Serum cystatin C,monocyte/high-density lipoprotein-C ratio,and uric acid for the diagnosis of coronary heart disease and heart failure

BACKGROUND Coronary heart disease(CHD)and heart failure(HF)are the major causes of morbidity and mortality worldwide.Early and accurate diagnoses of CHD and HF are essential for optimal management and prognosis.However,conventional diagnostic methods such as electrocardiography,echocardiography,and cardiac biomarkers have certain limitations,such as low sensitivity,specificity,availability,and cost-effectiveness.Therefore,there is a need for simple,noninvasive,and reliable biomarkers to diagnose CHD and HF.AIM To investigate serum cystatin C(Cys-C),monocyte/high-density lipoprotein cholesterol ratio(MHR),and uric acid(UA)diagnostic values for CHD and HF.METHODS We enrolled 80 patients with suspected CHD or HF who were admitted to our hospital between July 2022 and July 2023.The patients were divided into CHD(n=20),HF(n=20),CHD+HF(n=20),and control groups(n=20).The serum levels of Cys-C,MHR,and UA were measured using immunonephelometry and an enzymatic method,respectively,and the diagnostic values for CHD and HF were evaluated using receiver operating characteristic(ROC)curve analysis.RESULTS Serum levels of Cys-C,MHR,and UA were significantly higher in the CHD,HF,and CHD+HF groups than those in the control group.The serum levels of Cys-C,MHR,and UA were significantly higher in the CHD+HF group than those in the CHD or HF group.The ROC curve analysis showed that serum Cys-C,MHR,and UA had good diagnostic performance for CHD and HF,with areas under the curve ranging from 0.78 to 0.93.The optimal cutoff values of serum Cys-C,MHR,and UA for diagnosing CHD,HF,and CHD+HF were 1.2 mg/L,0.9×10^(9),and 389μmol/L;1.4 mg/L,1.0×10^(9),and 449μmol/L;and 1.6 mg/L,1.1×10^(9),and 508μmol/L,respectively.CONCLUSION Serum Cys-C,MHR,and UA are useful biomarkers for diagnosing CHD and HF,and CHD+HF.These can provide information for decision-making and risk stratification in patients with CHD and HF.

Serum uric acid as a prognostic marker in the setting of advanced vascular disease： a prospective study in the elderly

Background Many epidemiological studies analyze the relationship between hyperuricemia and cardiovascular outcomes. This observational prospective study investigates the association of serum uric acid （SUA） levels with adverse cardiovascular events and deaths in an elderly population affected by advanced atherosclerosis. Methods Two hundred and seventy six elderly patients affected by advanced atherosclerosis （217 males and 59 females; aged 71.2 ±7.8 years） were included. All patients were assessed for history of cardiovascular disease, cancer, obesity and traditional risk factors. Patients were followed for approximately 31 ±11 months. Major events were recorded during follow-up, defined as myocardial infarction, cerebral isehemia, myocardial and/or peripheral revascularization and death. Results Mean SUA level was 5.47 ±1.43 mg/dL; then we further divided the population in two groups, according to the median value （5.36 mg/dL）. During a median follow up of 31 months （5 to 49 months）, 66 cardiovascular events, 9 fatal cardiovascular events and 14 cancer-related deaths have occurred. The patients with increased SUA level presented a higher significant incidence of total cardiovascular events （HR： 1.867, P = 0.014, 95% CI： 1.134-3.074）, The same patients showed a significant increased risk of cancer-related death （HR： 4.335, P = 0.025, 95% CI： 1.204-15.606）. Conclusions Increased SUA levels are independently and significantly associated with risk of cardiovascular events and cancer related death in a population of mainly elderly patients affected by peripheral vasculopathy.

