Abstract
Xanthine oxidoreductase (XOR) is the rate-limiting enzyme in uric acid (UA) production that plays a pivotal role in generating oxidative stress. Gender differences in the impact of plasma XOR activity on coronary artery spasm (CAS) remain unclear. We investigated plasma XOR activity in 132 patients suspected of having CAS (male, n = 78; female, n = 54) and who underwent an intracoronary acetylcholine provocation test. Plasma XOR activity was significantly lower in female patients compared with male patients. CAS was provoked in 36 male patients and 17 female patients, and both had significantly higher plasma XOR activity than those without. Multivariate logistic regression analysis showed that this activity was independently associated with the incidence of CAS in both sexes after adjusting for confounding factors. The optimal cut-off values for predicting CAS were lower in female patients than in male patients. Multivariate analysis demonstrated that female patients with high XOR activity exhibited a higher incidence of CAS than male patients. Plasma XOR activity was an independent predictor of the incidence of CAS in both sexes. The impact of plasma XOR activity on CAS was stronger in female patients than in male patients.
Highlights
Coronary artery spasm (CAS) is an important cause of acute coronary syndrome (ACS)and sudden death [1]
Serum Uric acid (UA) levels and plasma Xanthine oxidoreductase (XOR) activity were significantly lower in female patients than in male patients
There were no significant differences in body mass index (BMI), medication use, prevalence of hypertension, dyslipidemia, and diabetes mellitus between male and female patients
Summary
Coronary artery spasm (CAS) is an important cause of acute coronary syndrome (ACS)and sudden death [1]. Coronary artery spasm (CAS) is an important cause of acute coronary syndrome (ACS). Patients with CAS are associated with poor prognosis compared with those without CAS in ACS patients [2]. It has been reported that women have higher mortality rates than men after myocardial infarction [3]. It was reported that female patients with CAS had more frequently diffuse spasm by acetylcholine tests than male patients [4]. Decreased nitric oxide (NO) bioavailability due to increased reactive oxygen species (ROS) is one of the most important causes of CAS [5]. Uric acid (UA) is the end-product of purine metabolism that can induce inflammation and ROS production in vascular endothelial cells, leading to a number of cardiovascular diseases [6,7]. It has been demonstrated that serum UA is independently correlated with CAS [8]
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