Skip to main content
Top
Published in:

Open Access 01-12-2023 | Myocardial Infarction | Research

The association between serum uric acid and creatine phosphokinase in the general population: NHANES 2015–2018

Authors: Xinxin Chen, Jiuhong You, Mei Zhou, Hui Ma, Cheng Huang

Published in: BMC Cardiovascular Disorders | Issue 1/2023

Login to get access

Abstract

Background

The association between serum creatine phosphokinase (CPK), a standard biochemical measure of acute myocardial infarction, and serum uric acid (sUA) has not been studied. This study aimed to determine the association between sUA and CPK in the general population of the US.

Methods

Data from the National Health and Nutrition Examination Survey (NHANES) 2015–2018 were used, including a total of 8,431 subjects aged ≥ 30 years. Weighted multiple regression analysis was used to estimate the independent relationship between sUA and CPK. Fitted smoothing curves and weighted generalized additive models were also performed.

Results

We found a positive relationship between sUA and CPK after adjusting for potential confounders. In subgroup analyses stratified by sex and race/ethnicity, sUA was positively correlated with CPK in each subgroup. The association between sUA and CPK followed an inverted U-shaped curve in females (turning point: sUA = 428.3 μmol/L).

Conclusions

Our study suggested that sUA level was positively correlated with CPK in the general population of the US. However, CPK increased with sUA until the turning point (sUA = 428.3 μmol/L) in females. Fundamental research and large sample prospective studies are needed to determine the exact mechanism of the association between sUA and CPK.
Literature
1.
go back to reference Aujla RS, Patel R. Creatine Phosphokinase. StatPearls. Treasure Island (FL): StatPearls Publishing Copyright © 2022, StatPearls Publishing LLC.; 2022. Aujla RS, Patel R. Creatine Phosphokinase. StatPearls. Treasure Island (FL): StatPearls Publishing Copyright © 2022, StatPearls Publishing LLC.; 2022.
2.
go back to reference Sowards KJ, Mukherjee K, Norris PR, Shintani A, Ware LB, Roberts LJ 2nd, et al. Elevated serum creatine phosphokinase is associated with mortality and inotropic requirement in critically injured adults. Injury. 2014;45(12):2096–100.PubMedPubMedCentralCrossRef Sowards KJ, Mukherjee K, Norris PR, Shintani A, Ware LB, Roberts LJ 2nd, et al. Elevated serum creatine phosphokinase is associated with mortality and inotropic requirement in critically injured adults. Injury. 2014;45(12):2096–100.PubMedPubMedCentralCrossRef
4.
go back to reference Boriani G, Biagini E, Ziacchi M, Malavasi VL, Vitolo M, Talarico M, et al. Cardiolaminopathies from bench to bedside: challenges in clinical decision-making with focus on arrhythmia-related outcomes. Nucleus (Austin, Tex). 2018;9(1):442–59.PubMed Boriani G, Biagini E, Ziacchi M, Malavasi VL, Vitolo M, Talarico M, et al. Cardiolaminopathies from bench to bedside: challenges in clinical decision-making with focus on arrhythmia-related outcomes. Nucleus (Austin, Tex). 2018;9(1):442–59.PubMed
5.
go back to reference Grenadier E, Keidar S, Kahana L, Alpan G, Marmur A, Palant A. The roles of serum myoglobin, total CPK, and CK-MB isoenzyme in the acute phase of myocardial infarction. Am Heart J. 1983;105(3):408–16.PubMedCrossRef Grenadier E, Keidar S, Kahana L, Alpan G, Marmur A, Palant A. The roles of serum myoglobin, total CPK, and CK-MB isoenzyme in the acute phase of myocardial infarction. Am Heart J. 1983;105(3):408–16.PubMedCrossRef
