Ghannam, Mohammad

Abstract Disclosure: A. Nasir: None. F. Dehghani: None. F. Saeidifard: None. M. Ghannam: None. A. Almakadma: None. I. Idries: None. A. Esteghamat: None. R. Nieto- Martinez: None. J.I. Mechanick: None. Background: The Dysglycemia-Based Chronic Disease (DBCD) multi-morbidity care model was developed by American Association of Clinical Endocrinology to address the requirement for preventive care measures to reduce the impact of type two diabetes (T2D ) and its complications. The DBCD model consists of four distinct stages including: insulin resistance, prediabetes, T2D and vascular complication spectrum. This study assesses the prevalence and associated risk factors for each of the four DBCD stages in Iranian adults. Methods: From February 2002 to March 2020, 10,087 participants who attended clinic of Vali-Asr Hospital, Tehran, Iran, were evaluated. In total, 3,465 (34.3%) men with median age of 54.47 years and 6,629 (65.67%) women with median age of 50.2 years were included. A 10 ml blood sample was collected after an overnight fast, centrifuged, and stored at -70°C for lab evaluation to measure fasting blood sugar (FBS). Hemoglobin A1c was measured using high-performance liquid chromatography, while fasting and post-prandial glucose were assessed using enzymatic colorimetric methods. Results: Stage 1 was found in 19.7% of the population (23.2% in women and 13.1% in men), stage 2 in 17.8% of the population (19.3% in women and 14.8% in men), stage 3 in 31.4% of the population (28.2% in women and 37.5% in men), and stage 4 in 21.3% of the population (16.2% in women and 30.9% in men). DBCD stages increased significantly with age (stage 1=43.12, stage 2=51.24, stage 3=54.89, stage 4=61.51, P-value <0.01). All DBCD stages were associated with hypertension (stage 1: OR=3.07, stage 2: OR=5.08 ,stage 3: OR=7.87 and stage 4: OR=17.17) dyslipidemia (stage 1: OR=2.85, stage 2: OR=2.68, stage 3: OR=8.32, and stage 4: OR=7.66)and metabolic syndrome (stage 1: OR=14.04, stage 2: OR=21.95, stage 3: OR=32.50, and stage 4: OR=42.54). Conclusion: The findings of the current study further support the importance of the DBCD model in early detection and prevention of dysglycemia and their associated complications. Presentation: Sunday, July 13, 2025

Hyperuricemia, characterized by elevated serum uric acid levels, has been linked to cardiovascular diseases such as hypertension, atrial fibrillation, chronic kidney disease, heart failure, metabolic syndrome, and coronary artery disease. This relationship, however, is complex; while some studies indicate a strong association, others suggest that it may be influenced by confounding factors. The rising global prevalence of hyperuricemia underscores the necessity for a deeper understanding of its cardiovascular implications. Hyperuricemia results from an imbalance in uric acid production and excretion, driven by dietary factors, obesity, insulin resistance, and other conditions. Elevated uric acid levels contribute to cardiovascular risk through mechanisms such as inflammation, oxidative stress, endothelial dysfunction, and activation of the renin-angiotensin-aldosterone system. This review highlights the importance of ongoing research to clarify hyperuricemia’s role in cardiovascular disease and suggests that urate-lowering therapies, such as xanthine oxidase inhibitors, may confer cardiovascular benefits; however, evidence remains conflicting. The Cardiovascular Safety of Febuxostat and Allopurinol in Patients with Gout and Cardiovascular Morbidities (CARES) trial indicated an increased risk of cardiovascular and all-cause mortality with febuxostat compared with allopurinol, raising safety concerns. In contrast, the Febuxostat versus Allopurinol Streamlined Trial (FAST) demonstrated that febuxostat was noninferior to allopurinol, with even lower all-cause mortality. These opposing findings emphasize the complexity of treatment decisions and the need for individualized management strategies for hyperuricemia. Clinical decisions should consider individual patient risks and characteristics. Ultimately, this comprehensive analysis aims to enhance prevention and management strategies for cardiovascular diseases related to hyperuricemia. The overview includes discussions on major studies such as the Framingham Heart Study, CARES, FAST, PRIZE, and FREED trials, examining their results. It explores whether hyperuricemia is a causal factor versus an associated risk factor and whether it serves as a marker or mediator of disease. Additionally, the review addresses novel biomarkers and predictive models, the management of hyperuricemia in the context of cardiovascular risk, the role of urate-lowering therapies in cardiovascular disease, variability in guidelines and recommendations, and the impact of hyperuricemia in special populations such as those with diabetes and chronic kidney disease. The cardiovascular risk associated with hyperuricemia across various demographics is also discussed. Furthermore, the review suggests that existing risk scores might be modified to include uric acid levels in patients with hyperuricemia.