Serum Bilirubin as a Predictor of Coronary Artery Disease Severity in Patients Undergoing Primary Percutaneous Coronary Intervention

Introduction: Coronary artery disease (CAD) is one of the most common causes of death worldwide. In 2010, about 7 out of total 53 million deaths were due to ischemic heart disease. The aim of this study is to evaluate the relationship of serum bilirubin level with the severity and complexity of coronary artery disease (CAD) in the patients undergoing primary percutaneous coronary intervention (PCI). Materials and Methods: 70 patients with STEMI who were undergoing primary PCI were included in the study. All the patients included in the study were subjected to full routine investigations and standard coronary angiographic projections. Total bilirubin level was measured and the patients were divided into two groups. Group 1 was with serum TB (and Group 2 was with serum TB (>1 mg/dl). Severity and complexity of coronary artery lesions will be assessed using Gensini score. Results: After PCI, the two studied groups were compared regarding the number of vessels affected by one and more than one vessel disease. Single vessel disease was frequent in Group 2 (71%) with significant p value (0.003). Cardiac enzymes (troponin I) was more in Group 1 (S. Bil value (0.02). Also (ALT, AST) were more in Group 1 (p value = 0.01). By comparing the 2 groups, there was a significant difference regarding (EF) between both which was less in Group 1 (S.TB 1), p value significance (0, 0001). Also GENSENI was more in Group 1 (S.TB 1) with mean (80.35 vs 34.71) and significant pvalue (0.0001). There was a highly significant negative correlation between serum bilirubin & GENSENI score (r = -0.762, p value 0.0001). Regarding the incidence of complications, incidence was more in Group 1 (S.TB 1), which means a significant difference between both groups with significant p value (0.0001). There was a significant negative correlation between serum bilirubin & incidence of complications (R = -0.38, pvalue 0.001). Also, there was a significant negative correlation between GENSINI score, complication and bilirubin among both groups (r: -0.762\-0.38) with p value (0.0001\0.001) respectively. Conclusion: In conclusion, our results suggested that the Serum Bilirubin level is inversely correlated with the severity of CAD. Also, the SB level is an independent predictor of cardiovascular events in CAD patients. Understandably, our findings need further verification by large-scale, multicenter clinical trials in the future.

Association between Serum Uric Acid to HDL-Cholesterol Ratio and Nonalcoholic Fatty Liver Disease Risk among Chinese Adults

Objective The aim of this case-control study was to explore the association between serum uric acid to high density lipoprotein cholesterol ratio(UHR) and the risk of nonalcoholic fatty liver disease(NAFLD) in Chinese adults.Methods A total of 636 patients with NAFLD and 754 controls were enrolled from the Affiliated Hospital of Qingdao University, China, between January and December 2016. All patients completed a comprehensive questionnaire survey and underwent abdominal ultrasound examination and a blood test. NAFLD was diagnosed using ultrasonography after other etiologies were excluded. Logistic regression and restricted cubic spline model were conducted to evaluate the relationship of UHR with NAFLD risk.Results The multivariable adjusted odds ratio(95% confidence interval, CI) for NAFLD in the highest versus lowest quartile of UHR was 3.888(2.324–6.504). In analyses stratified by sex and age, we observed significant and positive associations between UHR and the risk of NAFLD in each subgroup. In analyses stratified by body mass index(BMI), a significant and positive association was found only in individuals with a BMI of ≥ 24 kg/m2. Our dose-response analysis indicated a linear positive correlation between UHR and the risk of NAFLD.Conclusion UHR is positively associated with the risk of NAFLD and may serve as an innovative and noninvasive marker for identifying individuals at risk of NAFLD.

Serum Levels of Antioxidant Vitamins in Relation to Coronary Artery Disease: A Case Control Study of Koreans