6.
go back to reference Hess JW, Macdonald RP, Frederick RJ, Jones RN, Neely J, Gross D. SERUM CREATINE PHOSPHOKINASE (CPK) ACTIVITY IN DISORDERS OF HEART AND SKELETAL MUSCLE. Ann Intern Med. 1964;61:1015–28.PubMedCrossRef Hess JW, Macdonald RP, Frederick RJ, Jones RN, Neely J, Gross D. SERUM CREATINE PHOSPHOKINASE (CPK) ACTIVITY IN DISORDERS OF HEART AND SKELETAL MUSCLE. Ann Intern Med. 1964;61:1015–28.PubMedCrossRef
7.
go back to reference Reed GW, Rossi JE, Cannon CP. Acute myocardial infarction. Lancet (London, England). 2017;389(10065):197–210.PubMedCrossRef Reed GW, Rossi JE, Cannon CP. Acute myocardial infarction. Lancet (London, England). 2017;389(10065):197–210.PubMedCrossRef
8.
go back to reference Maiuolo J, Oppedisano F, Gratteri S, Muscoli C, Mollace V. Regulation of uric acid metabolism and excretion. Int J Cardiol. 2016;213:8–14.PubMedCrossRef Maiuolo J, Oppedisano F, Gratteri S, Muscoli C, Mollace V. Regulation of uric acid metabolism and excretion. Int J Cardiol. 2016;213:8–14.PubMedCrossRef
9.
go back to reference Liu H, Zhang XM, Wang YL, Liu BC. Prevalence of hyperuricemia among Chinese adults: a national cross-sectional survey using multistage, stratified sampling. J Nephrol. 2014;27(6):653–8.PubMedCrossRef Liu H, Zhang XM, Wang YL, Liu BC. Prevalence of hyperuricemia among Chinese adults: a national cross-sectional survey using multistage, stratified sampling. J Nephrol. 2014;27(6):653–8.PubMedCrossRef
10.
go back to reference Singh G, Lingala B, Mithal A. Gout and hyperuricaemia in the USA: prevalence and trends. Rheumatology (Oxford). 2019;58(12):2177–80.PubMedCrossRef Singh G, Lingala B, Mithal A. Gout and hyperuricaemia in the USA: prevalence and trends. Rheumatology (Oxford). 2019;58(12):2177–80.PubMedCrossRef
11.
go back to reference Chen-Xu M, Yokose C, Rai SK, Pillinger MH, Choi HK. Contemporary Prevalence of Gout and Hyperuricemia in the United States and Decadal Trends: The National Health and Nutrition Examination Survey, 2007–2016. Arthritis & rheumatology (Hoboken, NJ). 2019;71(6):991–9.CrossRef Chen-Xu M, Yokose C, Rai SK, Pillinger MH, Choi HK. Contemporary Prevalence of Gout and Hyperuricemia in the United States and Decadal Trends: The National Health and Nutrition Examination Survey, 2007–2016. Arthritis & rheumatology (Hoboken, NJ). 2019;71(6):991–9.CrossRef
13.
go back to reference Kang YH, Min HG, Kim IJ, Kim YK, Son SM. Comparison of alanine aminotransferase, white blood cell count, and uric acid in their association with metabolic syndrome: a study of Korean adults. Endocr J. 2008;55(6):1093–102.PubMedCrossRef Kang YH, Min HG, Kim IJ, Kim YK, Son SM. Comparison of alanine aminotransferase, white blood cell count, and uric acid in their association with metabolic syndrome: a study of Korean adults. Endocr J. 2008;55(6):1093–102.PubMedCrossRef
14.
go back to reference Weaver DJ Jr. Uric acid and progression of chronic kidney disease. Pediatric nephrology (Berlin, Germany). 2019;34(5):801–9.PubMedCrossRef Weaver DJ Jr. Uric acid and progression of chronic kidney disease. Pediatric nephrology (Berlin, Germany). 2019;34(5):801–9.PubMedCrossRef
15.
go back to reference Borghi C, Rodriguez-Artalejo F, De Backer G, Dallongeville J, Medina J, Nuevo J, et al. Serum uric acid levels are associated with cardiovascular risk score: A post hoc analysis of the EURIKA study. Int J Cardiol. 2018;253:167–73.PubMedCrossRef Borghi C, Rodriguez-Artalejo F, De Backer G, Dallongeville J, Medina J, Nuevo J, et al. Serum uric acid levels are associated with cardiovascular risk score: A post hoc analysis of the EURIKA study. Int J Cardiol. 2018;253:167–73.PubMedCrossRef
