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 Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 6  |  Issue : 3  |  Page : 132-135

Study of Association of Serum Uric Acid with Serum Lipids, Left Ventricular Ejection Fraction and In-hospital Outcome in Patients with Acute ST-Elevation Myocardial Infarction: An Observational Study


1 Medical Officer, Government District Bangaur Hospital, Pali, India
2 Department of General Medicine, SMS Medical College and Hospital, Jaipur, Rajasthan, India

Date of Web Publication7-Dec-2016

Correspondence Address:
Ravindra Pal
Government District Bangaur Hospital, Pali, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2321-8568.195319

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  Abstract 

Aim: The aim of this study was to assess the clinical value of serum uric acid (SUA) levels in patients with acute ST-elevation myocardial infarction (STEMI). Materials and Methods: Totally 200 consecutive patients with STEMI were prospectively studied from January 2014 to December 2014. The levels of serum lipid, left ventricular ejection fraction (LVEF) and in-hospital major adverse cardiovascular events in patients with hyperuricaemia (n = 56) were compared with those in patients without hyperuricaemia (n = 144). All data were analysed with GraphPad prism version 6.0 software (Graphpad Software, Inc., CA, USA). Results: SUA level was positively correlated with serum triglyceride level (TGL) (r = 0.102, P = 0.042) and negatively with high-density lipoprotein-cholesterol (HDL-C) (r = −0.149, P = 0.0034). Serum TGL was significantly higher in hyperuricaemic patients (153.7 ΁ 63.87 vs. 138.2 ΁ 34.69, P = 0.027). Patients with left ventricular failure (P = 0.006) and cardiogenic shock (P = 0.029) had significantly higher levels of uric acid. There was no significant difference in males and females with respect to serum TGLs, cardiogenic shock and left ventricular failure. However, no significant association was observed between SUA level and diabetes mellitus, hypertension, LVEF, HDL-C, low-density lipoprotein-cholesterol, total cholesterol, acute renal failure and overall mortality. Conclusion: We conclude that high SUA is significantly associated with high serum TGLs and occurrence of cardiogenic shock and left ventricular failure irrespective of the sex.

Keywords: Left ventricular ejection fraction, serum lipids, serum uric acid


How to cite this article:
Pal R, Kanvaria P, Nawal C L. Study of Association of Serum Uric Acid with Serum Lipids, Left Ventricular Ejection Fraction and In-hospital Outcome in Patients with Acute ST-Elevation Myocardial Infarction: An Observational Study. Adv Hum Biol 2016;6:132-5

How to cite this URL:
Pal R, Kanvaria P, Nawal C L. Study of Association of Serum Uric Acid with Serum Lipids, Left Ventricular Ejection Fraction and In-hospital Outcome in Patients with Acute ST-Elevation Myocardial Infarction: An Observational Study. Adv Hum Biol [serial online] 2016 [cited 2019 Dec 12];6:132-5. Available from: http://www.aihbonline.com/text.asp?2016/6/3/132/195319


  Introduction Top


As early as the 19 th century, it was known that high uric acid levels are associated with hypertension. Despite the lack of experimental studies, increased uric acid levels were commonly considered a consequence rather than a cause of cardiovascular disease. However, both animal and human studies have recently shown that high uric acid levels may impair kidney function by causing glomerular damage and preglomerular arteriolosclerosis, effects that ultimately result in arterial hypertension. [1],[2],[3],[4],[5],[6],[7] Large cohort studies have shown that uric acid is an important independent risk factor for cardiovascular mortality. [8],[9] The role of uric acid in coronary heart disease is less clear. Some studies reported an independent association between uric acid and coronary heart disease, [10],[11],[12],[13],[14] but others only found an association in women, [15],[16],[17] and in yet others, the associations disappeared after adjustment for confounders. [15],[17],[18],[19]

We performed this study to assess the clinical value of serum uric acid (SUA) in patients with ST-elevation myocardial infarction (STEMI) by comparing their clinical characteristics, LVEF and in-hospital outcome.


