Biomedical Science Letters (대한의생명과학회지)

The Korean Society for Biomedical Laboratory Sciences (대한의생명과학회)
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Preoperative Levels of Uric Acid and Its Association to Some Perioperative Parameters in the Patients with Unstable Angina or Myocardial Infarction

  • Kang, Chan-Sik (Department of Clinical Laboratory Science, College of Health Sciences, Catholic University of Pusan) ;
  • Seok, Seong-Ja (Department of Clinical Pathology, Sorabol College) ;
  • Choi, Hwa-Sik (Deptment of Clinical Laboratory Science, Shinheung College) ;
  • Kim, Dae-Sik (Department of Clinical Laboratory Science, Dongnam Health College) ;
  • Choi, Seok-Cheol (Department of Clinical Laboratory Science, College of Health Sciences, Catholic University of Pusan) ;
  • Moon, Seong-Min (Department of Clinical Laboratory Science, College of Health Sciences, Catholic University of Pusan)
  • Received : 2011.05.31
  • Accepted : 2011.06.18
  • Published : 2011.06.30
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Abstract

Several studies have reported a relation between serum levels of uric acid and a wide variety of cardiovascular conditions. But, the relationship between serum levels of uric acid and coronary artery disease (CAD) is still controversial. The present study was retrospectively designed to investigate whether CAD can be stratified by the level of uric acid and there are the relationships between preoperative levels of uric acid and perioperative biochemical markers in fifty-adult patients that underwent coronary artery bypass grafting surgery (CABG) and twenty-normal subjects. They were divided into the control, the unstable angina (UA-group) and the myocardial infarction group (MI-group). In preoperative levels of uric acid, the MI-group was higher than control and the UA-group. The MI-group had significantly higher correlations than the UA-group between preoperative levels of uric acid and left ventricular ejection fraction, cardiac markers (creatine kinase, lactate dehydrogenase and brain natriuretic peptide), renal markers (blood urea nitrogen and creatinine) or total leukocyte levels. At postoperative periods, the MI-group had higher relationships of uric acid with aspartate aminotransferase, blood urea nitrogen or creatinine levels. Although there was not statistically significant, the UA-group tended to have higher correlation coefficients than the MI-group between preoperative levels of uric acid and intensive care unit-stay (ICU), or postoperative mechanical ventilation time. These results reflect that increased levels of serum uric acid may be a tool for the diagnosis of coronary heart disease and may be considered as a good predictor in assessing the cardiac and renal functions in patients with myocardial infarction or unstable angina at the preoperative period. However, further studies should be performed in a large patient population.

