Panagiota Drivelegka (1), Helena Forsblad-D’Elia (1), Göran Bergström (2,3), Erika Fagman (4,5), Lennart Th Jacobsson (1), Mats Dehlin (1)
Affiliation(s):
1. Department Of Rheumatology And Inflammation Research, Institute Of Medicine, The Sahlgrenska Academy At University Of Gothenburg, Gothenburg, Sweden.
2. Department Of Molecular And Clinical Medicine, The Sahlgrenska Academy, University Of Gothenburg, Gothenburg, Sweden.
3. Department Of Clinical Physiology, Region Västra Götaland, Gothenburg, Sweden.
4. Department Of Radiology, Institute Of Clinical Sciences, The Sahlgenska Academy, University Of Gothenburg, Sweden.
5. Department Of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
Background: There is considerable controversy on whether elevated urate levels are independently associated with the development of cardiovascular disease (CVD). Segment involvement score (SIS), as a marker of subclinical atherosclerosis, represents the total number of coronary segments with atherosclerotic plaque, calcified and/or non-calcified, and thus reflects the overall burden of coronary atherosclerosis. Extent of coronary artery disease as quantified by SIS is a strong, independent predictor of cardiovascular events (1). Whether urate levels are associated with SIS has not been previously studied.
Objectives: To study the association between hyperuricemia and SIS in the participants of the Swedish Cardiopulmonary Bioimage Study (SCAPIS).
Methodology: SCAPIS is a nationwide, population-based study aiming to improve CVD risk prediction. The study included randomly selected individuals aged 50-64 years recruited at six university hospitals in Sweden during the period 2013-2018 (N= 30,000 participants). We used data from SCAPIS Gothenburg (N= 4,949 participants), including urate levels and SIS, measured by computed tomography angiography (CTA). Individuals with known coronary heart disease and/or gout were excluded. Hyperuricemia was defined as urate levels ≥ 405 µmol/L. The association between hyperuricemia and SIS was assessed by multivariate logistic regression analysis. We calculated Odds ratios (OR) and 95% confidence intervals (CI), crude and with adjustments for age, smoking, body mass index (BMI), diabetes, dyslipidemia, and hypertension. A SIS score >0 was considered to indicate the presence of coronary atherosclerosis and was used as the cutoff value. Results In total, 2,438 men (mean age, 57.3 years) and 2,511 women (mean age, 57.4 years) were included. Urate levels were higher in men than in women (mean levels, 348 vs 270 µmol/L respectively). Hyperuricemia was more common in men than in women (18% vs 2%). Age, BMI, and hypertension showed no differences between men and women, while diabetes and dyslipidemia were more common in men than in women (4% vs 2% and 13% vs 9%, respectively). Any CTA-detected atherosclerosis (SIS>0) was found in 1,404 (57.6%) men and 752 (30%) women. Hyperuricemia was significantly associated with SIS>0 in men (OR, 1.3; 95%CI, 1.04-1.6), but not in women (OR, 1.3; 95%CI, 0.7-2.3) in the multivariate logistic regression analysis (Table 1).
Conclusions: Hyperuricemia was independently associated with the presence of coronary artery atherosclerosis, as reflected by SIS, in men but not in women. Findings are compatible with a pathophysiological role of urate in atherosclerosis. Whether the observed difference between sexes reflects biological differences in effect of urate or is explained by other factors, such as later onset of atherosclerosis or less statistical power in women will be examined in follow-up studies.
References: 1. Ayoub C, Erthal F, Abdelsalam MA, Murad MH, Wang Z, Erwin PJ, et al. Prognostic value of segment involvement score compared to other measures of coronary atherosclerosis by computed tomography: A systematic review and meta-analysis. J Cardiovasc Comput Tomogr. 2017;11(4):258-67.