Are You At Risk for a Morning Heart Attack?

A recent study[i] discussed the correlation between uric acid, morning blood pressure surge and metabolic syndrome.  It is a known fact that people with high blood pressure have a blunted response of their blood pressure when sleeping.  Normally, when sleeping your blood pressure should go down.  Those with hypertension have blood pressure that doesn’t drop as much as it should, or worse yet, actually goes up when they are sleeping. 

In addition to this they suffer with an increased morning blood pressure surge which leads to increased cardiovascular events (heart attacks and stroke) from 6 AM until noon.  Having high blood pressure and metabolic syndrome increases the severity of the problem and the risk of having a cardiovascular event of some kind.

Uric acid levels that are elevated can trigger the development of insulin resistance, chronic kidney failure and insulin resistance.  By understanding some key takeaway points you can evaluate and treat any risk factors you have and reduce your overall risk for having a morning heart attack!

Uric Acid

Uric acid is an end product of purine, nucleic acid and nucleoprotein metabolism.  Levels of uric acid can be elevated in people that have gout, renal failure, inflammation, high sugar diets, and excessive oxidative stress.  High uric acid levels might not only reflect these changes but may also cause oxidative stress, insulin resistance and metabolic syndrome.[ii]  In one study those individuals with uric acid levels greater than 6 had increased progression of chronic liver disease and higher risk of cirrhosis-related hospitalization and death.  Elevated uric acid levels have also been shown to directly promote oxidative stress.[iii]  Think of oxidative stress as the rust that damages all the cells in your body.  Not a good thing!

Metabolic Syndrome

This study looked at 81 newly diagnosed hypertensive patients with metabolic syndrome.  To be diagnosed with metabolic syndrome 3 out of the following 5 criteria must be met: 

(1)    Triglyceride levels greater than 150, or taking medications to lower high triglycerides.

(2)    HDL less than 50 for women or less than 40 for men.

(3)    Waist circumference greater than 35 inches for women or 40 inches for men.

(4)    Blood pressure greater than 130/85, or taking medications to lower blood pressure.

(5)    Fasting glucose greater than 100.

The study concluded that evaluation of hypertensive patients should also include a waist circumference measurement, uric acid testing and assessment for abdominal obesity.  In those individuals with elevated uric acid levels there is a correlation to having an abnormal blood pressure drop overnight and this places these individuals at greater risk of a cardiovascular event.  Not only that, but those individuals with a blood pressure that did not drop overnight also had higher waist-to-hip ratios and altered cholesterol profiles.

Action Steps

(1)     Know your numbers!  Do you meet the diagnostic criteria for metabolic syndrome?  Do you have elevated uric acid levels on blood testing? 

(2)    Make lifestyle changes to reduce your blood pressure, metabolic syndrome risk factors and elevated uric acid.  This includes consuming a supplemented Mediterranean style diet that avoids processed foods, sugars, white foods and high glycemic index carbohydrates.

(3)    Take nutrient support in the evening, before bed, if you are hypertensive for proper nitric oxide support.  This can help provide lower blood pressure and proper blood flow to all the tissues as you sleep and help to re-establish a natural decline in blood pressure when sleeping.

(4)    Measure your current oxidative stress levels with effective testing such as Oxidata testing, urinary chloride testing and urinary electrolytes.  These tests are part of our Integra in-office diagnostic testing panels.

[i] Tutal E. et al. Is there a link between hyperuricemia, morning blood pressure surge, and non-dipping blood pressure pattern in metabolic syndrome patients? Int J Nephrol Renovasc Dis. 2013 Apr 26;6:71-7. 

[ii] Afzali A, Weiss NS, Boyko EJ, Ioannou GN.  Association between serum uric acid level and chronic liver disease in the United States. Hepatology. 2010 Aug;52(2):578-89.

[iii] Esen AM,  Akcakoyun M, Esen O,  Acar G, Emiroglu Y,  Pala S, Kargin R,  Karapinar H, Ozcan O,  Barutcu I.  Uric Acid as a marker of oxidative stress in dilatation of the ascending aorta.  Am J Hypertens. 2011 Feb;24(2):149-54. Epub 2010 Oct 14.

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