Analysis Of The Relationship Between Serum Uric Acid And Carotid Atherosclerosis

Objective(s):More and more epidemiological and genetic studies have shown that elevated serum uric acid(SUA)plays an important role in the occurrence and progression of CVDs.As an alternative marker for cardiovascular risk prediction and an early indicator of atherosclerosis in subclinical context,the relationship between SUA and CAS is still unclear.To determine whether uric acid is an independent risk factor for carotid atherosclerosis,and to provide clinical evidence for whether to use uric acid-lowering therapy in patients with clinical atherosclerosis.Then try to find the best cut-off value of UA for predicting carotid atherosclerosis,so as to provide the basis for the best treatment goal of clinical uric acid control.Methods:A total of 356 patients with multiple major risk factors for atherosclerosis who met the inclusion and exclusion criteria were collected from the second affiliated Hospital of Kunming Medical University from June 2021 to August 2022.retrieve the patient’s basic demographic characteristics such as height,weight,systolic blood pressure,diastolic blood pressure,associated diseases(hypertension,diabetes,coronary heart disease,stroke and chronic nephropathy)and drug use from the hospital electronic medical record system.The laboratory results included TG,TC,LDL-C,HDL-C,non HDL-C,Lp(a),APOA1,APOB,serum uric acid data at least twice in the past half a year to calculate the mean value of UA(SUA),and the larger value of Maxc IMT between the left and right carotid arteries.The total plaque area was the sum of the thickest plaques on the left and right.The data were analyzed by SPSS 23 statistical software.According to the presence or absence of carotid atherosclerosis,the subjects were divided into two groups for preliminary analysis.After grouping according to sex,the variables that may affect carotid atherosclerosis were included in the binary Logistic regression equation to analyze the risk factors of carotid atherosclerosis.Then the subjects with ideal blood lipid control were divided into groups according to the thickening of c IMT and the presence of carotid atherosclerotic plaque,and analyzed whether uric acid was an independent influencing factor of c IMT thickening and plaque.Taking CAS as the state variable and SUA as the test variable,the ROC curve was made,and the SUA corresponding to the maximum Jordan index was taken as the best truncation value.Through the specificity and sensitivity as the evaluation index,the best truncation value of SUA was compared with the upper limit of the reference interval of SUA used in clinic to evaluate whether the ability of the best truncation value to predict CAS was higher than the upper limit of the reference interval of SUA.The difference was statistically significant(P < 0.05).Results:1.after grouping according to sex,the possible risk factors of carotid atherosclerosis were analyzed by difference analysis and multivariate Logistic regression analysis.The results showed that only hypertension was an independent risk factor for carotid atherosclerosis.2.The patients with ideal blood lipid control(LDL-C < 2.6mmol/L)were analyzed in the subgroup.The age,history of hypertension,SUA,LP(a)and the use of statins in the c IMT thickening group were significantly higher than those in the control group.The age,history of hypertension,SUA and statins in the plaque group were significantly higher than those in the non-plaque group,and the difference was statistically significant.3.After univariate and multivariate Logistic regression,after adjusting for age,sex,history of hypertension,diabetes,smoking,drinking and LP(a),the increase of SUA was an independent factor affecting the thickening of c IMT and the formation of carotid atherosclerotic plaque(OR > 1,P<0.05).4.Taking CAS as the state variable and SUA as the test variable,the ROC curve is made.The results show that the area under the curve corresponding to the most approximate index in women is 0.684(95%CI 0.572-0.797),and the best truncation value is 330.83μmol/L.In men,the area under the curve corresponding to the index is0.617(95%CI 0.503-0.73),and the best truncation value is 376.58 μmol/L.5.In clinical application,we use female 357μmol/L and male 428μmol/L as the upper limit of the reference interval of SUA.Using carotid ultrasound as the gold standard for the diagnosis of carotid atherosclerosis,the sensitivity of the upper limit of the reference interval of SUA to predict carotid atherosclerosis is 36.96%,the specificity is 77.8%,and the correct rate is 49.75%.The sensitivity,specificity and correct rate of SUA in predicting carotid atherosclerosis were 63.77%,66.67% and 64.68%,respectively.The predictive ability of the best truncation value to CAS was significantly higher than the upper limit of the reference interval of SUA(P < 0.05 by Kappa test).Conclusion(s):1.In this study,Age,history of hypertension and elevated SUA level are the risk factors of c IMT thickening and carotid atherosclerotic plaque.LP(a)increased only in c IMT thickening group,indicating that LP(a)was only related to c IMT thickening.2.In the population with better control of blood lipids,the increase of serum uric acid level is not only an independent factor affecting the thickening of c IMT,but also an independent risk factor for the formation of carotid atherosclerotic plaque.3.The best cut-off value of uric acid for predicting carotid atherosclerosis is330.83μmol/L in women and 376.58μmol/L in men,which is lower than the upper limit of the current reference interval of SUA,and has a higher ability to predict carotid atherosclerosis than the upper limit of the reference interval of SUA.