  Materials and Methods Top


A total of 200 consecutive patients (all adults) with acute STEMI were enrolled in this study from January 2014 to December 2014 at the Department of Medicine, SMS Hospital, Jaipur, Rajasthan, India. The patients who had liver disease, renal disease or gout were excluded from the study. In addition, patients who were chronic alcoholics or on drugs that are known to alter uric acid levels and on lipid-lowering agents were excluded from the study. The diagnosis of patients followed ESC/ACCF/AHA/WHF expert consensus third universal definition of MI.

Investigations

A fasting sample was taken within 24 h for SUA, total cholesterol (TC), high-density lipoprotein-cholesterol (HDL-C) and low-density lipoprotein-cholesterol (LDL-C). Hyperuricaemia was defined as a SUA >7 mg/dl (420 μmol/L) in males and >6 mg/dl (357 μmol/L) in females. Echocardiography was done in all patients. Other investigations were performed as required. The patients were observed during in-hospital stay for rhythm disturbances, cardiogenic shock, left ventricular failure, acute renal failure and mortality.


  Results Top


A total of 200 patients were studied. The overall total prevalence of hyperuricaemia was 28% (males - 28.9%, females - 25.8%). The maximum prevalence of hyperuricaemia was in the age group of 51-60 years (50%) for the males and 61-70 years (43.75%) for the females. The maximum incidence of acute STEMI was also found in the same age group (51-60 for males and 61-70 for females). Males had significantly higher levels of uric acid in comparison to females.

Statistically significantly higher levels of triglyceride were found among the hyperuricaemic group (153.7 ± 63.87 vs. 138.2 ± 34.69, P = 0.027). In addition, a significant positive correlation was found between uric acid and triglyceride level (TGL) (r = 0.102, P = 0.042), and a significant negative correlation was found between HDL-C and uric acid (r = −0.149, P = 0.0034). SUA levels were significantly higher in patients with cardiogenic shock (P = 0.029) and left ventricular failure. There was no significant difference in males and females with respect to serum TGLs, cardiogenic shock and left ventricular failure.

LVEF, HDL-C, LDL-C and TC were not significantly different in the two groups. There was no significant association between uric acid and hypertension, diabetes mellitus, rhythm abnormalities, acute renal failure and overall mortality.


  Discussion Top


The present study was conducted in 200 patients of acute STEMI admitted to the hospital. When these patients were grouped according to the uric acid levels, it was found that the total prevalence of hyperuricaemia was 28%. In the study conducted by Chen et al., [20] the prevalence of hyperuricaemia was found to be 23.7%. Among males, the prevalence was 28.9% and in females, it was 25.8%. When the age-wise distribution was considered, the maximum prevalence was in the age group of 51-60 years (50%) for the males and 61-70 years (43.75%) for the females. The maximum incidence of acute STEMI was also found in the same age group. This confirms that age is an important risk factor for myocardial infarction. Singh et al. [21] and Yadav et al. [22] proposed that the peak incidence of myocardial infarction is a decade later in females as shown in our study. In our study, males (6.817 ± 2.536) had significantly (P = 0.0369) higher levels of uric acid in comparison to females (5.971 ± 2.840) as was observed by Kojima et al. [23] However, in the study done by Nadkar and Jain, [24] there was no significant difference in uric acid levels among males and females.

Uric acid and left ventricular ejection fraction

Our study and a study by Bae et al. [25] showed a lower LVEF in patients with high uric acid, but this association was not significant, whereas the study done by Chen et al. [20] showed a significantly lower LVEF in patients with high SUA.

Uric acid and serum lipids

Our study found significantly higher levels of triglyceride among the hyperuricaemic group (P = 0.027) as in the study by Chen et al. [20] This study and a study by Bae et al. [25] did not show a significant association with uric acid levels unlike the study by Chen et al. where a significantly lower HDL-C was found in the hyperuricaemic group.

