The impact of serum uric acid level on arterial stiffness and carotid atherosclerosis: The Korean Multi-Rural Communities Cohort study

Highlights

• Serum uric acid level is an important risk factor for arterial stiffness in Korean males, but not female.

• Serum uric acid is not associated with carotid IMT.

• Significant difference of carotid IMT and baPWV was noted between male and female.

Abstract

Objective

Serum uric acid level has been found to be associated with a risk factor for cardiovascular diseases. However, the topic has not been explored in the general population, especially in Korea. This study was designed to determine whether serum uric acid is associated with carotid atherosclerosis and arterial stiffness in the Korean Multi-Rural Communities Cohort study.

Methods

A total of 5568 participants from the Korean Multi-Rural Communities Cohort were evaluated for the risk of hyperuricemia in cardiovascular atherosclerosis. Important surrogates for cardiovascular atherosclerosis such as intima–media thickness (IMT) and brachial-ankle pulse wave velocity (baPWV) were assessed. We evaluated the association between these atherosclerosis indices and serum uric acid level or hyperuricemia through multivariate-adjusted logistic and linear regression analyses.

Results

There was a significant difference of carotid IMT and baPWV between males and females (p < 0.0001, respectively). Both male and female subjects with hyperuricemia showed higher baPWV than subjects without hyperuricemia (p = 0.0004 for males; p = 0.001 for females). Serum uric acid level was positively correlated with baPWV in males (β = 0.0006, p < 0.0001) and in females (β = 0.0001, p = 0.04), whereas no association between serum uric acid and carotid IMT was found in either gender. A linear relationship of baPWV with increasing serum uric acid level was observed in males (p = 0.0005) and in females (p = 0.004).

Conclusion

Serum uric acid level could be considered an important risk factor for arterial stiffness in Korean population, whereas carotid IMT is not associated with serum uric acid in either gender when using data from the Korean Multi-Rural Communities Cohort study.

Introduction

Several epidemiological studies have addressed the concept that serum uric acid level could be considered a risk indicator for cardiovascular diseases (CVD) including metabolic syndrome, coronary artery disease, and carotid atherosclerosis [1], [2], [3]. Regarding the association between hyperuricemia and CVD, recent epidemiologic data and meta-analysis of 26 eligible studies showed consistent results, suggesting hyperuricemia increased the risk of CVD [4], [5], [6]. Based on the experimental studies, uric acid was implicated in various pathological mechanisms in CVD pathogenesis such as endothelial dysfunction [7], promotion of vascular smooth muscle cell proliferation [8], and induction of vasoconstrictive mediators such as entdothelin-1 and angiotensin II [9], [10]. These results suggest that uric acid has a role in the aberrant changes of vascular properties. In contrast, uric acid was thought to be only an embedded component involved in the clustering of traditional CVD risk factors [11]. Recent data from a prospective study and meta-analysis found no predictive importance of coronary heart disease [12]. Based on these contrasting opinions, the association of uric acid and CVD remains controversial.

Brachial-ankle pulse wave velocity (baPWV) for arterial stiffness [13], [14] and intima–media thickness (IMT) for carotid atherosclerosis [15] are regarded as non-invasive indicators of cardiovascular events. Several previous studies have suggested that uric acid is associated with baPWV [16], [17] and IMT [18]. However, the association of uric acid with a risk of increased arterial stiffness and atherosclerosis in epidemiologic and retrospective studies in the Korean population [16], [19] remains controversial. Therefore, additional data to confirm these associations is needed by using variable indices for CVD such as IMT and baPWV. This study was designed to identify the role of hyperuricemia and serum uric acid level in PWV and IMT as surrogate markers indices for arterial stiffness and carotid atherosclerosis in the Korean Multi-Rural Communities Cohort study.