Lin Yajuan, Hidru Tesfaldet Habtemariam, Fan Rui, Gao Jinghan, Li Han, Yang Xiaolei, Xia Yunlong
Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China.
Front Cardiovasc Med. 2021 Aug 23;8:732715. doi: 10.3389/fcvm.2021.732715. eCollection 2021.
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. 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. 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 ( < 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]. 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.
血清尿酸（SUA）水平和脂质成分，如低密度脂蛋白（LDL）、高密度脂蛋白（HDL）和脂蛋白（a）[Lp(a)]，均已被报道与冠心病（CAD）相关。然而，目前尚不清楚在急性冠状动脉综合征（ACS）患者中，不同脂质指标浓度下SUA状态对心肌血运重建（MRT）风险的影响。我们回顾性分析了14234例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）手术史的ACS患者的医院样本。所有患者均接受了冠状动脉造影。采用二元逻辑回归模型，并使用95%置信区间（CIs）的比值比（OR）来近似UA和脂质谱与心肌血运重建的相关风险，以最低四分位数/三分位数作为参考类别。总体而言，14234例患者中有8818例（61.9%）接受了MRT。SUA升高和HDL升高与住院期间MRT可能性增加呈负相关（<0.001）。然而，LDL和Lp(a)水平与ACS患者的MRT呈正相关。此外，SUA与脂质谱之间的相互作用分析，特别是与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，结果显示按脂质成分分组的SUA四分位数较高的患者接受MRT的机会显著降低，LDL三分位数中受试者的最低OR（95%CI）为0.222（0.170 - 0.290）、0.478（0.374 - 0.612）和0.604（0.468 - 0.780），Lp(a)三分位数中分别为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，随着SUA水平升高，MRT的发生率稳步下降。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]三分位数的患者MRT风险显著更低。SUA水平升高可能会降低ACS患者接受MRT的机会，即使是那些Lp(a)和低密度脂蛋白胆固醇（LDL-c）升高的患者。血清尿酸升高可能在ACS急性期起到保护作用。
