Association Between Serum Uric Acid and Perioperative and Late Cardiovascular Outcome in Patients With Suspected or Definite Coronary Artery Disease Undergoing Elective Vascular Surgery

      The role of uric acid as an independent marker of cardiovascular risk is unclear. Therefore, our aim was to assess the independent contribution of preoperative serum uric acid levels to the risk of 30-day and late mortality and major adverse cardiac event (MACE) in patients scheduled for open vascular surgery. In total, 936 patients (76% male, age 68 ± 11 years) were enrolled. Hyperuricemia was defined as serum uric acid >0.42 mmol/l for men and >0.36 mmol/l for women, as defined by large epidemiological studies. Outcome measures were 30-day and late mortality and MACE (cardiac death or myocardial infarction). Multivariable logistic and Cox regression analysis were used, adjusting for age, gender, and all cardiac risk factors. Data are presented as odds ratios or hazard ratios, with 95% confidence intervals. Hyperuricemia was present in 299 patients (32%). The presence of hyperuricemia was associated with heart failure, chronic kidney disease, and the use of diuretics. Perioperatively, 46 patients (5%) died and 61 patients (7%) experienced a MACE. Mean follow-up was 3.7 years (range: 0 to 17 years). During follow-up, 282 patients (30%) died and 170 patients (18%) experienced a MACE. After adjustment for all clinical risk factors, the presence of hyperuricemia was not significantly associated with an increased risk of 30-day mortality or MACE, odds ratios of 1.5 (0.8 to 2.8) and 1.7 (0.9 to 3.0), respectively. However, the presence of hyperuricemia was associated with an increased risk of late mortality and MACE, with hazard ratios of 1.4 (1.1 to 1.7) and 1.7 (1.3 to 2.3), respectively. In conclusion, the presence of preoperative hyperuricemia in vascular patients is a significant predictor of late mortality and MACE.
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        • Garcia Puig J.
        • Mateos F.A.
        Clinical and biochemical aspects of uric acid overproduction.
        Pharm World Schi. 1994; 16: 40-54
        • Mikkelsen W.M.
        • Dodge H.J.
        • Valkenburg H.
        The distribution of serum uric acid values in a population unselected as to gout of hyperuricemia: Tecumseh, Michigan 1959–1960.
        Am J Med. 1965; : 242-251
        • Levine W.
        • Dyer A.R.
        • Shekelle R.B.
        • Schoenberger J.A.
        • Stamler J.
        Serum uric acid and 11.5-year mortality of middle-aged women: findings of the Chicago Heart Association Detection Project in Industry.
        J Clin Epidemiol. 1989; 42: 257-267
        • Alderman M.H.
        • Cohen H.
        • Madhavan S.
        • Kivlighn S.
        Serum uric acid and cardiovascular events in successfully treated hypertensive patients.
        Hypertension. 1999; 34: 144-150
        • Freedman D.S.
        • Williamson D.F.
        • Gunter E.W.
        • Byers T.
        Relation of serum uric acid to mortality and ischemic heart disease.
        Am J Epidemiol. 1995; 141: 637-644
        • Niskanen L.K.
        • Laaksonen D.E.
        • Nyyssönen K.
        • Alfthan G.
        • Lakka H.M.
        • Lakka T.A.
        • Salonen J.T.
        Uric acid level as a risk factor for cardiovascular and all-cause mortality in middle-aged men: a prospective cohort study.
        Arch Intern Med. 2004; 164: 1546-1551
        • Wannamethee S.G.
        • Shaper A.G.
        • Whincup P.H.
        Serum urate and the risk of major coronary heart disease events.
        Heart. 1997; 78: 147-153
        • Culleton B.F.
        • Larson M.G.
        • Kannel W.B.
        • Levy D.
        Serum uric acid and risk for cardiovascular disease and death: the Framingham Heart Study.
        Ann Intern Med. 1999; 131: 7-13
        • Froissart M.
