Korean Circ J.  2007 Apr;37(4):161-166. 10.4070/kcj.2007.37.4.161.

Serum Uric Acid is Associated with Cardiovascular Events in Patients with Coronary Artery Disease

• Bae JH
• Hyun DW
• Kwon TG
• Yoon HJ
• Lerman A
• Rihal CS

• KMID: 2227073
• DOI: http://doi.org/10.4070/kcj.2007.37.4.161

Abstract

BACKGROUND AND OBJECTIVES: Whether uric acid is a predictor of cardiovascular events remains controversial. We sought to evaluate the effects of the serum uric acid levels on major adverse cardiovascular events (MACEs) in the patients with coronary artery disease (CAD).
SUBJECTS AND METHODS
The study population consisted of 660 consecutive patients with CAD, and they were followed up for a mean of 27 months (maximum: 62 months). The recorded MACEs included acute myocardial infarction (AMI), stroke, coronary artery bypass graft, percutaneous coronary intervention (PCI) due to de novo lesion during follow up, congestive heart failure (CHF) and sudden cardiac death.
RESULTS
In the CAD patients with a uric acid level < or =3.88 mg/dL (the lowest quartile), as compared with those CAD patients with uric acid levels >5.74 mg/dL (the highest quartile), the MACE rate increased from 7.2% to 20.1%. On univariate Cox regression analysis, the highest uric acid quartile was a predictor of AMI, CHF and MACE. The absolute serum uric acid level was predictive of PCI, CHF and MACE. Multivariate Cox regression analysis showed that the independent predictors of MACE were presentation with acute coronary syndrome (HR 1.70, 95% CI: 1.04 to 2.78, p=0.033), multi-vessel disease (HR 2.43, 95% CI: 1.44 to 4.12, p=0.001), and the uric acid levels (HR 1.22, 95% CI: 1.05 to 1.43, p=0.010), and the highest uric acid quartile (HR 2.54, 95% CI: 1.58 to 4.10, p<0.001).
CONCLUSION
The serum uric acid level and multi-vessel disease are associated with subsequent cardiovascular events in the patients with CAD.

Keyword

Uric acid; Coronary artery disease; Prognosis

MeSH Terms

Acute Coronary Syndrome
Coronary Artery Bypass
Coronary Artery Disease*
Coronary Vessels*
Death, Sudden, Cardiac
Follow-Up Studies
Heart Failure
Humans
Myocardial Infarction
Percutaneous Coronary Intervention
Prognosis
Stroke
Transplants
Uric Acid*
Uric Acid

Figure

• 

  Fig. 1 Kaplan-Meier curve for event-free cumulative survival according to the quartiles of the serum uric acid levels. A: for all major adverse cardiovascular events. B: for acute myocardial infarction. C: for percutaneous coronary intervention. D: for congestive heart failure. See table 1 for the serum uric acid quartiles, and the figures on the X-axis represent months.

Reference

1. Hare JM, Johnson RJ. Uric acid predicts clinical outcomes in heart failure: insights regarding the role of xanthine oxidase and uric acid in disease pathophysiology. Circulation. 2003. 107:1951–1953.

2. Mercuro G, Vitale C, Cerquetani E, et al. Effect of hyperuricemia upon endothelial function in patients at increased cardiovascular risk. Am J Cardiol. 2004. 94:932–935.

3. Ward HJ. Uric acid as an independent risk factor in the treatment of hypertension. Lancet. 1998. 352:670–671.

4. Cicoira M, Zanolla L, Rossi A, et al. Elevated serum uric acid levels are associated with diastolic dysfunction in patients with dilated cardiomyopathy. Am Heart J. 2002. 143:1107–1111.

5. Bickel C, Rupprecht HJ, Blankenberg S, et al. Serum uric acid as an independent predictor of mortality in patients with angiographically proven coronary artery disease. Am J Cardiol. 2002. 89:12–17.

6. Kojima S, Sakamoto T, Ishihara M, et al. Prognostic usefulness of serum uric acid after acute myocardial infarction (the Japanese Acute Coronary Syndrome Study). Am J Cardiol. 2005. 96:489–495.

7. Anker SD, Doehner W, Rauchhaus M, et al. Uric acid and survival in chronic heart failure: validation and application in metabolic, functional, and hemodynamic staging. Circulation. 2003. 107:1991–1997.

8. Culleton BF, Larson MG, Kannel WB, Levy D. Serum uric acid and risk for cardiovascular disease and death. Ann Intern Med. 1999. 131:7–13.

9. Rich MW. Uric acid: is it a risk factor for cardiovascular disease? Am J Cardiol. 2000. 85:1018–1021.

10. Alderman MH, Cohen H, Madhavan S, Kivlighn S. Serum uric acid and cardiovascular events in successfully treated hypertensive patients. Hypertension. 1999. 34:144–150.

11. Moriarity JT, Folsom AR, Iribarren C, Nieto FJ, Rosamond WD. Serum uric acid and risk of coronary heart disease. Ann Epidemiol. 2000. 10:136–143.

12. Yoo TW, Sung KC, Kim YC, et al. The relationship of the hypertension, insulin resistance, and metabolic syndrome in the serum uric acid level. Korean Circ J. 2004. 34:874–882.

13. McCord JM. Oxygen-derived free radicals in postischemic tissue injury. N Engl J Med. 1985. 312:159–163.

14. Prendergast BD, Sagach VF, Shah AM. Basal release of nitric oxide augments the Frank-Starling response in the isolated heart. Circulation. 1997. 96:1320–1329.