic stenosis undergoing TAVR?
Elevated serum uric acid is an independent risk factor for severe aortic valve calcification and increased 30-day and 1-year mortality in patients with aortic stenosis undergoing TAVR.
Effect estimate: OR 1.001 (95% CI 1.000-1.003)
p-value: p=0.014
Abstract Background In recent years, the morbidity and mortality rates of aortic stenosis (AS) have risen significantly. Despite this, no effective pharmacologic interventions currently exist to inhibit disease progression. A key pathologic feature of AS is aortic valve calcification. Targeting modifiable risk factors for valvular calcification may delay AS progression. Aims To investigate risk factors for aortic valve calcification and explore potential targeted therapeutic approaches. Methods We analyzed all AS patients undergoing transcatheter aortic valve replacement (TAVR) between January 2016 and December 2023. Severe valvular calcification was defined as computed tomography (CT)-derived calcification volume exceeding the median value of the cohort. Patients were divided into two groups: severe calcification (n=328) and moderate/mild calcification (n=357). Multivariate logistic regression analysis was used to identify independent predictors of severe calcification. Cox proportional hazards regression analysis was employed to evaluate factors affecting 30-day and 1-year survival. In vitro experiments utilized human primary valvular interstitial cells (HVICs) to evaluate the degree of calcification and expression of calcification-associated markers following uric acid exposure. Results Multivariate logistic regression analysis identified serum uric acid as an independent predictor of severe valvular calcification OR=1.001, 95% CI (1.000–1.003), P=0.014. In vitro experiments, uric acid exposure significantly exacerbated HVIC calcification, evidenced by increased alizarin red staining (P0.001). Furthermore, uric acid-enriched pro-calcific media upregulated expression of calcification-related genes RUNX2 and COL1A1 compared to controls (P0.01). After adjusting for age, sex, BMI, hypertension, diabetes, coronary artery disease, smoking, chronic kidney disease, cholesterol, triglycerides, hemoglobin A1c, and creatinine, multivariate Cox regression analysis demonstrated that elevated uric acid independently predicted 30-day mortality HR=1.004, 95% CI (1.001–1.006), P=0.005 and 1-year mortality HR=1.004, 95% CI (1.001–1.006), P=0.001. Higher uric acid levels correlated with incremental mortality risk of AS patients. Conclusions Serum uric acid is an independent risk factor for aortic valve calcification, and the addition of uric acid makes HVIC calcification more severe. Elevated uric acid levels are strongly associated with adverse clinical outcomes, including increased 30-day and 1-year mortality in AS patients. These findings implicate uric acid in the pathogenesis of valvular calcification and suggest that uric acid-lowering strategies may represent a novel therapeutic avenue to improve prognosis in AS.Uric acid aggravates valvular calcificat High level of uric acid is associated wi
Chen et al. (Sat,) conducted a cohort in Aortic stenosis (n=685). Elevated serum uric acid vs. Lower serum uric acid was evaluated on Severe valvular calcification (OR 1.001, 95% CI 1.000-1.003, p=0.014). Elevated serum uric acid was an independent predictor of severe valvular calcification (OR 1.001; 95% CI 1.000-1.003; P=0.014) and 1-year mortality in patients with aortic stenosis.
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