In our study, LDL-C and TC were higher and HDL-C was lower in the hyperuricaemic group, but the association was not significant, similar results were obtained by Chen et al., [20] Bae et al., [25] Dharma et al., [26] and Tatli et al. [27] Whereas in the study by Baruah et al., [28] significantly elevated levels of triglyceride and TC and significantly decreased levels of HDL were found in hyperuricaemic patients. On correlation of SUA levels with LVEF, TGL, HDL-C, LDL-C and TC, a significant positive correlation (r = 0.102, P = 0.042) was found between uric acid and TGL whereas a significant negative correlation (r = −0.149, P = 0.034) was found between HDL-C and uric acid, similar results were obtained in the study by Chen et al. [20]

Uric acid and hypertension

In our study, there was no significant association between SUA levels and hypertension. This is consistent with the study by Nadkar and Jain [24] and Chen et al., [20] Dharma et al., [26] Fadella and Boufaris et al., [29] and Tatli et al. [27] However, in the study done by Kojima et al., [23] hypertension was significantly associated with high SUA levels.

Uric acid and diabetes mellitus

In our study, there was no significant difference between SUA levels and diabetes. This is consistent with the study by Nadkar and Jain [24] and Chen et al., [20] Tuomilehto et al., [30] Dharma et al., [26] and Tatli et al. [27] However, in the study done by Safi et al., [31] diabetes was significantly associated with high SUA levels.

Uric acid and rhythm abnormalities

Our study showed no significant difference in the occurrence of rhythm abnormalities with SUA levels. This is consistent with the study done by Chen et al. [20]

Uric acid and major adverse cardiovascular events

In our study, it was found that SUA levels were significantly higher in patients with cardiogenic shock (P = 0.029) and left ventricular failure (P = 0.006). This is consistent with the study done by Kojima et al., [23] Agrawal et al., [32] Chen et al., [20] Nadkar and Jain, [24] Cicoira et al. [33] and Olexa et al., [34] in which SUA levels were higher in patients who were higher in Killip class.

In our study, the occurrence of acute renal failure and overall mortality was higher in hyperuricaemic patients when compared to patients with normal uric acid. However, the difference was not statistically significant. Whereas in the study done by Chen et al., [20] the difference was significant. Possibly because of small number of patients, statistical significance could not be proved in acute renal failure and overall mortality.

The major adverse cardiovascular events which have included heart failure, death, reinfarction, recurrent angina, stroke and urgent revascularisation in various combinations were found to occur more significantly in patients with raised uric acid in studies. [25],[26],[35]

In Rotterdam's study [36] and in our study, there was no significant difference in males and females with respect to serum TGLs, cardiogenic shock and left ventricular failure, whereas Culleton et al., [15] Freedman et al. [16] and Moriarity et al. [17] found an association between uric acid and coronary heart disease only in women.

In our patients, SUA was measured on day 1. In the study by Agrawal et al., [32] high SUA was associated with high mortality irrespective of the day of estimation.


  Conclusion Top


We conclude that high SUA is significantly associated with high serum TGLs and occurrence of cardiogenic shock and left ventricular failure irrespective of the sex.

Study limitations

The study sample was small. SUA was measured after the occurrence of acute myocardial infarction. A study with measurement of SUA before and after the occurrence of acute myocardial infarction is required. The observation period was in-hospital stay. A study with longer observation will show the long-term prognosis of SUA in patients with acute myocardial infarction. Some patients were critically ill at the time of admission and expired after resuscitative efforts. Blood samples could not be collected and these patients were excluded from the study. This is a source of bias.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Johnson RJ, Kang DH, Feig D, Kivlighn S, Kanellis J, Watanabe S, et al. Is there a pathogenetic role for uric acid in hypertension and cardiovascular and renal disease? Hypertension 2003;41:1183-90.  Back to cited text no. 1
    
2.
Johnson RJ, Feig DI, Herrera-Acosta J, Kang DH. Resurrection of uric acid as a causal risk factor in essential hypertension. Hypertension 2005;45:18-20.  Back to cited text no. 2
    
3.
Iseki K, Ikemiya Y, Inoue T, Iseki C, Kinjo K, Takishita S. Significance of hyperuricemia as a risk factor for developing ESRD in a screened cohort. Am J Kidney Dis 2004;44:642-50.  Back to cited text no. 3
    
4.
Watanabe S, Kang DH, Feng L, Nakagawa T, Kanellis J, Lan H, et al. Uric acid, hominoid evolution, and the pathogenesis of salt-sensitivity. Hypertension 2002;40:355-60.  Back to cited text no. 4
    