Keywords

References

  1. Achar SA, Kundu S, Norcross WA. Diagnosis of acute coronary syndrome. Am Fam Physician 2005. 72: 119-126.
  2. Alberto P, Francesca I, Chiara S, Ranuccio N. Acute coronary syndromes: From the laboratory markers to the coronary vessels. Biomarker Insights 2006. 1: 123-130.
  3. Anderson RJ, O'Brien M, MaWhinney S, VillaNueva CB, Moritz TE, Sethi GK, Henderson WG, Hanmermeister KE, Grover FL, Shroyer AL. Renal failure predisposes patients to adverse outcome after coronary artery bypass surgery. Kidney Int. 1999. 55: 1057-1062. https://doi.org/10.1046/j.1523-1755.1999.0550031057.x
  4. Anker SD, Doehner W, Rauchhaus M, Sharma R, Francis D, Knosalla C, Davos CH, Cicoira M, Hetzer R, Ponikowski P, Coats AJS. Uric acid and survival in chronic heart failure: Validation and application in metabolic, functional, and hemodynamic staging. Circulation 2003. 107: 1991-1997. https://doi.org/10.1161/01.CIR.0000065637.10517.A0
  5. Baker JF, Krishnan E, Chen L, Schumacher HR. Serum uric acid and cardiovascular disease: Recent developments, and where do they leave us? Am J Med. 2005. 118: 86-826.
  6. Baillie K, Bates M, Thompson R, Waring S, Partridge R, Simpson A, Maxwell S. Endogenous urate production augments plasma antioxidants capacity in healthy lowland subjects exposed to high altitude. Chest 2007. 131: 1473-1478. https://doi.org/10.1378/chest.06-2235
  7. Bos MJ, Koudstaal PJ, Hofman A, Witteman JCM, Breteler MMB. Uric acid is a risk factor for myocardial infarction and stroke: The Rotterdam study. Stroke 2006. 37: 1503-1507. https://doi.org/10.1161/01.STR.0000221716.55088.d4
  8. Braunwald E. ACC/AHA guidelines for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction. J Am Coll Cardiol. 2000. 36: 970-1062. https://doi.org/10.1016/S0735-1097(00)00889-5
  9. Brown TM, Bittner V. Biomarkers of atherosclerosis: Clinical applications. Curr Cardiol Rep. 2008. 10: 497-504. https://doi.org/10.1007/s11886-008-0078-1
  10. Butler R, Morris AD, Belch JJF, Hill A, Struthers AD. Allopurinol normalizes endothelial dysfunction in type 2 diabetes with mild hypertension. Hypertension 2000. 35: 746-751. https://doi.org/10.1161/01.HYP.35.3.746
  11. Cannon PJ, Stason WB, Demartini FE, Sommers SC, Laragh JH. Hyperuricemia in primary and renal hypertension. N Engl J Med. 1966. 275: 457-464. https://doi.org/10.1056/NEJM196609012750902
  12. Dawson J, Walters M. Uric acid and xanthine oxidase: Future therapeutic targets in the prevention of cardiovascular disease? Br J Clin Pharmacol. 2006. 62: 633-644. https://doi.org/10.1111/j.1365-2125.2006.02785.x
  13. de Lemos JA, Morrow DA. Brain natriuretic peptide measurement in acute coronary syndromes: Ready for clinical application? Circulation 2002. 106: 2868-2870. https://doi.org/10.1161/01.CIR.0000042763.07757.C0
  14. de Lemos JA, McGuire DK, Drazner MH. B-type natriuretic peptide in cardiovascular disease. Lancet 2003. 362: 316-322. https://doi.org/10.1016/S0140-6736(03)13976-1
  15. Doehner W, Schoene N, Leyva-Leon F, Pavit DV, Reaveley DA, Schuler G, Coats AJS, Anker SD, Hambrecht R. Effects of xanthine oxidase inhibition with alloputinol on endothelial function and peripheral blood flow in hyperuricemic patients with chronic heart failure. Circulation 2002. 105: 2619-2624. https://doi.org/10.1161/01.CIR.0000017502.58595.ED
  16. Fang J, Alderman MH. Serum uric acid and cardiovascular mortality. JAMA. 2000. 283: 2404-2410. https://doi.org/10.1001/jama.283.18.2404
  17. Farquharson CA, Butler RH, Belch JJ, Struthers AD. Allopurinol improves endothelial dysfunction in chronic heart failure. Circulation 2002. 106: 221-226. https://doi.org/10.1161/01.CIR.0000022140.61460.1D
  18. Feig DI, Kang DH, Johnson RJ. Uric acid and cardiovascular risk. N Engl J Med. 2008. 359: 1811-1821. https://doi.org/10.1056/NEJMra0800885
  19. Ford ES, Cook CLIS, Choi HK. Serum concentrations of uric acid and the metabolic syndrome among US children and adolescents. Circulation 2007. 115: 2526-2532. https://doi.org/10.1161/CIRCULATIONAHA.106.657627
  20. Galvan AQ, A Natali, Baldi S, Frascerra S, Sanna G, Ciociaro D, Ferrannini E. Effect of insulin on uric acid excretion in humans. Am J Physiol. 1995. 268: E1-E5.
