RESEARCH PAPER
Association of urinary cotinine-verified smoking status with hyperuricemia: Analysis of population-based nationally representative data
Yunkyung Kim 1,   Jihun Kang 2, 3  
 
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1
Department of Rheumatology, Kosin University Gospel Hospital, Kosin University, Busan, Republic of Korea
2
Department of Family Medicine, Kosin University Gospel Hospital, Kosin University, Busan, Republic of Korea
3
Central Institute for Medical Research, Kosin University Gospel Hospital, Busan, Republic of Korea
CORRESPONDING AUTHOR
Jihun Kang   

Department of Family Medicine, Kosin University Gospel Hospital, Kosin University, 262, Gamcheon-ro, Seo-gu, Busan 49267, Republic of Korea
Publication date: 2020-10-06
 
Tob. Induc. Dis. 2020;18(October):84
 
KEYWORDS
TOPICS
ABSTRACT
Introduction:
Smoking status based solely on self-reporting is unreliable and might be inaccurate, particularly among women. This study investigated the association between urinary cotinine-verified smoking status and hyperuricemia in a nationwide Korean population.

Methods:
This study included 5,329 participants aged ≥19 years with information on smoking status, urine cotinine levels and serum uric acid. We determined smoking status according to self-reports and urinary cotinine levels. Multivariate linear regression analysis was used to measure the association between smoking exposure and serum uric acid levels. The effects of smoking on hyperuricemia were evaluated by multivariate logistic regression analysis.

Results:
Biochemically-verified active and passive smokers comprised 22% (38.7% of men and 8.8% of women) and 12.3% (11.9% of men and 12.6% of women) of the study population, respectively. While reclassification rate of active smokers was 1.4% in men, 31.8% of cotinine-verified female active smokers were self-reported never smokers. Higher uric acid levels were observed with increased tobacco exposure among women (P trend = 0.007) but not among men. After adjusting for confounders, the risk of hyperuricemia increased with tobacco exposure only in women (P trend = 0.016).

Conclusions:
Cotinine-verified smoking status was associated with increased serum uric acid and hyperuricemia in a dose-response manner only in women. This study might provide evidence to support the importance of smoking cessation in women with gout and further studies are necessary to elucidate the underlying mechanism of the observed association.

CONFLICTS OF INTEREST
The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none was reported.
FUNDING
This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MEST) (No. 2019R1G1A1099627). This study was also supported by a grant from Kosin University College of Medicine (Kosin-19-01).
AUTHORS' CONTRIBUTIONS
YK conceived and designed the study, collected, analyzed, and interpreted the data and wrote and revised the report. JK conceived and designed the study, collected, analyzed, and interpreted the data, and provided important intellectual context and critical revisions for the manuscript. Both authors have approved the final version for publication and accepted the responsibility for the accuracy and integrity of the data and analysis. A STROBE statement with a checklist of items that should be included in reports of cross-sectional studies has been included in the Supplementary file.
PROVENANCE AND PEER REVIEW
Not commissioned; externally peer reviewed.
 
REFERENCES (34)
1.
Wortmann RL. Gout and hyperuricemia. Curr Opin Rheumatol. 2002;14(3):281-286. doi:10.1097/00002281-200205000-00015.
 
2.
Borghi C. The management of hyperuricemia: back to the pathophysiology of uric acid. Curr Med Res Opin. 2017;33(sup3):1-4. doi: 10.1080/03007995.2017.1378502.
 
3.
Dehghan A, van Hoek M, Sijbrands EJ, Hofman A, Witteman JCM. High serum uric acid as a novel risk factor for type 2 diabetes. Diabetes Care. 2008;31(2):361-362. doi:10.2337/dc07-1276.
 
4.
Kuwabara M, Niwa K, Nishi Y, et al. Relationship between serum uric acid levels and hypertension among Japanese individuals not treated for hyperuricemia and hypertension. Hypertens Res. 2014;37(8):785. doi:10.1038/hr.2014.75.
 
5.
Li L, Yang C, Zhao Y, Zeng X, Liu F, Fu P. Is hyperuricemia an independent risk factor for new-onset chronic kidney disease?. A systematic review and meta-analysis based on observational cohort studies. BMC Nephrol. 2014;15(1):122. doi:10.1186/1471-2369-15-122.
 