5.
Sundström J, Sullivan L, D'Agostino RB, Levy D, Kannel WB, Vasan RS. Relations of serum uric acid to longitudinal blood pressure tracking and hypertension incidence. Hypertension 2005;45:28-33.  Back to cited text no. 5
    
6.
Alper AB Jr., Chen W, Yau L, Srinivasan SR, Berenson GS, Hamm LL. Childhood uric acid predicts adult blood pressure: The Bogalusa heart study. Hypertension 2005;45:34-8.  Back to cited text no. 6
    
7.
Johnson RJ, Rodriguez-Iturbe B, Kang DH, Feig DI, Herrera-Acosta J. A unifying pathway for essential hypertension. Am J Hypertens 2005;18:431-40.  Back to cited text no. 7
    
8.
Niskanen LK, Laaksonen DE, Nyyssönen K, Alfthan G, Lakka HM, Lakka TA, et al. Uric acid level as a risk factor for cardiovascular and all-cause mortality in middle-aged men: A prospective cohort study. Arch Intern Med 2004;164:1546-51.  Back to cited text no. 8
    
9.
Fang J, Alderman MH. Serum uric acid and cardiovascular mortality the NHANES I epidemiologic follow-up study, 1971-1992. National Health and Nutrition Examination Survey. JAMA 2000;283:2404-10.  Back to cited text no. 9
    
10.
Bengtsson C, Lapidus L, Stendahl C, Waldenström J. Hyperuricaemia and risk of cardiovascular disease and overall death. A 12-year follow-up of participants in the population study of women in Gothenburg, Sweden. Acta Med Scand 1988;224:549-55.  Back to cited text no. 10
    
11.
Goldberg RJ, Burchfiel CM, Benfante R, Chiu D, Reed DM, Yano K. Lifestyle and biologic factors associated with atherosclerotic disease in middle-aged men 20-year findings from the Honolulu Heart Program. Arch Intern Med 1995;155:686-94.  Back to cited text no. 11
    
12.
Kannel WB. Metabolic risk factors for coronary heart disease in women: Perspective from the Framingham Study. Am Heart J 1987;114:413-9.  Back to cited text no. 12
    
13.
Liese AD, Hense HW, Lowel H, Doring A, Tietze M, Keil U. Association of serum uric acid with all-cause and cardiovascular disease mortality and incident myocardial infarction in the MONICA Augsburg Cohort. Epidemiology 1999;10:391-7.  Back to cited text no. 13
    
14.
Persky VW, Dyer AR, Idris-Soven E, Stamler J, Shekelle RB, Schoenberger JA, et al. Uric acid: A risk factor for coronary heart disease? Circulation 1979;59:969-77.  Back to cited text no. 14
    
15.
Culleton BF, Larson MG, Kannel WB, Levy D. Serum uric acid and risk for cardiovascular disease and death: The Framingham Heart Study. Ann Intern Med 1999;131:7-13.  Back to cited text no. 15
    
16.
Freedman DS, Williamson DF, Gunter EW, Byers T. Relation of serum uric acid to mortality and ischemic heart disease. The NHANES I epidemiologic follow-up study. Am J Epidemiol 1995;141:637-44.  Back to cited text no. 16
    
17.
Moriarity JT, Folsom AR, Iribarren C, Nieto FJ, Rosamond WD. Serum uric acid and risk of coronary heart disease: Atherosclerosis risk in communities (ARIC) study. Ann Epidemiol 2000;10:136-43.  Back to cited text no. 17
    
18.
Brand FN, McGee DL, Kannel WB, Stokes J 3 rd , Castelli WP. Hyperuricemia as a risk factor of coronary heart disease: The Framingham study. Am J Epidemiol 1985;121:11-8.  Back to cited text no. 18
    
19.
Wannamethee SG, Shaper AG, Whincup PH. Serum urate and the risk of major coronary heart disease events. Heart 1997;78:147-53.  Back to cited text no. 19
    
