Title : Serum uric acid is independently associated with increased cardiovascular risk in Nigerian patients
Abstract:
Background:
Serum uric acid (sUA) has been known to be associated with an increased risk of developing cardiovascular disease in different populations. However, whether this is also the case with Nigerian patients remains understudied. The study aimed to assess the association between sUA levels and two measures of cardiovascular risk i.e. Framingham 10-year cardiovascular risk score and Atherogenic Index of Plasma (AIP).
Methods:
This was a retrospective study carried out using data from clinical records of new patients presenting at Meridian Cardiac Center over a period of 1 year from November 2022 to October 2023. In total, 428 patients presented newly to the hospital in that time period. After exclusions for incomplete anthropometric, clinical and laboratory data, as well as patients for whom the Framingham Risk Score (FRS) could not be calculated (290), the records of 138 patients were included in the project. Data from the records was used to calculate the FRS and AIP. Statistical tests of association were used to determine the significance of the relationship between sUA levels and the measures of cardiovascular risk. Two-tailed p <0.05 was deemed statistically significant.
Results:
Hyperuricemia was found to be more prevalent in individuals with central obesity i.e. Waist circumference ≥94cm in males or 80cm in females (93.4% vs 6.6%; p=0.03). Serum uric acid also positively correlated with FRS (Correlation coefficient 0.190; p<0.05), serum triglyceride levels and AIP (Corelation coefficient 0.259 and 0.294 respectively; p<0.001 for both). After multivariate analyses, uric acid was noted to be significantly and independently associated with high FRS and AIP after adjusting for age, smoking and diabetes history, blood pressure, total and high-density lipoprotein cholesterol, serum triglycerides, and waist circumference (p<0.001).
Binary logistic regression analysis was carried out to assess if high uric acid levels could predict a high FRS and AIP. Elevated sUA significantly predicted high AIP levels in univariate analysis (Odds ratio 1.46, 95% Confidence Interval 1.05-2.03).
Conclusion:
The results emphasize the emergence of sUA as a cardiovascular risk factor of note in clinical settings. We recommend an inclusion of sUA testing in the laboratory investigation panel for CVD-free individuals undergoing cardiovascular risk assessment. This could prompt identification of at-risk patients who would benefit from early institution of lifestyle modification. More research is needed to deduce the relationship, if any, between cardiovascular risk reduction and pharmacological reduction of sUA levels.
Audience Take Away:
- This research adds to the existing literature demonstrating elevated serum uric acid level as an independent cardiovascular risk factor in Nigerians and Sub-Saharan Africa as a whole
- A singular uric acid test can predict cardiovascular risk as much as an entire lipid profile panel, thereby reducing cost of laboratory investigations and benefiting patients in low and lower-middle income health settings
- It is hoped that this presentation would lead to increased uptake of serum uric acid testing in clinical settings for cardiovascular risk assessment
- Further research regarding cardiovascular risk reduction via modulation of serum uric acid levels is needed