        • Rossert J.
        • Jacquot C.
        • Paillard M.
        • Houillier P.
        Predictive performance of the modification of diet in renal disease and Cockroft-Gault equations for estimating renal function.
        J Am Soc Nephrol. 2005; 16: 763-773
        • Lee T.H.
        • Marcantonio E.R.
        • Mangione C.M.
        • Thomas E.J.
        • Polanczyk C.A.
        • Cook E.F.
        • Sugarbaker D.J.
        • Donaldson M.C.
        • Poss R.
        • Ho K.K.
        • et al.
        Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery.
        Circulation. 1999; 100: 1043-1049
        • Tuttle K.R.
        • Short R.A.
        • Johnson R.J.
        Sex differences in uric acid and risk factors for coronary artery disease.
        Am J Cardiol. 2001; 87: 1411-1414
        • Vigna G.B.
        • Bolzan M.
        • Romagnoni F.
        • Valerio G.
        • Vitale E.
        • Zuliani G.
        • Fellin R.
        Lipids and other risk factors selected by discriminant analysis in symptomatic patients with supra-aortic and peripheral atherosclerosis.
        Circulation. 1992; 85: 2205-2211
        • Saggiani F.
        • Pilati S.
        • Targher G.
        • Branzi P.
        • Muggeo M.
        • Bonora E.
        Serum uric acid and related factors in 500 hospitalized subjects.
        Metabolism. 1996; 45: 1557-1561
        • Brand F.N.
        • McGee D.L.
        • Kannel W.B.
        • Stokes III, J.
        • Castelli W.P.
        Hyperuricemia as a risk factor of coronary heart disease: The Framingham Study.
        Am J Epidemiol. 1985; 121: 11-18
        • Klein R.
        • Klein B.E.
        • Cornoni J.
        • Maready J.
        • Cassel J.C.
        • Tyroler H.A.
        Serum uric acid, Georgia.
        Arch Intern Med. 1973; 132: 401-410
        • Fang J.
        • Alderman M.H.
        Serum uric acid and cardiovascular mortality the NHANES I epidemiologic follow-up study, 1971–1992.
        JAMA. 2000; 283: 2404-2410
        • Strasak A.M.
        • Kelleher C.C.
        • Brant L.J.
        • Rapp K.
        • Ruttmann E.
        • Concin H.
        • Diem G.
        • Pfeiffer K.P.
        • Ulmer H.
        • VHM&PP Study Group
        Serum uric acid is an independent predictor for all major forms of cardiovascular death in 28,613 elderly women: A prospective 21-year follow-up study.
        Int J Cardiol. 2008; 125: 232-239
        • Suarna C.
        • Dean R.T.
        • May J.
        • Stocker R.
        Human atherosclerotic plaque contains both oxidized lipids and relatively large amounts of α-tocopherol and ascorbate.
        Arterioscler Thromb Vasc Biol. 1995; 15: 1616-1624
        • Visy J.M.
        • Le Coz P.
        • Chadefaux B.
        • Fressinaud C.
        • Woimant F.
        • Marquet J.
        • Zittoun J.
        • Visy J.
        • Vallat J.M.
        • Haguenau M.
        Homocystinuria due to 5,10-methylenetetrahydrofolate reductase deficiency revealed by stroke in adult siblings.
        Neurology. 1991; 41: 1313-1315
        • De Scheerder I.K.
        • van de Kraay A.M.
        • Lamers J.M.
        • Koster J.F.
        • de Jong J.W.
        • Serruys P.W.
        Myocardial malondialdehyde and uric acid release after short-lasting coronary occlusions during angioplasty: potential mechanisms for free radical generation.
        Am J Cardiol. 1991; 68: 392-395
        • Kanellis J.
        • Kang D.H.
        Uric acid as a mediator of endothelial dysfunction, inflammation, and vascular disease.
        Semin Nephrol. 2005; : 39-42