Abstract
Objective: Both serum uric acid (SUA) levels and lipid components, such as LDL, HDL, and Lp(a), have been reported to associate with CAD. However, the influence of SUA status at different concentrations of lipid indices for the risk of myocardial revascularization (MRT) in ACS patients is currently unknown.Methods: We retrospectively analyzed a hospital-based sample of 14,234 ACS patients with no previous history of percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) surgery. All patients went for coronary angiography. Binary logistic regression models were performed, and the odds ratios (OR) at 95% confidence interval (CIs) were used to approximate the associated risk of UA and lipid profile for myocardial revascularization, with the lowest quartile/tertile serving as the reference category.Results: Overall, 8,818 (61.9%) patients undergone MRT out of 14,234 patients. Elevated SUA and HDL were negatively associated with an increased likelihood of MRT during admission (P < 0.001). However, LDL and Lp(a) levels were positively associated with MRT among ACS patients. Furthermore, interaction analyses between SUA and lipid profiles, particularly LDL and Lp(a), compared with those in the lowest quartile of SUA levels, show that patients in higher SUA quartiles grouped by lipid components had a significantly lower chance of undergoing MRT, with the lowest OR (95%CI) for subjects being 0.222 (0.170-0.290), 0.478 (0.374-0.612), and 0.604 (0.468-0.780) in LDL tertiles, being 0.671(0.523-0.862), 0.316(0.242-0.413), and 0.410 (0.310-0.542) in Lp(a) tertiles, respectively. In the three tertiles of HDL levels, the incidence of MRT dropped steadily as SUA levels increased. Also, we further analyzed ACS patients without diabetes. Compared with the first quartile of SUA levels, the risks of MRT were significantly lower in different tertiles of lipids components [LDL, Lp(a), HDL].Conclusion: An increase in SUA levels may decrease the chance of undergoing MRT in ACS patients, even in those with increased Lp(a) and LDL-c. Elevated serum uric acid may play a protective role during an acute stage of ACS.
Highlights
Coronary artery disease (CAD) is one of the main causes of death all over the world, especially in Asian countries, where its morbidity and mortality are higher than those in Western countries [1, 2]
After excluding patients with diabetes mellitus, our results showed that the increase of Serum uric acid (SUA) was still associated with the decreased risk of myocardial revascularization at different concentrations of lipid indices, suggesting that DM status did not influence the outcome of the data
Our findings show that high LDL and Lp(a) levels were positively associated with MRT among acute coronary syndrome (ACS) patients, whereas highdensity lipoprotein cholesterol (HDL-c) was negatively associated with MRT
Summary
Coronary artery disease (CAD) is one of the main causes of death all over the world, especially in Asian countries, where its morbidity and mortality are higher than those in Western countries [1, 2]. In acute myocardial infarction, acute oxidative stress has been observed, in which the subsequent rise of SUA concentration reaches maximal concentrations within a short interval of time (several minutes or hours) [20]. This indicates that there is ongoing controversy as to whether the acute increase in UA itself is sufficient to implicate a potential protective benefit during acute coronary syndrome (ACS) or the effect of such an acute increase of UA can be affected by the lipid status of the patients during ACS
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