Abstract
Objectives: To determine the association of hyperuricemia with the presence and severity of coronary artery disease in patients undergoing coronary angiography.
 Methodology: This case control study was carried out in the Department of Cardiology, Chaudhary Pervaiz Elahi Institute of Cardiology, Multan for six months. Total number of 292 patients (146 cases with coronary artery disease and 146 controls with normal coronary arteries) having age 40-60 years of both genders were included in this study. Coronary angiography was performed using standard angiographic techniques. After undergoing coronary angiography, patients with 50% luminal stenosis or more in any one of the coronary arteries were labeled case group. Patients with normal coronaries or less than 50% luminal stenosis in any one of the coronary vessels were taken as control group. Serum uric acid was advised and value was noted along with the basic demographic data and established risk factors of coronary artery disease.
 Results: Mean age was 50.79±6.08 years. Mean serum uric acid was 7.54±3.60 mg/dl. Hyperuricemia was diagnosed in 94 (64.40%) patients with significant CAD (case group) and in only 59 (40.40%) in control group. The odds ratio was 2.66 (95% CI 1.66 to 7.28) with p-value of <0.001. Triple vessel disease was diagnosed in 66.7% patients with hyperuricemia and in only 33.3% patients without hyperuricemia [OR 4.0 (2.09-7.64), p-value <0.001].
 Conclusion: There is a significant association between the presence and severity of coronary artery disease with hyperuricemia.
Highlights
The end oxidation product of purine metabolism is uric acid.[1]
The rationale to design this study is that the available evidences shows contradictory results of different studies in different populations, As our population differs from others in terms of lifestyle, daily routine activity, fast food and meat consumption, we designed this study to see the association of hyperuricemia with the presence of Coronary artery disease (CAD) but to find out if there is association between hyperuricemia and the severity of CAD in the population of South Punjab
Patients with luminal stenosis of greater than 50% in at least one of the coronary arteries assessed at coronary angiography were labeled as coronary artery disease (Case group)
Summary
The end oxidation product of purine metabolism is uric acid.[1]. Increased levels of serum uric acid, hyperuricemia, are linked with multiple diseases like gout, hyperlipidemia, hypertension, resistance to insulin, diabetes and coronary artery disease.[2]. Kuwabara concluded that hyperuricemia in patients with cardiovascular risk factors like hypertension is considered as a risk factor for cardiovascular disease and appropriate intervention must be done at an early stage.[6] Gagliardi et al reported that hyperuricemia is independently associated with coronary artery calcification presence and severity.[7] At the same time there are many studies which showed the contradictory results.[8,9] there are studies which concluded further workup is needed for developing hyperuricemia as an independent risk factor and whether to modify it or not.[10,11,12] Our institute is the largest referral cardiology hospital of South Punjab region of Pakistan with a large catchment area. This study will help clinicians and cardiologists to look whether hyperuricemia is a potential risk factor for coronary artery or not and encourage more research in future to see if managing hyperuricemia could reduce the risk of CAD or not
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