Increased Overall Heart Rate Irregularity Risk by Hyperuricemia in the General Population: Results from the Korean National Health and Nutrition Examination Survey

Background and objectives: Hyperuricemia is one of the well-known cardiovascular risk factors. There is a growing interest in the association between hyperuricemia and arrhythmia. We used the representative sample data of Korean population to study the association between hyperuricemia and heart rate irregularity (HRI) that reflects total arrhythmia. Materials and Methods: We performed weighted multivariate logistic regression analysis to assess the association between hyperuricemia and HRI. Results: Of the 10,827 subjects, 1308 (13.2%) had hyperuricemia and 130 (1%) had HRI. In the presence of hyperuricemia, HRI was three times higher than that in the absence of hyperuricemia (OR 2.98, 95% CI 1.71–5.18). The risk of HRI was highest in subjects with both hypertension and hyperuricemia. In the subgroup analysis, the association of hyperuricemia with HRI was most pronounced in the smoker group. Conclusions: Hyperuricemia was highly correlated with HRI in adult Korean representative sample data. Hyperuricemia was associated with a nearly tripled risk for HRI. Hypertension has a synergistic effect with hyperuricemia on HRI. Further research is warranted to clarify the relationship between hyperuricemia and arrhythmia and its mechanism.

Information S1. Measurement of heart rate in the Korean National Health and Nutrition Examination Survey.

1) Eligible and excluded subjects
Pulse of all subjects aged 10 years or older are measured. However, subjects with rashes, open wounds, weakness, splints, edema, hematomas, and arteriovenous fistula for dialysis are excluded from the measurement. Female subjects underwent axillary node biopsy or surgery, or one radical mastectomy, measured on the opposite arm. Female subjects who underwent both radical mastectomies are excluded from the measurement.

2) Preparation before pulse measurement
A. Sitting posture Sit back against the back of the chair so that the subject's spine is in a straight line and help them sit stably and comfortably. Do not cross the legs and keep their feet flat on the floor. If their feet do not touch the floor, use a footrest.

B. Measuring arm selection
In principle, right arm measurement is used for standardization. However, if measurement is not possible on the right arm, the measurement is made on the left arm.

C. Precautions before measurement
To measure the pulse in a stable state, the subject must have a 5-minute rest period while sitting in a chair before measurement. Words, conversations, and movements can affect the measurement, so avoid them until the measurement is finished. After the 5-minute rest period, the pulse rate is measured.

3) Measurement of pulse rate
With the sleeve of the measuring arm fully rolled up, palms face up and the elbows are supported with armrests to keep slightly bent.
Measure and record the right radial pulse for 15 seconds. If the pulse is irregular or bradycardia (<15 beats for 15 seconds) or tachycardia (>26 beats for 15 seconds), check the pulse rate for 60 seconds and check whether it is regular and record it. Data are presented as weighted mean ± standard error (SE) or weighted percentage (SE). a Low education level means middle school graduate or less. b Physical activity is defined in accordance with the WHO recommendations, which refers to more than 150 minutes of moderate-intensity aerobic physical activity throughout the week, or more than 75 minutes of vigorous-intensity aerobic physical activity throughout the week, or an equivalent combination of moderate-and vigorous-intensity activity. c TG values are presented as a geometric mean (95% confidence interval). d An eGFR calculated from serum creatinine using an isotope dilution mass spectrometry (IDMS) traceable Modification of Diet in Renal Disease (MDRD) Study equation. e Hyperuricemia is defined as a serum uric acid level of ≥7.0 mg/dL for men. f Hypertension is defined as a systolic BP >140 mmHg, or a diastolic BP >90 mmHg, or taking antihypertensive medication. g Diabetes mellitus is defined as a fasting blood glucose level >126 mg/dL, or previous history of diagnosis by a doctor, or taking hypoglycemic agent or insulin. h Hyperlipidemia is defined as a fasting total C ≥240 mg/dL or taking a lipid lowering agent. Abbreviations: HR, heart rate; BMI, body mass index; WC, waist circumference; BP, blood pressure; C, cholesterol; TG, triglyceride; eGFR, estimated glomerular filtration rate; hs-CRP, high-sensitivity C-reactive protein. Data are presented as weighted mean ± standard error (SE) or weighted percentage (SE). a Low education level means middle school graduate or less. b Physical activity is defined in accordance with the WHO recommendations, which refers to more than 150 minutes of moderate-intensity aerobic physical activity throughout the week, or more than 75 minutes of vigorous-intensity aerobic physical activity throughout the week, or an equivalent combination of moderate-and vigorous-intensity activity. c TG values are presented as a geometric mean (95% confidence interval). d An eGFR calculated from serum creatinine using an isotope dilution mass spectrometry (IDMS) traceable Modification of Diet in Renal Disease (MDRD) Study equation. e Hyperuricemia is defined as a serum uric acid level of ≥7.0 mg/dL for men. f Hypertension is defined as a systolic BP >140 mmHg, or a diastolic BP >90 mmHg, or taking antihypertensive medication. g Diabetes mellitus is defined as a fasting blood glucose level >126 mg/dL, or previous history of diagnosis by a doctor, or taking hypoglycemic agent or insulin. h Hyperlipidemia is defined as a fasting total C ≥240 mg/dL or taking a lipid lowering agent. Abbreviations: HR, heart rate; BMI, body mass index; WC, waist circumference; BP, blood pressure; C, cholesterol; TG, triglyceride; eGFR, estimated glomerular filtration rate; hs-CRP, high-sensitivity C-reactive protein; N/A, not applicable.