DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20202082

Hyperuricemia as a risk factor for increase severity of coronary vessel occlusion disease: a cross-sectional study in North Indian population

Gaurav Singhal, Shilpa Bhardwaj, Ashok Kumar Ahirwar, Harish C. Sharma

Abstract


Background: Cardiovascular disease (CVD) is the most common cause of death worldwide. The present study was conducted to study uric acid as a potential biomarker in predicting the severity of CVD in terms of vessel involvement.

Methods: A cross-sectional study, conducted at Rajiv Gandhi Super Speciality Hospital, Tahirpur, Delhi. A total of 52 consecutive male and female patients age between 30 to 70 years was included in this study. Written informed consent was obtained from all the enrolled patients. Automated analysers were used for the analysis of blood glucose, lipid profile and serum uric acid level. IBM SPSS Statistics (Version 20.0, IBM SPSS, IL, USA) was used for the statistical analyses.

Results: In this study, a total of 52 consecutive patients were divided into three groups; single-vessel disease (n=19), double vessel disease (n=19) and triple vessel disease (n=14). Biochemical profile of all the groups was calculated. A group of triple vessel disease patients showing higher amount (164±42 mg/dl) of cholesterol level as compared to the other two groups (157±34 mg/dl). The mean level of serum uric acid levels significantly differed and its mean levels increases as the severity of vessel diseases increases. The receiver operating characteristic curve shows the uric level has 71% sensitivity and 52.5% specificity for detecting the severity of coronary vessel disease.

Conclusions: This study demonstrated an increased serum uric acid levels were associated with increased severity of vessel disease, and serum uric acid is an independent risk factor for coronary artery disease.


Keywords


Coronary vessel occlusion, Cardiovascular disease, Hyperuricemia, Serum uric acid

Full Text:

PDF

References


Sayols-Baixeras S, Lluís-Ganella C, Lucas G, Elosua R. Pathogenesis of coronary artery disease: focus on genetic risk factors and identification of genetic variants. Applic Clini Genet. 2014;7:15.

Saleh M, Ambrose JA. Understanding myocardial infarction. F1000Research. 2018;7.

Rosengren A, Smyth A, Rangarajan S, Ramasundarahettige C, Bangdiwala SI, AlHabib KF, et al. Socioeconomic status and risk of cardiovascular disease in 20 low-income, middle-income, and high-income countries: the Prospective Urban Rural Epidemiologic (PURE) study. Lancet Global Health. 2019 Jun 1;7(6):e748-60.

Lardaro T, McKinney J, Brywczynski J, Slovis C. Five Common Causes of Sudden Unexpected Death Every EMS Provider Should Know. J Emerg Med Servic. 2015;40(1):1-6.

Naghshtabrizi B, Moradi A, Amiri J, Aarabi S, Sanaei Z. An evaluation of the numbers and locations of coronary artery disease with some of the major atherosclerotic risk factors in patients with coronary artery disease. J Clini Diagnos Res. 2017 Aug;11(8):OC21.

Rafieian-Kopaei M, Setorki M, Doudi M, Baradaran A, Nasri H. Atherosclerosis: process, indicators, risk factors and new hopes. Int J Prevent Medi. 2014 Aug;5(8):927.

Gaubert M, Marlinge M, Alessandrini M, Laine M, Bonello L, Fromonot J, et al. Uric acid levels are associated with endothelial dysfunction and severity of coronary atherosclerosis during a first episode of acute coronary syndrome. Purinerg Signal. 2018 Jun 1;14(2):191-9.

Yamagishi SI, Ishibashi Y, Ojima A, Sugiura T, Matsui T. Linagliptin, a xanthine-based dipeptidyl peptidase-4 inhibitor, decreases serum uric acid levels in type 2 diabetic patients partly by suppressing xanthine oxidase activity. Int J Cardiol. 2014 Sep 20;176(2):550-2.

Žitňanová I, Korytár P, Aruoma OI, Šustrová M, Garaiová I, Muchová J, et al. Uric acid and allantoin levels in Down syndrome: antioxidant and oxidative stress mechanisms?. Clini Chim Acta. 2004 Mar 1;341(1-2):139-46.

Kuwabara M, Hisatome I, Niwa K, Hara S, Roncal-Jimenez CA, Bjornstad P, et al. Uric acid is a strong risk marker for developing hypertension from prehypertension: a 5-year Japanese cohort study. Hypertension. 2018 Jan;71(1):78-86.