17.
18.
go back to reference Holme I, Aastveit AH, Hammar N, Jungner I, Walldius G. Uric acid and risk of myocardial infarction, stroke and congestive heart failure in 417,734 men and women in the Apolipoprotein MOrtality RISk study (AMORIS). J Intern Med. 2009;266(6):558–70.PubMedCrossRef Holme I, Aastveit AH, Hammar N, Jungner I, Walldius G. Uric acid and risk of myocardial infarction, stroke and congestive heart failure in 417,734 men and women in the Apolipoprotein MOrtality RISk study (AMORIS). J Intern Med. 2009;266(6):558–70.PubMedCrossRef
19.
go back to reference Mandurino-Mirizzi A, Crimi G, Raineri C, Pica S, Ruffinazzi M, Gianni U, et al. Elevated serum uric acid affects myocardial reperfusion and infarct size in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. J Cardiovasc Med (Hagerstown). 2018;19(5):240–6.PubMedCrossRef Mandurino-Mirizzi A, Crimi G, Raineri C, Pica S, Ruffinazzi M, Gianni U, et al. Elevated serum uric acid affects myocardial reperfusion and infarct size in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. J Cardiovasc Med (Hagerstown). 2018;19(5):240–6.PubMedCrossRef
20.
go back to reference Hajizadeh R, Ghaffari S, Salehi R, Mazani S, Aghavali S. Association of serum uric acid level with mortality and morbidity of patients with acute ST-elevation myocardial infarction. Journal of cardiovascular and thoracic research. 2016;8(2):56–60.PubMedPubMedCentralCrossRef Hajizadeh R, Ghaffari S, Salehi R, Mazani S, Aghavali S. Association of serum uric acid level with mortality and morbidity of patients with acute ST-elevation myocardial infarction. Journal of cardiovascular and thoracic research. 2016;8(2):56–60.PubMedPubMedCentralCrossRef
21.
go back to reference Cicero AF, Rosticci M, Tocci G, Bacchelli S, Urso R, D’Addato S, et al. Serum uric acid and other short-term predictors of electrocardiographic alterations in the Brisighella Heart Study cohort. Eur J Intern Med. 2015;26(4):255–8.PubMedCrossRef Cicero AF, Rosticci M, Tocci G, Bacchelli S, Urso R, D’Addato S, et al. Serum uric acid and other short-term predictors of electrocardiographic alterations in the Brisighella Heart Study cohort. Eur J Intern Med. 2015;26(4):255–8.PubMedCrossRef
22.
go back to reference Liu CW, Chen KH, Tseng CK, Chang WC, Wu YW, Hwang JJ. The dose-response effects of uric acid on the prevalence of metabolic syndrome and electrocardiographic left ventricular hypertrophy in healthy individuals. Nutr Metab Cardiovasc Dis. 2019;29(1):30–8.PubMedCrossRef Liu CW, Chen KH, Tseng CK, Chang WC, Wu YW, Hwang JJ. The dose-response effects of uric acid on the prevalence of metabolic syndrome and electrocardiographic left ventricular hypertrophy in healthy individuals. Nutr Metab Cardiovasc Dis. 2019;29(1):30–8.PubMedCrossRef
23.
go back to reference Cicero AF, Rosticci M, Reggi A, Derosa G, Parini A, Grandi E, et al. Relationship between serum uric acid and electrocardiographic alterations in a large sample of general population: data from the Brisighella Heart Study. High blood pressure & cardiovascular prevention : the official journal of the Italian Society of Hypertension. 2015;22(2):129–34.CrossRef Cicero AF, Rosticci M, Reggi A, Derosa G, Parini A, Grandi E, et al. Relationship between serum uric acid and electrocardiographic alterations in a large sample of general population: data from the Brisighella Heart Study. High blood pressure & cardiovascular prevention : the official journal of the Italian Society of Hypertension. 2015;22(2):129–34.CrossRef
