|Year : 2016 | Volume
| 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
Ravindra Pal1, Prabhat Kanvaria2, CL Nawal2
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 Publication||7-Dec-2016|
Government District Bangaur Hospital, Pali, Rajasthan
Source of Support: None, Conflict of Interest: None
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 11];6:132-5. Available from: http://www.aihbonline.com/text.asp?2016/6/3/132/195319
| Introduction|| |
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. ,,,,,, Large cohort studies have shown that uric acid is an important independent risk factor for cardiovascular mortality. , 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, ,,,, but others only found an association in women, ,, and in yet others, the associations disappeared after adjustment for confounders. ,,,
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|| |
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.
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|| |
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|| |
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.,  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.  and Yadav et al.  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.  However, in the study done by Nadkar and Jain,  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.  showed a lower LVEF in patients with high uric acid, but this association was not significant, whereas the study done by Chen et al.  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.  This study and a study by Bae et al.  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.,  Bae et al.,  Dharma et al.,  and Tatli et al.  Whereas in the study by Baruah et al.,  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. 
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  and Chen et al.,  Dharma et al.,  Fadella and Boufaris et al.,  and Tatli et al.  However, in the study done by Kojima et al.,  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  and Chen et al.,  Tuomilehto et al.,  Dharma et al.,  and Tatli et al.  However, in the study done by Safi et al.,  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. 
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.,  Agrawal et al.,  Chen et al.,  Nadkar and Jain,  Cicoira et al.  and Olexa et al.,  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.,  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. ,,
In Rotterdam's study  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.,  Freedman et al.  and Moriarity et al.  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.,  high SUA was associated with high mortality irrespective of the day of estimation.
| 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.
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
Conflicts of interest
There are no conflicts of interest.
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