Serum uric acid and acute coronary syndrome: Case-Control study
Keywords:
acute coronary syndrome, serum uric acid, ACS, IBN SINA HospitalAbstract
Background: Acute Coronary Syndrome represents a challenge to the global public health, because of the high morbidity and mortality. Identifying the risk factors and biomarkers is important for early detection, risk stratification, and effective management. Recent studies suggest a potential association between elevated serum uric acid levels and Acute Coronary Syndrome, yet the relationship remains poorly understood and need further investigation.
Objective: This study aims to assess the relationship between serum uric acid levels and the incidence of ACS in a defined population. thereby assessing its potential as a biomarker for detection and prognosis.
Methods: Employing a case-control design, this study will involve participants diagnosed with ACS at IBN SINA Hospital and a matched control group of apparently healthy individuals. Exclusion criteria include chronic kidney disease, malignancies, active inflammatory conditions, and the use of drugs affecting serum uric acid levels. Data collection will focus on demographic information, medical history, clinical characteristics, and serum uric acid levels, determined through blood sample analysis.
Results: Our study involved 64 ACS cases with a mean age of 59.39±11.886 years and 60 healthy controls with a mean age of 56.35±8.631 years. We observed that the median serum uric acid level was significantly higher in ACS cases (341.0) compared to controls (333.0) with a p-value of 0.046, indicating a statistically significant difference.
Gender-based analysis revealed a significant difference in serum uric acid levels among females between cases and controls (p=0.035), but not among males (p=0.602). Age group analysis showed a significant difference only in the 70-79 age group (p=0.045). The ROC analysis suggested that serum uric acid level has a modest discriminatory ability for ACS with an area under the curve of 0.604 (p=0.046).
Conclusion: Elevated serum uric acid levels are associated with an increased risk of ACS, particularly among females and in older age groups. Serum uric acid could serve as a potential biomarker for ACS detection and prognosis, though its utility may vary across different demographic groups. Our findings highlight the importance of considering serum uric acid levels in the risk stratification and management of ACS patients
References
1- Hygesen, K., Alpert, J. S., Jaffe, A. S., Chaitman, B. R., Bax, J. J., Morrow, D. A., & White, H. D. (2018). Fourth Universal Definition of Myocardial Infarction (2018). Circulation, 1. doi:10.1161/cir.0000000000000617
2- Libby P. (2013). Mechanisms of acute coronary syndromes and their implications for therapy. New England Journal of Medicine, 368(21), 2004-2013. doi: 10.1056/NEJMra1216063
3- Gregory A. Roth et al. "Global Burden of Cardiovascular Diseases and Risk Factors, 1990–2019." Journal of the American College of Cardiology, 76 (2020): 2982 - 3021. https://doi.org/10.1016/j.jacc.2020.11.010.
4- D. H. Prasetyo et al. "Correlation between Serum Uric Acid Level and Severity of Coronary Artery Stenosis in Patients with Acute Coronary Syndrome." Majalah Kedokteran Bandung (2021). https://doi.org/10.15395/MKB.V53N1.2221
5- Sakata, S., Hata, J., Honda, T., Hirakawa, Y., Oishi, E., Shibata, M., Yoshida, D., Goto, K., Kitazono, T., & Ninomiya, T. (2020). Serum uric acid levels and cardiovascular mortality in a general Japanese population: the Hisayama Study. Hypertension Research, 43, 560-568. https://doi.org/10.1038/s41440-019-0390-8.
6- Chrysant, S. (2023). Association of hyperuricemia with cardiovascular diseases: current evidence. Hospital practice. https://doi.org/10.1080/21548331.2023.2173413
7- Saito, Y., Kitahara, H., Nakayama, T., Fujimoto, Y., & Kobayashi, Y. (2019). Relation of Elevated Serum Uric Acid Level to Endothelial Dysfunction in Patients with Acute Coronary Syndrome. Journal of Atherosclerosis and Thrombosis, 26, 362 - 367. https://doi.org/10.5551/jat.45179.
8- Reginato, A.M.; Mount, D.B.; Yang, I.; Choi, H.K. The Genetics of Hyperuricaemia and Gout. Nat. Rev. Rheumatol. 2012, 8, 610–621.
