Hyperuricemia and its association with carotid intima-media thickness in hypertensive and non hypertensive patients

Abstract

Carotid intima-media thickness (C-IMT) measured noninvasively by ultrasonography is widely used as a marker for increased risk of cardiovascular disease. Also hyperuricemia (HU) is a well recognized risk factor for cardiovascular diseases. The study was designed to assess the relation between hyperuricemia and carotid intima-media thickness C-IMT in patients with and without hypertension (HTN). This study included 126 patients divided into four groups: (1) Group A, included 59 hypertensive patients with hyperuricemia. (2) Group B, included 29 hypertensive patients without hyperuricemia. (3) Group C, included 17 patients with hyperuricemia and normal blood pressure without history of hypertension. (4) Group D, included 21 control subjects. We measured carotid intima-media thickness by B-mode ultrasound in the common carotid and internal carotid artery. Routine echocardiography and uric acid level was assessed for all patients. We found that C-IMT was significantly higher in group A, B and C than group D; and it was significantly higher in group A than B. This means that C-IMT is significantly higher in all hypertensive groups than control group but it was significantly higher in hypertensive hyperuricemia (group A) than those hypertensives without hyperuricemia. We also observed a higher C-IMT in hyperuricemic non hypertensive patients than control group this means that hyperuricemia per se could be a risk factor for atherosclerosis. Uric acid levels among the whole number of patients included in the study and among the groups with hyperuricemia (group A and C) were positively correlated with the intimal-media thickness (IMT) while there were no correlations in the other two groups without hyperuricemia. We found that left ventricular hypertrophy (LVH) was significantly higher in hypertensive patients (group A&B) than normotensives (group C&D) either with or without hyperuricemia and this was evident in the hypertensive hyperuricemic patients (group A); but unexpectedly we observed the presence of LVH in the hyperuricemic non hypertensive patients (group C) which was significantly higher than the control group (group D). This means that hyperuricemia is a risk factor for development of LVH hypertrophy independently of hypertension. Therefore, higher serum uric acid levels are associated with increased C-IMT and left ventricular hypertrophy in hypertensive and even non hypertensive patients. So, early screening for hyperuricemia and lowering serum uric acid levels might be beneficial in slowing progression of atherogenesis.

Hyperuricemia Is Associated with Left Ventricular Dysfunction and Inappropriate Left Ventricular Mass in Chronic Kidney Disease

“…Uric acid (UA) is the end product of purine metabolism in humans, and approximately 70% of UA load is eliminated through the kidneys [ 7 ]. In the general population, hyperuricemia has been associated with many CV anomalies, including increased local arterial stiffness, carotid intima-media thickness, LVH, and atherosclerosis [ 8 , 9 , 10 , 11 , 12 ]. In patients with CKD, hyperuricemia has also been associated with many adverse CV outcomes, and high rates of CV events and CV mortality [ 13 , 14 , 15 ].…”

Carotid intima-media thickness in patients with hyperuricemia: a systematic review and meta-analysis

“…After reading the full texts, 5 articles were excluded because they were meta-analyses or reviews; 8 articles were excluded because they were not full texts; 14 articles were excluded due having an outcome indicator without CIMT; 13 articles were excluded because they lacked means with SDs of CIMT; and 9 articles were excluded on account of inconformity with case-control studies. Ultimately, 8 articles (3998 cases and 9049 controls) [9,10,[13][14][15][16][17][18] that met the requirements were included.…”

“…In this analysis, 13,047 people were included from 8 observational studies [9,10,[13][14][15][16][17][18]. The information on the value of CIMT is shown in Table 2.…”

“…CIMT, measured by ultrasound at the carotid artery level, is a highly efficient marker for detecting the progression of early atherosclerosis and forecasting cardiovascular events, and it is of critical importance in cardiovascular disorders [11,12]. Due to the noninvasive characteristics and ease to use of CIMT ultrasound detection, many studies using CIMT measured by ultrasound to assess the risk of atherosclerosis and cardiovascular events in hyperuricemia patients [13][14][15][16][17][18]. Therefore, in our present study, CIMT was compared between hyperuricemia patients and control subjects to explore the relationship between CIMT and UA and to further clarify the link between cardiovascular diseases and uric acid.…”