Biscaglia S, Ceconi C, Malagù M, Pavasini R, Ferrari R. Uric acid and coronary artery disease: an elusive link deserving further attention. Int J Cardiol. 2016 Jun 15;213:28-32..

Wu Y, Xiong X, Fraser WD, Luo ZC. Association of uric acid with progression to preeclampsia and development of adverse conditions in gestational hypertensive pregnancies. Am J Hypertens. 2012 Jun 1;25(6):711-7.

Yu TY, Jee JH, Bae JC, Jin SM, Baek JH, Lee MK, et al. Serum uric acid: a strong and independent predictor of metabolic syndrome after adjusting for body composition. Metabolism. 2016 Apr 1;65(4):432-40.

Zhang X, Huang ZC, Lu TS, You SJ, Cao YJ, Liu CF. Prognostic significance of uric acid levels in ischemic stroke patients. Neurotox Res. 2016 Jan 1;29(1):10-20.

Gersch C, Palii SP, Kim KM, Angerhofer A, Johnson RJ, Henderson GN. Inactivation of nitric oxide by uric acid. Nucleosid, Nucleotid Nucl Acids. 2008 Aug 11;27(8):967-78.

Kanellis J, Watanabe S, Li JH, Kang DH, Li P, Nakagawa T, et al. Uric acid stimulates monocyte chemoattractant protein-1 production in vascular smooth muscle cells via mitogen-activated protein kinase and cyclooxygenase-2. Hypertension. 2003 Jun 1;41(6):1287-93.

Kang DH, Park SK, Lee IK, Johnson RJ. Uric acid-induced C-reactive protein expression: implication on cell proliferation and nitric oxide production of human vascular cells. J Am Soc Nephrol. 2005 Dec 1;16(12):3553-62.

Efstathiadou A, Gill D, McGrane F, Quinn T, Dawson J. Genetically Determined Uric Acid and the Risk of Cardiovascular and Neurovascular Diseases: A Mendelian Randomization Study of Outcomes Investigated in Randomized Trials. J Am Heart Assoc. 2019 Sep 3;8(17):e012738..

Kleber ME, Delgado G, Grammer TB, Silbernagel G, Huang J, Kramer BK, et al. Uric acid and cardiovascular events: a Mendelian randomization study. J Am Soc Nephrol. 2015;26:2831-2838.

Testa A, Prudente S, Leonardis D, Spoto B, Sanguedolce MC, Parlongo RM, et al. A genetic marker of hyperuricemia predicts cardiovascular events in a meta-analysis of three cohort studies in high risk patients. Nutr Metab Cardiovasc Dis. 2015;25:1087-94.

Gotsman I, Keren A, Lotan C, Zwas DR. Changes in uric acid levels and allopurinol use in chronic heart failure: association with improved survival. J Card Fail. 2012;18:694-701.

Zhao X, Zhang HW, Xu RX, Guo YL, Zhu CG, Wu NQ, et al. Oxidized-LDL is a useful marker for predicting the very early coronary artery disease and cardiovascular outcomes. Personal Medi. 2018 Nov;15(6):521-9.

Larsen TR, Gerke O, Diederichsen AC, Lambrechtsen J, Steffensen FH, Sand NP, et al. The association between uric acid levels and different clinical manifestations of coronary artery disease. Coronary Art Dis. 2018 May 1;29(3):194-203.

Prasad M, Matteson EL, Herrmann J, Gulati R, Rihal CS, Lerman LO, et al. Uric acid is associated with inflammation, coronary microvascular dysfunction, and adverse outcomes in postmenopausal women. Hypertension. 2017 Feb;69(2):236-42.

Baldus S, Köster R, Chumley P, Heitzer T, Rudolph V, Ostad MA, et al. Oxypurinol improves coronary and peripheral endothelial function in patients with coronary artery disease. Free Radic Biol Med. 2005;39:1184-90.

Soucy KG, Lim HK, Attarzadeh DO, Santhanam L, Kim JH, Bhunia AK, et al. Dietary inhibition of xanthine oxidase attenuates radiation-induced endothelial dysfunction in rat aorta. J Appl Physiol. 2010;108:1250-58.

Nomura J, Busso N, Ives A, Matsui C, Tsujimoto S, Shirakura T, et al. Xanthine oxidase inhibition by febuxostat attenuates experimental atherosclerosis in mice. Sci Rep. 2014;4:4554.

Tian TT, Li H, Chen SJ, Wang Q, Tian QW, Zhang BB, et al. Serum uric acid as an independent risk factor for the presence and severity of early-onset coronary artery disease: a case-control study. Dis Mark. 2018;2018.