6.
Chen JH, Chuang SY, Chen HJ, Yeh WT, Pan WH. Serum uric acid level as an independent risk factor for all‐cause, cardiovascular, and ischemic stroke mortality: a Chinese cohort study. Arthritis Care Res (Hoboken). 2009;61(2):225-232. doi:10.1002/art.24164.
 
7.
Chen PH, Chen YW, Liu WJ, Hsu SW, Chen CH, Lee CL. Approximate Mortality Risks between Hyperuricemia and Diabetes in the United States. J Clin Med. 2019;8(12):2127. doi:10.3390/jcm8122127.
 
8.
Cho SK, Winkler CA, Lee SJ, Chang Y, Ryu S. The Prevalence of Hyperuricemia Sharply Increases from the Late Menopausal Transition Stage in Middle-Aged Women. J Clin Med. 2019;8(3):296. doi:10.3390/jcm8030296.
 
9.
Matsuo H, Yamamoto K, Nakaoka H, et al. Genome-wide association study of clinically defined gout identifies multiple risk loci and its association with clinical subtypes. Ann Rheum Dis. 2016;75(4):652-659. doi:10.1136/annrheumdis-2014-206191.
 
10.
Merriman TR. An update on the genetic architecture of hyperuricemia and gout. Arthritis Res Ther. 2015;17(1):98. doi:10.1186/s13075-015-0609-2.
 
11.
Choi HK, Atkinson K, Karlson EW, Willett W, Curhan G. Purine-rich foods, dairy and protein intake, and the risk of gout in men. N Engl J Med. 2004;350(11):1093-1103. doi:10.1056/NEJMoa035700.
 
12.
Choi HK, Curhan G. Soft drinks, fructose consumption, and the risk of gout in men: prospective cohort study. BMJ. 2008;336(7639):309-312. doi:10.1136/bmj.39449.819271.BE.
 
13.
Rathmann W, Funkhouser E, Dyer AR, Roseman JM. Relations of hyperuricemia with the various components of the insulin resistance syndrome in young black and white adults: the CARDIA study. Ann Epidemiol. 1998;8(4):250-261. doi:10.1016/s1047-2797(97)00204-4.
 
14.
Fukuhara A, Saito J, Sato S, et al. The association between risk of airflow limitation and serum uric acid measured at medical health check-ups. Int J Chron Obstruct Pulmon Dis. 2017;12:1213. doi:10.2147/COPD.S126249.
 
15.
Wang W, Krishnan E. Cigarette smoking is associated with a reduction in the risk of incident gout: results from the Framingham Heart Study original cohort. Rheumatology (Oxford). 2014;54(1):91-95. doi:10.1093/rheumatology/keu304.
 
16.
Nakanishi N, Tatara K, Nakamura K, Suzuki K. Risk factors for the incidence of hyperuricaemia: a 6-year longitudinal study of middle-aged Japanese men. Int J Epidemiol. 1999;28(5):888-893. doi:10.1093/ije/28.5.888.
 
17.
Jung-Choi KH, Khang YH, Cho HJ. Hidden female smokers in Asia: a comparison of self-reported with cotinine-verified smoking prevalence rates in representative national data from an Asian population. Tob Control. 2012;21(6):536-542. doi:10.1136/tobaccocontrol-2011-050012.
 
18.
Kang JH, Song YM. Association between cotinine-verified smoking status and metabolic syndrome: Analyses of Korean National Health and Nutrition Examination Surveys 2008–2010. Metab Syndr Relat Disord. 2015;13(3):140-148. doi:10.1089/met.2014.0124.
 
19.
Jeong BY, Lim MK, Yun EH, Oh JK, Park EY, Lee DH. Tolerance for and potential indicators of second-hand smoke exposure among nonsmokers: a comparison of self-reported and cotinine verified second-hand smoke exposure based on nationally representative data. Prev Med. 2014;67:280-287. doi:10.1016/j.ypmed.2014.07.003.
 
20.
Magnus JH, Doyle MK, Srivastav SK. Serum uric acid and self-reported rheumatoid arthritis in a multiethnic adult female population. Curr Med Res Opin. 2010;26(9):2157-2163. doi:10.1185/03007995.2010.502007.
 