24.
go back to reference Cuspidi C, Facchetti R, Bombelli M, Sala C, Tadic M, Grassi G, et al. Uric Acid and New Onset Left Ventricular Hypertrophy: Findings From the PAMELA Population. Am J Hypertens. 2017;30(3):279–85.PubMed Cuspidi C, Facchetti R, Bombelli M, Sala C, Tadic M, Grassi G, et al. Uric Acid and New Onset Left Ventricular Hypertrophy: Findings From the PAMELA Population. Am J Hypertens. 2017;30(3):279–85.PubMed
25.
go back to reference Zhang Y, Post WS, Blasco-Colmenares E, Dalal D, Tomaselli GF, Guallar E. Electrocardiographic QT interval and mortality: a meta-analysis. Epidemiology. 2011;22(5):660–70.PubMedPubMedCentralCrossRef Zhang Y, Post WS, Blasco-Colmenares E, Dalal D, Tomaselli GF, Guallar E. Electrocardiographic QT interval and mortality: a meta-analysis. Epidemiology. 2011;22(5):660–70.PubMedPubMedCentralCrossRef
26.
go back to reference Mozos I, Costea C, Serban C, Susan L. Factors associated with a prolonged QT interval in liver cirrhosis patients. J Electrocardiol. 2011;44(2):105–8.PubMedCrossRef Mozos I, Costea C, Serban C, Susan L. Factors associated with a prolonged QT interval in liver cirrhosis patients. J Electrocardiol. 2011;44(2):105–8.PubMedCrossRef
27.
go back to reference Guo X, Li Z, Liu Y, Yu S, Yang H, Zheng L, et al. Sex-specific association between serum uric acid and prolonged corrected QT interval: Result from a general rural Chinese population. Medicine. 2016;95(50): e5568.PubMedPubMedCentralCrossRef Guo X, Li Z, Liu Y, Yu S, Yang H, Zheng L, et al. Sex-specific association between serum uric acid and prolonged corrected QT interval: Result from a general rural Chinese population. Medicine. 2016;95(50): e5568.PubMedPubMedCentralCrossRef
28.
go back to reference Corry DB, Eslami P, Yamamoto K, Nyby MD, Makino H, Tuck ML. Uric acid stimulates vascular smooth muscle cell proliferation and oxidative stress via the vascular renin-angiotensin system. J Hypertens. 2008;26(2):269–75.PubMedCrossRef Corry DB, Eslami P, Yamamoto K, Nyby MD, Makino H, Tuck ML. Uric acid stimulates vascular smooth muscle cell proliferation and oxidative stress via the vascular renin-angiotensin system. J Hypertens. 2008;26(2):269–75.PubMedCrossRef
29.
go back to reference Wang M, Lin X, Yang X, Yang Y. Research progress on related mechanisms of uric acid activating NLRP3 inflammasome in chronic kidney disease. Ren Fail. 2022;44(1):615–24.PubMedPubMedCentralCrossRef Wang M, Lin X, Yang X, Yang Y. Research progress on related mechanisms of uric acid activating NLRP3 inflammasome in chronic kidney disease. Ren Fail. 2022;44(1):615–24.PubMedPubMedCentralCrossRef
30.
go back to reference Glantzounis GK, Tsimoyiannis EC, Kappas AM, Galaris DA. Uric acid and oxidative stress. Curr Pharm Des. 2005;11(32):4145–51.PubMedCrossRef Glantzounis GK, Tsimoyiannis EC, Kappas AM, Galaris DA. Uric acid and oxidative stress. Curr Pharm Des. 2005;11(32):4145–51.PubMedCrossRef
31.
go back to reference Toldo S, Abbate A. The NLRP3 inflammasome in acute myocardial infarction. Nat Rev Cardiol. 2018;15(4):203–14.PubMedCrossRef Toldo S, Abbate A. The NLRP3 inflammasome in acute myocardial infarction. Nat Rev Cardiol. 2018;15(4):203–14.PubMedCrossRef
32.