With the changes in trends of disease pattern from infectious to chronic degenerative disease, cardiovascular disease has been considered as the major cause of death in Korea.Numerous studies have been done on the antioxidant effects of some vitamins in the prevention of chronic illness, but not many in relation to the cardiovascular disease.Therefore, the relation between antioxidant vitamins, mainly α-tocopherol (α-T) and B-carotene (B-C), and coronary artery disease (CAD) such as angina pectoris and myocardial infarction has been investigated in this study.The blood samples were obtained from the CAD patients who were angiographically diagnosed within a month (100 case group). Patients who had an experience of PTCA or CABG were excluded from the study. Control subjects were healthy adults who had normal EKG values, no chest pain and no past history of cardiac disease (100 control group). All subjects were free of serum lipid lowering drugs. Serum α-T and B-C were analysed using HPLC. In addition to antioxidant vitamins, serum lipids (total cholesterol, HDL, TG) were also measured. Each case and control was matched in terms of age and sex. And all the CAD risk factors such as blood pressure, smoking, alcohol, serum lipid profile and BMI were adjusted to determine pure effect(s) of α-T and B-C on the CAD.The concentrations of both α-T and B-C were significantly lower in the CAD group than those in control group (P<0.05); in CAD group, mean values of α-T and B-C were 11.9±7.2 (μg/ml), 35.8±3.1 (μg/dl) respectively. As for the levels of B-C, it shows inverse relation with age, but not for the α-T Ievels. Serum levels of both vitamins did not show any significant differences in terms of sex, but men have a tendency o higher levels of B-C,but lower levels of α-T

Research survey and review of the effect of Compound Danshen Dripping Pills on the uric acid metabolism of patients with coronary heart disease

A growing number of studies have reported that serum uric acid（SUA） is associated with coronary heart disease（CHD）, which has been increasingly recognized and valued by the medical community. This paper surveys the epidemiological studies of hyperuricemia and CHD and summarizes the clinical study discussing the association between hyperuricemia and coronary heart disease with a prospect of exploring the possible mechanisms of compound Danshen dripping pills in reducing SUA in patients with coronary heart disease.

Effect of genetic factors on the association between coronary artery disease and PTPN22 polymorphism

PTPN22 has been previously found associated with coronary artery disease(CAD). In the present note we have studied the effect of p53 codon 72,acid phosphatse locus 1(ACP1) and adenosine deaminase(ADA) genetic polymorphism on the strength of association between PTPN22 and CAD. We have studied 133 non diabetic subjects with CAD,122 non diabetic cardiovascular patients without CAD and 269 healthy blood donors. Informed written consent was obtained from all subjects and the study was approved by the Ethical Committee. A high significant association between PTPN22 and CAD is observed in carriers of *A allele of ACP1 with a higher proportion of *T allele carriers in non diabetic subjects with CAD as compared to controls and to non diabetic subjects with cardiovascular diseasewithout CAD. A similar pattern is observed in carriers of *Pro allele of p53 codon 72 with a higher proportion of *T allele carriers in non diabetic subjects with CAD as compared to other groups. A highly significant association between PTPN22 and CAD is observed in carriers of ADA2 *2 allele with higher proportion of *T allele carriers in non diabetic subjects with CAD as compared to other group. There is a high significant correlation between the number of factors that contributes to increase the strength of association between PTPN22 *T and CAD and the proportion of *T carriers in CAD. ACP1,p53 codon 72 and ADA are involved in immune reaction and give an important additive contribution to the strength of association between PTPN22 and CAD. This study stresses the importance of the simultaneous analysis of multiple genes functionally related to a specific disease: the approach may give important hints to understand multifactorial disorders.

