Arterial stiffness and central arterial wave reflection are associated with serum uric acid, total bilirubin, and neutrophil-to-lymphocyte ratio in patients with coronary artery disease

Abstract

ObjectiveTotal bilirubin (TB) was recently recognized as an endogenous anti-inflammatory and anti-oxidant molecule. Uric acid (UA) takes part in cardiovascular diseases by inducing oxidative stress, inflammation, and endothelial dysfunction. We assessed the relationship between serum TB levels, serum UA levels, and inflammatory status assessed by neutrophil-to-lymphocyte ratio (N/L) and arterial stiffness and arterial wave reflection in patients with a clinical diagnosis of coronary artery disease (CAD).MethodsWe included 145 consecutive patients admitted with stable angina pectoris (SAP) or acute coronary syndrome (ACS). Blood samples were drawn at admission for complete blood count and biochemistry. Non-invasive pulse waveform analysis for the determination of augmentation index (AIx) and carotid-femoral pulse wave velocity (PWV) measurements were performed with the commercially available SphygmoCor system.ResultsWhen patients were divided into tertiles of PWV and AIx, median N/L and median serum UA levels were the highest and mean TB levels were the lowest in the third tertile (p<0.001 for all). AIx and PWV were positively associated with serum UA and N/L and negatively associated with serum TB levels (p<0.001 for all). After adjustments for age, gender, heart rate, systolic blood pressure, and presence of diabetes, significant correlations persisted for N/L, UA, and TB in ACS patients (p<0.05). In the SAP group, TB was significantly negatively correlated with AIx and PWV, and UA was significantly positively correlated with PWV (p<0.05).ConclusionN/L ratio and serum UA and TB levels might be used to risk-stratify patients with respect to arterial stiffness in CAD patients, especially in the presence of ACS.

<p>Uric Acid and Arterial Stiffness</p>

“…The authors suggested that increased UA together with a higher N/L ratio and low bilirubin levels may represent an increased risk of arterial stiffness in coronary syndromes. 121 In stroke survivors, UA was independently associated with increased carotid PWV. 122 Future studies must test if treating hyperuricemia in clinically manifest atherosclerosis may favorably impact arterial stiffness and patients' prognosis.…”

Usefulness of the neutrophil-to-lymphocyte ratio to prediction of complications in type 2 diabetes mellitus

“…Increased NLR is associated with severe, extensive and complex CAD (6,25). Tanındı et al 25 showed that NLR is also associated with impaired myocardial perfusion in acute coronary syndrome (ACS), and may be useful for earlier risk stratification and for intensifying the atherosclerosis treatment in higher risk patients.…”

“…The immune response to various physiological challenges is characterized by increased neutrophil and decreased lymphocyte counts, and the neutrophil-to-lymphocyte ratio (NLR) was defined as a novel potential marker to determine inflammation in many kinds of chronic inflammatory disease including diabetes [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] . The count of white blood cell (WBC) is a basic but cheap, readily available, and sensitive indicator of the inflammatory status.…”

Bilirubin in coronary artery disease: Cytotoxic or protective?

“…This anti-oxidative effect of bilirubin is amplified by the recycling of bilirubin to biliverdin and so forth via redox reactions (Figure 1)[3]. This recycling of bilirubin amplifies its anti-oxidant potential up to 10000 times; (2) Bilirubin has been shown to be inversely associated with increased arterial stiffness[12,13]. Pre-clinical studies have observed this effect to be mediated by preservation of vascular nitric oxide, which mediates endothelial relaxation[2,13].…”

“…Besides vaso-relaxation, nitric oxide also inhibits leukocyte adhesion to endothelium, vascular smooth muscle cell migration and proliferation, platelet aggregation and neointimal formation[2,15]. Thus, preservation of nitric oxide offers a significant protection against atherosclerosis[12]; (3) Bilirubin has also been seen to reduce platelet aggregation. Kundur et al[3] showed that when unconjugated bilirubin is added to platelet rich plasma at concentrations seen in Gilbert syndrome (0.99-5.85 mg/dL), it inhibits both - collagen induced and adenosine diphosphate induced platelet aggregation, in a dose dependent fashion for the latter.…”