go back to reference Martinon F, Pétrilli V, Mayor A, Tardivel A, Tschopp J. Gout-associated uric acid crystals activate the NALP3 inflammasome. Nature. 2006;440(7081):237–41.PubMedCrossRef Martinon F, Pétrilli V, Mayor A, Tardivel A, Tschopp J. Gout-associated uric acid crystals activate the NALP3 inflammasome. Nature. 2006;440(7081):237–41.PubMedCrossRef
33.
go back to reference Zhang H, Ma Y, Cao R, Wang G, Li S, Cao Y, et al. Soluble uric acid induces myocardial damage through activating the NLRP3 inflammasome. J Cell Mol Med. 2020;24(15):8849–61.PubMedPubMedCentralCrossRef Zhang H, Ma Y, Cao R, Wang G, Li S, Cao Y, et al. Soluble uric acid induces myocardial damage through activating the NLRP3 inflammasome. J Cell Mol Med. 2020;24(15):8849–61.PubMedPubMedCentralCrossRef
34.
go back to reference Raedschelders K, Ansley DM, Chen DD. The cellular and molecular origin of reactive oxygen species generation during myocardial ischemia and reperfusion. Pharmacol Ther. 2012;133(2):230–55.PubMedCrossRef Raedschelders K, Ansley DM, Chen DD. The cellular and molecular origin of reactive oxygen species generation during myocardial ischemia and reperfusion. Pharmacol Ther. 2012;133(2):230–55.PubMedCrossRef
35.
go back to reference Manning A, Bernier M, Crome R, Little S, Hearse D. Reperfusion-induced arrhythmias: a study of the role of xanthine oxidase-derived free radicals in the rat heart. J Mol Cell Cardiol. 1988;20(1):35–45.PubMedCrossRef Manning A, Bernier M, Crome R, Little S, Hearse D. Reperfusion-induced arrhythmias: a study of the role of xanthine oxidase-derived free radicals in the rat heart. J Mol Cell Cardiol. 1988;20(1):35–45.PubMedCrossRef
36.
go back to reference Marković-Boras M, Čaušević A, Ćurlin M. A relation of serum homocysteine and uric acid in Bosnian diabetic patients with acute myocardial infarction. Journal of medical biochemistry. 2021;40(3):261–9.PubMedPubMedCentralCrossRef Marković-Boras M, Čaušević A, Ćurlin M. A relation of serum homocysteine and uric acid in Bosnian diabetic patients with acute myocardial infarction. Journal of medical biochemistry. 2021;40(3):261–9.PubMedPubMedCentralCrossRef
37.
go back to reference Watanabe S, Usui M. Serum uric acid level is associated with reperfusion ventricular arrhythmias in acute myocardial infarction. Diabetes & metabolic syndrome. 2021;15(4): 102198.CrossRef Watanabe S, Usui M. Serum uric acid level is associated with reperfusion ventricular arrhythmias in acute myocardial infarction. Diabetes & metabolic syndrome. 2021;15(4): 102198.CrossRef
38.
go back to reference Masi S, Pugliese NR, Taddei S. The difficult relationship between uric acid and cardiovascular disease. Eur Heart J. 2019;40(36):3055–7.PubMedCrossRef Masi S, Pugliese NR, Taddei S. The difficult relationship between uric acid and cardiovascular disease. Eur Heart J. 2019;40(36):3055–7.PubMedCrossRef
39.
go back to reference Shen S, He F, Cheng C, Xu B, Sheng J. Uric acid aggravates myocardial ischemia-reperfusion injury via ROS/NLRP3 pyroptosis pathway. Biomed Pharmacother. 2021;133:110990.PubMedCrossRef Shen S, He F, Cheng C, Xu B, Sheng J. Uric acid aggravates myocardial ischemia-reperfusion injury via ROS/NLRP3 pyroptosis pathway. Biomed Pharmacother. 2021;133:110990.PubMedCrossRef
40.
go back to reference Culleton BF, Larson MG, Kannel WB, Levy D. Serum uric acid and risk for cardiovascular disease and death: the Framingham Heart Study. Ann Intern Med. 1999;131(1):7–13.PubMedCrossRef Culleton BF, Larson MG, Kannel WB, Levy D. Serum uric acid and risk for cardiovascular disease and death: the Framingham Heart Study. Ann Intern Med. 1999;131(1):7–13.PubMedCrossRef