21.
Oh TR, Choi HS, Kim CS, et al. The effects of hyperuricemia on the prognosis of IgA nephropathy are more potent in females. J Clin Med. 2020;9(1):176. doi:10.3390/jcm9010176.
 
22.
Kim IY, Han KD, Kim DH, et al. Women with metabolic syndrome and general obesity are at a higher risk for significant hyperuricemia compared to men. J Clin Med. 2019;8(6):837. doi:10.3390/jcm8060837.
 
23.
Norvik JV, Schirmer H, Ytrehus K, et al. Uric acid predicts mortality and ischaemic stroke in subjects with diastolic dysfunction: the Tromsø Study 1994–2013. ESC Heart Fail. 2017;4(2):154-161. doi:10.1002/ehf2.12134.
 
24.
Haj Mouhamed D, Ezzaher A, Neffati F, Douki W, Gaha L, Najjar MF. Effect of cigarette smoking on plasma uric acid concentrations. Environ Health Prev Med. 2011;16(5):307-312. doi:10.1007/s12199-010-0198-2.
 
25.
Yang T, Zhang Y, Wei J, et al. Relationship between cigarette smoking and hyperuricemia in middle-aged and elderly population: A cross-sectional study. Rheumatol Int. 2017;37(1):131-136. doi:10.1007/s00296-016-3574-4.
 
26.
Kim H, Kim SH, Choi AR, et al. Asymptomatic hyperuricemia is independently associated with coronary artery calcification in the absence of overt coronary artery disease: a single-center cross-sectional study. Medicine (Baltimore). 2017;96(14). doi:10.1097/MD.0000000000006565.
 
27.
Chang CS, Chang YF, Liu PY, Chen CY, Tsai YS, Wu CH. Smoking, habitual tea drinking and metabolic syndrome in elderly men living in rural community: the Tianliao old people (TOP) study 02. PLoS One. 2012;7(6):e38874. doi:10.1371/journal.pone.0038874.
 
28.
McAdams-DeMarco MA, Law A, Maynard JW, Coresh J, Baer AN. Risk factors for incident hyperuricemia during mid-adulthood in African American and white men and women enrolled in the ARIC cohort study. BMC Musculoskelet Disord. 2013;14(1):347. doi:10.1186/1471-2474-14-347.
 
29.
Tsuchiya M, Asada A, Kasahara E, Sato EF, Shindo M, Inoue M. Smoking a single cigarette rapidly reduces combined concentrations of nitrate and nitrite and concentrations of antioxidants in plasma. Circulation. 2002;105(10):1155-1157. doi:10.1161/hc1002.105935.
 
30.
Mur C, Claria J, Rodela S, et al. Cigarette smoke concentrate increases 8-epi-PGF2α and TGFβ1 secretion in rat mesangial cells. Life Sci. 2004;75(5):611-621. doi:10.1016/j.lfs.2003.12.026.
 
31.
Jaimes EA, Tian RX, Raij L. Nicotine: the link between cigarette smoking and the progression of renal injury? Am J Physiol Heart Circ Physiol. 2007;292(1):H76-H82. doi:10.1152/ajpheart.00693.2006.
 
32.
Pekmez H, Ogeturk M, Ozyurt H, Sonmez MF, Colakoglu N, Kus I. Ameliorative effect of caffeic acid phenethyl ester on histopathological and biochemical changes induced by cigarette smoke in rat kidney. Toxicol Ind Health. 2010;26(3):175-182. doi:10.1177/0748233710362380.
 
33.
Jung W, Kim Y, Lihm H, Kang J. Associations between blood lead, cadmium, and mercury levels with hyperuricemia in the Korean general population: A retrospective analysis of population‐based nationally representative data. Int J Rheum Dis. 2019;22(8). doi:10.1111/1756-185X.13632.
 
34.
Fujiwara M, Hamatake Y, Arimoto S, Okamoto K, Suzuki T, Negishi T. Exposure to cigarette smoke increases urate level and decreases glutathione level in larval Drosophila melanogaster. Genes Environment. 2011;33(3):89-95. doi:10.3123/jemsge.33.89.
 
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