9- - Sun, H.; Wu, Y.; Bian, H.; Yang, H.; Wang, H.; Meng, X.; Jin, J. Function of Uric Acid Transporters and Their Inhibitors in Hyperuricaemia. Front. Pharmacol. 2021, 12, 1806.
10- Bose, B., Badve, S. V., Hiremath, S. S., Boudville, N., Brown, F. G., Cass, A., ... & Johnson, D. W. (2018). Uric acid and kidney disease: a review. Seminars in Nephrology, 38(5), 457-465.
11- Kimura, Y.; Tsukui, D.; Kono, H. Uric Acid in Inflammation and the Pathogenesis of Atherosclerosis. Int. J. Mol. Sci. 2021, 22, 12394. https://doi.org/10.3390/ijms222212394
12- Yu W, et al. High Level of Uric Acid Promotes Atherosclerosis by Targeting NRF2-Mediated Autophagy Dysfunction and Ferroptosis. Oxid Med Cell Longev. 2022. Available from: https://pubmed.ncbi.nlm.nih.gov/33488969/
13- Pagidipati NJ, Hess CN, Clare RM, Akerblom A, Tricoci P, Wojdyla D, Keenan RT, James S, Held C, Mahaffey KW, Klein AB, Wallentin L, Roe MT. An examination of the relationship between serum uric acid level, a clinical history of gout, and cardiovascular outcomes among patients with acute coronary syndrome. Am Heart J. 2017 May;187:53-61. doi: 10.1016/j.ahj.2017.02.023. Epub 2017 Feb 21. PMID: 28454808; PMCID: PMC9806969.
14- Padda, J., Khalid, K., Almanie, A., Hennawi, H., Mehta, K., Fernando, R., Padda, S., Cooper, A., & Jean-Charles, G. (2021). Hyperuricemia in Patients With Coronary Artery Disease and Its Association With Disease Severity. cureus , 13. https://doi.org/10.7759/cureus.17161.
15- Moriarity, J., Folsom, A., Iribarren, C., Nieto, F., & Rosamond, W. (2000). Serum uric acid and risk of coronary heart disease: Atherosclerosis Risk in Communities (ARIC) Study. Annals of epidemiology, 10 3, 136-43 . https://doi.org/10.1016/S1047-2797(99)00037-X.
16- Gaubert, M., Bardin, T., Cohen-Solal, A., Diévart, F., Fauvel, J., Guieu, R., Sadrin, S., Maixent, J., Galinier, M., & Paganelli, F. (2020). Hyperuricemia and Hypertension, Coronary Artery Disease, Kidney Disease: From Concept to Practice. International Journal of Molecular Sciences, 21. https://doi.org/10.3390/ijms21114066.
17- Li, M., Hu, X., Fan, Y. et al. Hyperuricemia and the risk for coronary heart disease morbidity and mortality a systematic review and dose-response meta-analysis. Sci Rep 6, 19520 (2016). https://doi.org/10.1038/srep19520
18- Yahia, Mohamed; Ahmad, Mustafa; and Elkersh, Ahmed (2023) "Correlation between serum uric acid level and angiographic severity of coronary artery disease in patients with acute coronary syndrome," Menoufia Medical Journal: Vol. 36: Iss. 2, Article 21. DOI: https://doi.org/10.59204/2314-6788.1093
19- Moldogazieva, N., Mokhosoev, I., Mel'nikova, T., Porozov, Y., & Terentiev, A. (2019). Oxidative Stress and Advanced Lipoxidation and Glycation End Products (ALEs and AGEs) in Aging and Age-Related Diseases. Oxidative Medicine and Cellular Longevity, 2019. https://doi.org/10.1155/2019/3085756.
20- Jiao, Y., Wang, J., Yang, X., Shen, M., Xue, H., Guo, J., Dong, W., Chen, Y., Xi, Q., & Fu, Z. (2021). Evaluation of the prognostic ability of serum uric acid for elderly acute coronary syndrome patients with diabetes mellitus: a prospective cohort study. Journal of Zhejiang University-SCIENCE B, 22, 856 - 865. https://doi.org/10.1631/jzus.B2000637.
Downloads
Published
Issue
Section
License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