Serum uric acid in patients with acute ST-elevation myocardial infarction

BACKGROUND:Few studies investigated serum uric acid levels in patients with acute STelevation myocardial infarction(STEMI).The study was to assess the clinical value of serum uric acid levels in patients with acute ST-elevation myocardial infarction(STEMI).METHODS:Totally 502 consecutive patients with STEMI were retrospectively studied from January 2005 to December 2010.The level of serum lipid,echocardiographic data and in-hospital major adverse cardiovascular events(MACE) in patients with hyperuricemia(n=119) were compared with those in patients without hyperuricemia(n=383).The relationship between the level of serum uric acid and the degree of diseased coronary artery was analyzed.All data were analyzed with SPSS version 17.0 software for Student's t test,the Chi-square test and Pearson's correlation coefficient analysis.RESULTS:Serum uric acid level was positively correlated with serum triglyceride level.Hyperlipidemia was more common in hyperuricemia patients than in non-hyperuricemia patients(43.7%vs.33.7%,P=0.047),and serum triglyceride level was significantly higher in hyperuricemia patients(2.11±1.24 vs.1.78±1.38,P=0.014).But no significant association was observed between serum uric acid level and one or more diseased vessels(P>0.05).Left ventricular end-diastolic diameter(LVEDd) was larger in hyperuricemia patients than in non-hyperuricemia patients(53.52±6.19 vs.52.18±4.89,P=0.041).The higher rate of left systolic dysfunction and diastolic dysfunction was discovered in hyperuricemia patients(36.4%vs.15.1%,P<0.001;68.2%vs.55.8%,P=0.023).Also,hyperuricemia patients were more likely to have in-hospital MACE(P<0.05).CONCLUSIONS:Serum uric acid level is positively correlated with serum triglyceride level,but not with the severity of coronary artery disease.Hyperuricemia patients with STEMI tend to have a higher rate of left systolic dysfunction and diastolic dysfunction and more likely to have more in-hospital MACE.

Correlation of serum Hcy and UA contents with coronary plaque property changes in diabetic patients with coronary heart disease

Objective: To study the correlation of serum Hcy and UA contents with coronary plaque property changes in diabetic patients with coronary heart disease. Methods: Patients who were diagnosed with type 2 diabetes mellitus in Dongguan Branch of Yan'an University Affiliated Hospital between May 2013 and June 2017 were selected and divided into the CHD+DM group who were complicated by coronary heart disease and the DM group who were not complicated by coronary heart disease according to the results of coronary CTA, and the healthy subjects who received physical examination in Dongguan Branch of Yan'an University Affiliated Hospital during the same period were selected as control group. The contents of homocysteine (Hcy), uric acid (UA), platelet activation indexes and protease indexes in serum were measured. Results: Serum Hcy, UA, sSema4D, sP-selectin, sE-selectin, MMP1, MMP3, CatK and ADAMTS4 contents of DM group and CHD+DM group were greatly higher than those of control group whereas Klotho and TIMP2 contents were greatly lower than those of control group;serum Hcy, UA, sSema4D, sP-selectin, sE-selectin, MMP1, MMP3, CatK and ADAMTS4 contents of CHD+DM group were greatly higher than those of DM group whereas Klotho and TIMP2 contents were greatly lower than those of DM group;serum sSema4D, sP-selectin, sE-selectin, MMP1, MMP3, CatK and ADAMTS4 contents of CHD+DM group were positively correlated with Hcy and UA contents while Klotho and TIMP2 contents were negatively correlated with Hcy and UA contents. Conclusion: The abnormal increase of serum Hcy and UA contents in diabetic patients with coronary heart disease can promote the activation and aggregation of platelet, the degradation of plaque fibrous cap and the decrease of plaque stability.

Lipid profile in children with coronary artery disease in Sindh,Pakistan

AIM:To evaluate lipid profile in children with coronary artery disease(CAD)in Hyderabad,Sindh,Pakistan.METHODS:The study included 100 children(6-15years),of which 43 were children of young parents(one or both)with recognized CAD,while the other 57 were children with no evidence of CAD(controls).All were evaluated for fasting blood lipid profile.Blood samples were collected from patients with CAD and healthy controls and analysis of the levels of lipid profile were carried out using a kit method on Microlab 300.RESULTS:Children with CAD had significantly higher levels of total serum cholesterol and triglycerides and decreased levels of high density lipoprotein and low density lipoprotein compared to children in the control group.Systolic and diastolic blood pressures were significantly higher,without any significant difference.CONCLUSION:CAD risk factors are significant regarding abnormal lipid levels.Genetic tendency seems to be important in the development of CAD in children.

