Close linkage between serum uric acid and cardiac dysfunction in patients with ischemic heart disease according to covariance structure analysis

Akira Yoshii,Yasunori Inoue,Tomohisa Nagoshi,Makoto Kawai,Michihiro Yoshimura,Goki Uno,Toshikazu D. Tanaka,Kosuke Minai,Satoshi Ito,Takayuki Ogawa,Kazuo Ogawa,Yoshiro Tanaka,Haruka Kimura

doi:10.1038/s41598-017-02707-y

Akira Yoshii, Yasunori Inoue + Show 11 more

Open Access

https://doi.org/10.1038/s41598-017-02707-y

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Journal: Scientific Reports	Publication Date: May 30, 2017
Citations: 18	License type: open-access

Affiliation: Jikei University School of Medicine

Abstract

High serum uric acid (UA) level has been assumed to be a risk factor for left ventricular (LV) dysfunction; however, the precise relationship between these conditions has not been fully examined because many confounding factors are associated with UA level. We herein examined the precise relationship by proposing structural equation models. The study population consisted of 1432 cases with ischemic heart disease who underwent cardiac catheterization. Multiple regression analyses and covariance structure analyses were performed to elucidate the cause-and-effect relationship between UA level and LV ejection fraction (LVEF). A path model exploring the factors contributing to LVEF showed that high UA was a significant cause of reduced LVEF (P = 0.004), independent of other significant factors. The degree of atherosclerosis, as estimated by the number of diseased coronary vessels, was significantly affected by high UA (P = 0.005); and the number of diseased coronary vessels subsequently led to reduced LVEF (P < 0.001). Another path model exploring the factors contributing to UA level showed that LVEF was a significant cause of high UA (P = 0.001), while other risk factors were also independent contributing factors. This study clearly demonstrated that there was a close link between high UA and LV dysfunction, which was represented by possible cause-and-effect relationship.

Highlights

Patients with high uric acid (UA) levels are predisposed to gout as a major clinical complication
It has almost been accepted that high UA levels are associated with most cardiovascular diseases, including heart failure, many more studies are required to confirm the positioning of high UA level as a risk factor for the respective cardiovascular disorders
We successfully proposed a path model based on a covariance structure analysis in order to explain a complex phenomenon involving possible causality[11]

Summary

Introduction

Patients with high uric acid (UA) levels are predisposed to gout as a major clinical complication. Elevated UA levels are associated with the presence of hypertension, diabetes, and metabolic syndrome[6,7,8], while the relationship between ischemic heart disease (IHD) and serum UA level remains controversial Another recent meta-analysis studying the relationship between serum UA and IHD showed that a high UA level was not likely to be a main determinant of IHD and that it may not significantly contribute to the prediction of IHD in the general population[9]. There is a degree of intractableness associated with performing a precise analysis because serum UA level is likely to be associated with many other risk factors, including -but not limited to- male gender, obesity, dyslipidemia All of these risk factors may –both individually and collectively- affect the progression of cardiovascular diseases. We successfully proposed a path model based on a covariance structure analysis in order to explain a complex phenomenon involving possible causality[11]

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