  21. Hare JM, Johnson RJ. Uric acid predicts clinical outcomes in heart failure: Insights regarding the role of xanthine oxidase and uric acid in disease pathophysiology. Circulation 2003. 107: 1951-1953. https://doi.org/10.1161/01.CIR.0000066420.36123.35
  22. Haverkate F, Thompson FG, Pyke SDM. Production of C-reactive protein and risk of coronary events in stable and unstable angina. Lancet 1997. 349: 462-466. https://doi.org/10.1016/S0140-6736(96)07591-5
  23. Heinig M, Johnson RJ. Role of uric acid in hypertension, renal disease, and metabolic syndrome. Cleve Clin J Med. 2006. 73: 1059-1064. https://doi.org/10.3949/ccjm.73.12.1059
  24. Johnson RJ, Kang DH, Feig D, Kivlighn S, Kanellis J, Watanabe S, Tuttle KR, Rodriguez-Iturbe B, Herrera-Acosta J, Mazzali M. Is there a pathogenetic role for uric acid in hypertension and cardiovascular and renal disease? Hypertension 2003. 41: 1183-1190. https://doi.org/10.1161/01.HYP.0000069700.62727.C5
  25. Lee TH, Goldman L. Serum enzyme assays in the diagnosis of acute myocardial infarction. Ann Intern Med. 1986. 105: 221-233. https://doi.org/10.7326/0003-4819-105-2-221
  26. Lehto S, Niskanen L, Ronnemaa T, Laakso M. Serum uric acid is a strong predictor of stroke in patients with non-insulindependent diabetes mellitus. Stroke 1998. 29: 635-639. https://doi.org/10.1161/01.STR.29.3.635
  27. Leyva F, Anker S, Godsland JW, Wingrove CS, Chua TP, Stevenson JC, Coats AJ. Serum uric acid as an index of impaired oxidative metabolism in chronic heart failure. Eur Heart J. 1997. 8: 858-865.
  28. Many A, Hubel CQA, Roberts JM. Hyperuricemia and xanthine oxidase in preeclampsia, revited. Am J Obstet Gynecol. 1996. 174: 288-291. https://doi.org/10.1016/S0002-9378(96)70410-6
  29. Messerli FH, Frohlich ED, Dreslinski GR, Suarez DH, Aristimuno GG. Serum uric acid in essential hypertension: an indicator of renal vascular involvement. Arch Intern Med. 1980. 93: 817-821. https://doi.org/10.7326/0003-4819-93-6-817
  30. Morrow DA, Cannon CP, Jesse RL, Newby K, Ravkilde J, Storrow AB, Wu AHB, Christension RH. National academy of clinical biochemistry laboratory medicine practice guidelines: Clinical characteristics and utilization of biochemical markers in acute coronary syndromes. Circulation 2007. 115: e356-e375. https://doi.org/10.1161/CIRCULATIONAHA.107.182882
  31. Niskanen LK, Laaksonen DE, Nyyssonen K, Alfthan G, Lakka H, Lakka TA, Salonen JT. Uric acid level as a risk factor for cardiovascular and all-cause mortality in middle-aged men. Arch Intern Med. 2004. 164: 1546-1551. https://doi.org/10.1001/archinte.164.14.1546
  32. Ridker PM. C-reactive protein and the prediction of cardiovascular events among those at intermediate risk. J Am Coll Cardiol. 2007. 49: 2129-2138. https://doi.org/10.1016/j.jacc.2007.02.052
  33. Rock-Ramel F, Guisan B, Diezi J. Effects of uricosuric and antiuricosuric agents on urate transport in human brushborder membrane vesicles. J Pharmacol Exp Ther. 1997. 280: 839-845.
  34. Ryckwaert F, Boccara G, Frappier J, Colson PH. Incidence, risk factors, and prognosis of a moderate increase in plasma creatinine early after cardiac surgery. Crit Care Med. 2002. 30: 1495-1498. https://doi.org/10.1097/00003246-200207000-00016
  35. Schrier RW. Role of diminished renal function in cardiovascular mortality: Marker or pathogenic factor? J Am Coll Cardiol. 2006. 47: 1-8. https://doi.org/10.1016/j.jacc.2005.07.067
  36. Sim DS, Liew H, Andre P. Biomarkers and bioassays for cardiovascular diseases: Present and future. Biomarker Insights 2008. 3: 293-302.
  37. Siu YP, Leung KT, Tong MK, Kwan TH. Use of allopurinol in slowing the progression of renal disease through its ability to lower serum uric acid level. Am J Kidney Dis. 2006. 47: 51-59. https://doi.org/10.1053/j.ajkd.2005.10.006
  38. Storrow AB, Gibler WB. Chest pain centers: Diagnosis of acute coronary syndromes. Ann Emerg Med. 2000. 35: 449-461. https://doi.org/10.1016/S0196-0644(00)70006-0
  39. Talaat KM, el-Sheikh AR. The effect of mild hyperuricemia on urinary transforming growth factor beta and the progression of chronic kidney disease. Am J Nephrol. 2007. 27: 435-440. https://doi.org/10.1159/000105142
  40. Tuttle KR, Short RA, Johnson RJ. Sex differences in uric acid and risk factors for coronary artery disease. Am J Cardiol. 2001. 87: 1411-1414. https://doi.org/10.1016/S0002-9149(01)01566-1