20.
Chen L, Li XL, Qiao W, Ying Z, Qin YL, Wang Y, et al. Serum uric acid in patients with acute ST-elevation myocardial infarction. World J Emerg Med 2012;3:35-9.  Back to cited text no. 20
    
21.
Singh PS, Singh G, Singh SK. Clinical profile and risk factors in acute coronary syndrome. J Indian Acad Clin Med 2013;14:130-2.  Back to cited text no. 21
    
22.
Yadav P, Joseph D, Joshi P, Sakhi P, Jha RK, Gupta J. Clinical profile and risk factors in acute coronary syndrome. Natl J Community Med 2010;1:150-2.  Back to cited text no. 22
    
23.
Kojima S, Sakamoto T, Ishihara M, Kimura K, Miyazaki S, Yamagishi M, et al. Prognostic usefulness of serum uric acid after acute myocardial infarction (the Japanese Acute Coronary syndrome study). Am J Cardiol 2005;96:489-95.  Back to cited text no. 23
    
24.
Nadkar MY, Jain VI. Serum uric acid in acute myocardial infarction. J Assoc Physicians India 2008;56:759-62.  Back to cited text no. 24
    
25.
Bae JH, Hyun DW, Kwon TG, Yoon HJ, Lerman A, Rihal CS. Uric acid and prognosis in patients with CAD. Korean Circ J 2007;37:161-6.  Back to cited text no. 25
    
26.
Dharma S, Siswanto BB, Soerianata S, Wardeh AJ, Jukema JW. Serum uric acid as an independent predictor of cardiovascular event in patients with acute ST elevation myocardial infarction. J Clin Exp Cardiolog 2012;S5:5.  Back to cited text no. 26
    
27.
Tatli E, Aktoz M, Buyuklu M, Altun A. The relationship between coronary artery disease and uric acid levels in young patients with acute myocardial infarction. Cardiol J 2008;15:21-5.  Back to cited text no. 27
    
28.
Baruah M, Nath CK, Chaudhury B, Devi R, Ivvala AS. A study of serum uric acid and C-reactive protein in acute myocardial infarction. Int J Basic Med Sci Pharm 2012;2:21-4.  Back to cited text no. 28
    
29.
Fadella AA, Boufaris IB. Uric acid levels in patients with acute myocardial infarction. Life Sci J 2014;11:616-8.  Back to cited text no. 29
    
30.
Tuomilehto J, Zimmet P, Wolf E, Taylor R, Ram P, King H. Plasma uric acid level and its association with diabetes mellitus and some biologic parameters in a biracial population of Fiji. Am J Epidemiol 1988;127:321-36.  Back to cited text no. 30
    
31.
Safi AJ, Mahmood R, Khan MA, Haq A. Association of serum uric acid with type II diabetes mellitus. J Postgrad Med Inst 2004;18:59-63.  Back to cited text no. 31
    
32.
Agrawal S, Aundhkar SC, Patange A, Panpalia NG, Jain S, Garg R, et al. Evaluate the role of serum uric acid in acute myocardial infarction as a prognostic marker. Int J Health Sci Res 2014;4:120-8.  Back to cited text no. 32
    
33.
Cicoira M, Zanolla L, Rossi A, Golia G, Franceschini L, Brighetti G, et al. Elevated serum uric acid levels are associated with diastolic dysfunction in patients with dilated cardiomyopathy. Am Heart J 2002;143:1107-11.  Back to cited text no. 33
    
34.
Olexa P, Olexová M, Gonsorcík J, Tkác I, Kisel'ová J, Olejníková M. Uric acid - A marker for systemic inflammatory response in patients with congestive heart failure? Wien Klin Wochenschr 2002;114:211-5.  Back to cited text no. 34
    
35.
Car S, Trkulja V. Higher serum uric acid on admission is associated with higher short-term mortality and poorer long-term survival after myocardial infarction: Retrospective prognostic study. Croat Med J 2009;50:559-66.  Back to cited text no. 35
    
36.
Bos MJ, Koudstaal PJ, Hofman A, Witteman JC, Breteler MM. Uric acid is a risk factor for myocardial infarction and stroke: The Rotterdam study. Stroke 2006;37:1503-7.  Back to cited text no. 36
    




 

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