The Relationship Between Serum Uric Acid at Different Concentrations of Lipid Indices and the Risk of Myocardial Revascularization in Patients With Acute Coronary Syndrome: A Retrospective Analysis.
The Relationship Between Serum Uric Acid at Different Concentrations of Lipid Indices and the Risk of Myocardial Revascularization in Patients With Acute Coronary Syndrome: A Retrospective Analysis.
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急性冠脉综合征患者不同浓度血脂指数血尿酸与心肌血运重建风险关系的回顾性分析
DOI：
10.3389/fcvm.2021.732715
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发表时间：
2021
影响因子：
3.6
通讯作者：
Xia Y
中科院分区：
文献类型：
--
作者：
Lin Y;Hidru TH;Fan R;Gao J;Li H;Yang X;Xia Y
目的：血尿酸（SUA）水平和脂质成分（如LDL、HDL和Lp（a））已被报道与CAD相关。然而，目前尚不清楚在不同浓度的脂质指数下，SUA状态对ACS患者心肌血运重建（MRT）风险的影响。研究方法：我们回顾性分析了14，234例ACS患者的医院样本，这些患者既往无经皮冠状动脉介入治疗（PCI）或冠状动脉旁路移植术（CABG）手术史。所有患者均行冠状动脉造影。进行二元logistic回归模型，并使用95%置信区间（CI）的比值比（OR）来近似UA和血脂谱与心肌血运重建的相关风险，最低四分位数/三分位数作为参考类别。结果：总体而言，14，234例患者中有8，818例（61.9%）接受了MRT。SUA和HDL升高与入院时MRT的可能性增加呈负相关（P < 0.001）。ACS患者的MRT与LDL、Lp（a）水平呈正相关。此外，SUA与血脂谱，特别是LDL和Lp（a）之间的相互作用分析，与SUA水平最低四分位数的患者相比，显示按血脂组分分组的SUA水平较高四分位数的患者接受MRT的机会显著较低，受试者的最低OR（95%CI）为0.222 LDL三分位数分别为0.671（0.523-0.862）、0.316（0.242-0.413）和0.410（0.310-0.542）。在HDL水平的三个三分位数中，MRT的发生率随着SUA水平的增加而稳步下降。此外，我们进一步分析了无糖尿病的ACS患者。与SUA水平的第一个四分位数相比，不同脂质成分[LDL，Lp（a），HDL]的MRT风险显著降低。结论：SUA水平升高可能降低ACS患者接受MRT的机会，即使在Lp（a）和LDL-c升高的患者中也是如此。血清尿酸升高可能在ACS急性期起保护作用。
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.
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