Association between serum uric acid level and the severity of coronaryartery disease in patients with obstructive coronary artery disease

Background Many studies have shown that the serum uric acid(SUA) level is one of the cardiovascular risk factors. The aim of the study is to evaluate the relationship between SUA levels and the severity of coronary artery disease(CAD) assessed by angiography and the Syntax score in patients with obstructive CAD.Methods Participants who visited our hospital for a coronary angiography, from December 2007 to September 2012, were eligible for this analysis. SUA and other blood parameters after at least 12-hour fast were determined. First, the patients were divided into tertiles according to their Syntax scores(low Syntax score group: Syntax score ≤10.0; moderate Syntax score group: 10.0 <Syntax score ≤18.0; high Syntax score group: Syntax score >18.0). Second, to clarify the association between SUA levels and major adverse cardiovascular events(MACEs), all patients were divided into two subgroups on the basis of SUA levels. The cutoff value of SUA was defined by diagnostic criteria of hyperuricemia. Patients were separated into normal SUA group(n=251, with SUA <416 μmol/L for men and SUA <357 μmol/L for women) and high SUA group(n=96, with SUA ≥416 μmol/L for men and SUA ≥357 μmol/L for women). All participants were followed for a mean of 22.0 months(1–75 months, interquartile range: 28 months) for major adverse cardiovascular events(MACEs), including all-cause death, recurrent nonfatal myocardial infarction(re-MI) and recurrent percutaneous coronary intervention(re-PCI). Results A total of 347 patients were registered for the study. The SUA levels in the high Syntax score group were significantly higher than that of the moderate Syntax score group and the low Syntax score group((392.3±81.6) μmol/L vs.(329.9±71.0) μmol/L, P <0.001;(392.3±81.6) μmol/L vs.(311.4±64.7) μmol/L, P <0.001). The SUA level was positively correlated not only with the Syntax score(r=0.421, P <0.001; 95% CI: 0.333–0.512), but also with the number of diseased vessels(r=0.298, P <0.001; 95% CI: 0.194–0.396). After multiple linear regression analysis, SUA levels were identified to be independently correlated with a high Syntax score(B=0.033, 95% CI 0.023–0.042, P <0.001). Compared with the normal SUA subgroup, the high SUA subgroup tended to have a higher Syntax score(19.9±8.7 vs. 13.6±7.5, P <0.001) and more multi-vessel disease(70.8% vs. 46.6%, P <0.001). Follow-up data showed a higher incidence of MACE in the high SUA subgroup(20.8% vs. 6.0%, P <0.001). Binary Logistic regression analysis indicated that the elevated SUA can predict the long-term prognosis of patients with obstructive CAD(OR=2.968, 95% CI 1.256–7.011, P=0.013). KaplanMeier analysis showed a significantly lower event-free survival rate in patients with high SUA levels than in the normal SUA subgroup(79.2% vs. 94.0%, Log rank=17.645, P <0.001). Conclusions SUA levels were independently associated with the severity of CAD in patients with obstructive CAD. An elevated SUA is associated with cardiovascular events and may be useful as a biomarker of the severity of CAD.

Risk Analysis on Uric Acid Resulting in Carotid Atherosclerosis

Objectives To explore therisk of uric acid (UA) resulting in carotid atheroscle-rosis. Methods With a cross sectional study, 643subjects (aged 41-83 yrs, male 552 and female 91)were surveyed in 1999 in Guangdong Province, China.The main research variables were uric acid (UA), oc-currence and the size of carotid artery plaque. Re-sults There was no statistical significance betweenthe UA means of plaque occurrence and no - occur-rence groups (t=0.60, df=242, P=0.5495). It seemedUA was not a possible risk factor of carotid atheroscle-rosis (OR=1.060, P=0.8448>0.05, n=244) based on thelogistic regression analysis. Conclusions Our resultsare not consistent with serum UA being an indepen-dent risk factor for atherosclerosis and coronary heartdisease (CHD). It is necessary to do more research toleam the risk degree of UA during the progress ofatherosclerosis/CHD.