41.
go back to reference Kawabe M, Sato A, Hoshi T, Sakai S, Hiraya D, Watabe H, et al. Gender differences in the association between serum uric acid and prognosis in patients with acute coronary syndrome. J Cardiol. 2016;67(2):170–6.PubMedCrossRef Kawabe M, Sato A, Hoshi T, Sakai S, Hiraya D, Watabe H, et al. Gender differences in the association between serum uric acid and prognosis in patients with acute coronary syndrome. J Cardiol. 2016;67(2):170–6.PubMedCrossRef
42.
go back to reference Stubnova V, Os I, Høieggen A, Solbu MD, Grundtvig M, Westheim AS, et al. Gender differences in association between uric acid and all-cause mortality in patients with chronic heart failure. BMC Cardiovasc Disord. 2019;19(1):4.PubMedPubMedCentralCrossRef Stubnova V, Os I, Høieggen A, Solbu MD, Grundtvig M, Westheim AS, et al. Gender differences in association between uric acid and all-cause mortality in patients with chronic heart failure. BMC Cardiovasc Disord. 2019;19(1):4.PubMedPubMedCentralCrossRef
43.
go back to reference Wang Y, Charchar FJ. Establishment of sex difference in circulating uric acid is associated with higher testosterone and lower sex hormone-binding globulin in adolescent boys. Sci Rep. 2021;11(1):17323.PubMedPubMedCentralCrossRef Wang Y, Charchar FJ. Establishment of sex difference in circulating uric acid is associated with higher testosterone and lower sex hormone-binding globulin in adolescent boys. Sci Rep. 2021;11(1):17323.PubMedPubMedCentralCrossRef
44.
go back to reference Yahyaoui R, Esteva I, Haro-Mora JJ, Almaraz MC, Morcillo S, Rojo-Martínez G, et al. Effect of long-term administration of cross-sex hormone therapy on serum and urinary uric acid in transsexual persons. J Clin Endocrinol Metab. 2008;93(6):2230–3.PubMedCrossRef Yahyaoui R, Esteva I, Haro-Mora JJ, Almaraz MC, Morcillo S, Rojo-Martínez G, et al. Effect of long-term administration of cross-sex hormone therapy on serum and urinary uric acid in transsexual persons. J Clin Endocrinol Metab. 2008;93(6):2230–3.PubMedCrossRef
Metadata
Title
The association between serum uric acid and creatine phosphokinase in the general population: NHANES 2015–2018
Authors
Xinxin Chen
Jiuhong You
Mei Zhou
Hui Ma
Cheng Huang
Publication date
01-12-2023
Publisher
BioMed Central
Published in
BMC Cardiovascular Disorders / Issue 1/2023
Electronic ISSN: 1471-2261
DOI
https://doi.org/10.1186/s12872-023-03333-5

Other articles of this Issue 1/2023

BMC Cardiovascular Disorders 1/2023 Go to the issue

A quick guide to ECGs

Improve your ECG interpretation skills with this comprehensive, rapid, interactive course. Expert advice provides detailed feedback as you work through 50 ECGs covering the most common cardiac presentations to ensure your practice stays up to date. 

PD Dr. Carsten W. Israel
Developed by: Springer Medizin
Start the cases

Keynote webinar | Spotlight on medication adherence

  • Webinar | 27-06-2024 | 18:00 (CEST)

Medication non-adherence is a major barrier to effective healthcare delivery; half of all patients do not follow their doctor’s recommendations or treatment plan.

Our experts explain the fundamentals with a practical discussion of how to manage non-adherence in two common scenarios: hypertension and asthma control.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Watch now