A prospective comparison cohort study between baseline serum uric acid level and coronary artery disease in first-degree relatives and non-first-degree relatives of type 2 diabetes males

Objective To investigate the relationship between baseline serum uric acid and the severity of coronary artery disease(CAD)in the first-degree relatives or nonfirst-degree relatives of men with type 2 diabetes.Methods Three hundred and eighty-one men with negative coronary angiography for the first time were divided into diabetes and non-diabetes groups and followed-up for

Correlation between blood lipids and serum uric acid in the elderly patients with coronary heart disease

Objective:To explore the relationship between blood lipids and serum uric acid(UA)in the elderly patients with coronary heart disease(CHD).Method:Quartered patients according to their uric acid level.Systematic review and compare lipid level among this four groups.Polynary logistic stepwise regression analysis were employed to analyze independent risk factor of coronary heart disease.Results:Serum level of triglycerides(TAG)and very low density lipoprotein cholesterol(VLDL-C)increase significantly(F=7.42,p<0.01;F=5.42,p<0.01 respectively)while high density lipoprotein cholesterol(HDL-C)and Apolipoprotein A1(Apo A1)decrease(F=5.03,p<0.01;F=7.03,p<0.01)upon elevated serum uric acid level among coronary heart disease patients.Gender(OR=0.16,95%CI 0.078~0.315,p=0.001),Ccr(OR=0.95,CI=0.935~0.969,p=0.001),associated hypertension(OR=2.23,CI=1.156~4.285,p=0.017)or DM(OR=2.44,CI=1.154~5.168,p=0.02),TC(OR=1.56,CI=1.119~2.186,p=0.009),HDL-C(OR=0.02,CI=0.004~0.076,p=0.001),UA(OR=1.09,1.086~1.094,p=0.001)are all independent risk factors for coronary heart disease.Conclusion:TAG,VLDL-C were positively related to UA while HDL-C and Apo A1were negatively linked to UA among CHD patients.Gender,Ccr,Hypertension,DM,TC,HDL-C and UA are independent risk factors for CHD while BMI,TAG,LDL-C were not.

Predictive value of serum uric acid on cardiovascular disease and all-cause mortality in urban Chinese patients

Background The association between increased serum uric acid （SUA） levels and cardiovascular risk has been debated for decades. Several large studies have provided conflicting results regarding the clinical significance of elevated SUA levels in cardiovascular disease （CVD） or cerebrovascular disease. The aim of this study was to investigate the relationship between SUA and CVD and all-cause mortality and their potential diagnostic value. Methods A total of 3570 in-patients ranging in age from 56 to 95 years （mean （67.36_＋11.36） years） were selected from 20 hospitals in Beijing and Shanghai. A carefully designed questionnaire was used to gather baseline data of each patient All patients were divided into two main groups according to their SUA levels： high SUA and normal SUA groups. Serum indices and other important parameters were measured. Results Compared with normal SUA group, high SUA group had significant difference in systolic blood pressure （SBP）, total cholesterol （TC）, triglyceride （TG）, high density lipoprotein cholesterol （HDL-C）, body mass index （BMI）, and age （P 〈0.05 or P 〈0.01）. High SUA prevailed in female and patients with history of essential hypertension, while history of smoking and diabetes showed no significant difference between two groups. All-cause and CVD mortality occurred more frequently in high SUA group than in normal SUA group. In the accumulative survival analysis, high SUA group had lower survival rate than normal SUA group both in CVD and all-cause mortality. COX regression analysis indicated that the history of smoking, age and high SUA were independent risk factors for the development of CVD. Conclusions These preliminary observations suggest that patients with high SUA levels would face higher risk of mortality. SUA measurement may be applied as a routine predictor for clinical assessment.

Impact of gout on in-hospital outcomes of acute coronary syndrome-related hospitalizations and revascularizations: Insights from the national inpatient sample

BACKGROUND Previous studies have established a role of gout in predicting risk and prognosis of cardiovascular diseases. However, large-scale data on the impact of gout on inpatient outcomes of acute coronary syndrome (ACS)-related hospitalizations and post-revascularization is inadequate. AIM To evaluate the impact of gout on in-hospital outcomes of ACS hospitalizations, subsequent healthcare burden and predictors of post-revascularization inpatient mortality. METHODS We used the national inpatient sample (2010-2014) to identify the ACS and goutrelated hospitalizations, relevant comorbidities, revascularization and postrevascularization outcomes using the ICD-9 CM codes. A multivariable analysis was performed to evaluate the predictors of post-revascularization in-hospital mortality. RESULTS We identified 3144744 ACS-related hospitalizations, of which 105198 (3.35%) also had gout. The ACS-gout cohort were more often older white males with a higher prevalence of comorbidities. Coronary artery bypass grafting was required more often in the ACS-gout cohort. Post-revascularization complications including cardiac (3.2% vs 2.9%), respiratory (3.5% vs 2.9%), and hemorrhage (3.1% vs 2.7%) were higher whereas all-cause mortality was lower (2.2% vs 3.0%) in the ACSgout cohort (P < 0.001). An older age (OR 15.63, CI: 5.51-44.39), non-elective admissions (OR 2.00, CI: 1.44-2.79), lower household income (OR 1.44, CI: 1.17- 1.78), and comorbid conditions predicted higher mortality in ACS-gout cohort undergoing revascularization (P < 0.001). Odds of post-revascularization inhospital mortality were lower in Hispanics (OR 0.45, CI: 0.31-0.67) and Asians (OR 0.65, CI: 0.45-0.94) as compared to white (P < 0.001). However, postoperative complications significantly raised mortality odds. Mean length of stay, transfer to other facilities, and hospital charges were higher in the ACS-gout cohort. CONCLUSION Although gout was not independently associated with an increased risk of postrevascularization in-hospital mortality in ACS, it did increase postrevascularization complications.

Any link of gout disease control among hypertensive patients and onset of end-stage renal disease?Results from a population-based study

AIM To determine the impact of allopurinol non-adherence as a proxy for uncontrolled disease on primary prevention of end-stage renal disease(ESRD).METHODS A cohort of 2752 patients with gout diagnosis was reconstructed using the Québec Régie de l'assurance maladie du Québec and MedE cho administrative databases.Eligible patients were new users of allopurinol,aged 45-85,with a diagnosis of hypertension,and treated with an antihypertensive drug between 1997 and 2007.RESULTS Major risk factor for ESRD onset was chronic kidney disease at stages 1 to 3 [rate ratio(RR) = 8.00;95% confidence interval(CI):3.16-22.3 and the severity of hypertension(≥ 3 vs < 3 antihypertensives)] was a trending risk factor as a crude estimate(RR = 1.94;95%CI:0.68-5.51).Of 341 patients,cases(n = 22) and controls(n = 319),high adherence level(≥ 80%) to allopurinol therapy,compared with lower adherence level(< 80%),was associated with a lower rate of ESRD onset(RR = 0.35;95%CI:0.13-0.91).CONCLUSION Gout control seem to be associated with a significantdecreased risk of ESRD onset in hypertensive populations,further research should be conducted confirming this potential associated risk.

Hyperuricemia and severity of coronary artery disease in patients undergoing selective percutaneous coronary intervention

Background Hyperuricemia as an independent predictor for presence of coronary artery disease（CAD）has been studied insufficiently. In this study, we evaluated the predictive value of hyperuricemia for the severity of coronary artery disease. Methods A total of 683 patients undergoing elective percutaneous coronary intervention （PCI） were prospectively observed and were divided into two groups （hyperuricemic group, n = 216, and normouricemic group, n = 467）. Hyperuricemia （HUA） was defined as an serum uric acid level 7 mg/dL in males and 6 mg/dL in females. Severe CAD was defined as triple-vessel disease or left main disease. Results One hundred and eighteen （55%） severe CAD occurred in the hyperuricemic group and 211（45%） in the normouricemic group （P = 0.02）. The median uric acid levels of the severe CAD patients were significantly higher than secondary CAD （single vessel disease or two-vessel disease） patients （379 ± 111 vs 360 ± 105, P = 0.02）. Multivariate logistic regression analysis, after adjusting for potential confounding factors, showed that HUA was an independent risk factor of coronary artery disease （odds radio = 1.63, 95% confidence interval, 1.02-2.61, P = 0.040）. Moiety of in-hospital complications such as acute heart failure （17.6% vs. 6.2%, P 0.001）, hypotension （3.8%, vs. 1.3%, P = 0.04）, contrast induced nephropathy （CIN） （7.4% vs. 1.3%, P 0.001） after PCI, were significantly higher in hyperuricemic groups. Conclusions Hyperuricemia was an independent predictor for severe coronary artery disease （triple-vessel disease or left main disease）.

2型糖尿病合并冠心病患者血清Hcy、HbAlc和血尿酸水平变化的临床意义

目的探讨2型糖尿病合并冠心病患者血清同型半胱氨酸(Hcy)、糖化血红蛋白(HbAlc)和血尿酸水平变化的临床意义。方法选取2型糖尿病合并冠心病患者60例为合并冠心病组,单纯2型糖尿病患者45例为单纯糖尿病组,健康志愿者30名为健康对照组。采集空腹外周静脉血,检测血清Hcy、HbAlc及血尿酸水平;行冠状动脉造影检查,记录冠脉狭窄程度50%及以上的病变累及左前降支、回旋支或右冠脉的支数(单支病变、双支病变、多支病变)。收集2型糖尿病合并冠心病患者的年龄、性别、身高、体质量、吸烟情况及低密度脂蛋白、总胆固醇、甘油三酯、空腹血糖、维生素B12、叶酸水平。进行3 a随访,记录患者病情加重再入院、死亡情况。结果合并冠心病组血清Hcy、HbAlc及血尿酸水平明显高于单纯糖尿病组和健康对照组(P<0.05);多支病变患者血清Hcy、HbAlc及血尿酸水平明显高于双支病变和单支病变患者(P<0.05);预后不良组患者血清Hcy、HbAlc及血尿酸水平明显高于预后良好组患者(P<0.05);预后不良组患者中吸烟比例、空腹血糖水平明显高于预后良好组(P<0.05)。Hcy、HbAlc、血尿酸是2型糖尿病合并冠心病患者预后的独立影响因素。ROC曲线分析显示,血清Hcy、HbAlc及血尿酸水平对2型糖尿病合并冠心病患者预后具有较高的预测价值(P<0.05),联合检测的预测价值最高(AUC=0.947)。结论2型糖尿病合并冠心病患者血清Hcy、HbAlc及血尿酸水平升高,且与冠脉病变程度密切相关,联合检测可用于患者预后评估。

Usefulness of uric acid for predicting rapid coronay artery lesion progression after percutaneous coronary intervention

Background Rapid progression of non-culprit coronary artery lesion happens in some patients after percuta- neous coronary intervention （PCI）. However, the incidence and prognostic factors for progression of coronary le- sion are not clarified. Methods The patients who underwent two coronary angiography （CAG） from January 2015 to January 2017 in our hospital were selected as objects of this retrospective study. According to the results of the second CAG, they were divided into control group （No restenosis in the stent, no change or improvement of out-stent lesions, n=42） and lesion progression group（Aggravation of out-stent lesions, n = 29）. The clinical data of patients between the two groups were analyzed by statistics. Results The change of Lipopro- tein （a） （ Lp （a））and uric acid （UA） in lesion progression group were significantly different from control group （P=0.004 and P=0.037）. Regression analysis showed that, the change of UA was an independent predictive factor of coronary artery lesion progression in a short time（6 - 12 months）after PCI（odds ratio [OR]： 1.007; 95% confidence interval [CI] ： （1.000, 1.013） ; P=0.042）. Conclusion UA is an independent predictive factor of non-culprit coronary artery lesion after stent implanting.