Elevated serum uric acid tied to high-risk coronary artery plaques

Individuals with increased serum uric acid have a higher likelihood of showing high-risk coronary artery plaques on coronary CT angiography (CCTA), as reported in a retrospective study.

The study included 1,411 outpatients (mean age 64.26 years, 50.96 percent male) who underwent CCTA. High-risk plaques were defined as the presence of at least two of the following features: positive remodelling, low-attenuation plaque (LAP), napkin ring sign, and spotty calcification. Researchers also determined plaque volume, Agatston score, vessel stenosis, segment stenosis score (SSS), and segment involvement score (SIS) using the CT angiograms.

In the cohort, the median serum uric acid level at baseline was 425 µmol/L. There were 344 cases of high-risk plaques identified.

Multivariable logistic regression showed that each standard deviation-increment in serum uric acid was associated with roughly threefold greater odds of having high-risk plaques on CT angiogram (odds ratio [OR], 2.96, 95 percent confidence interval [CI], 1.85–4.76; p<0.001). This estimate was adjusted for sex, diabetes mellitus, smoking, obstructive CAD, age, Agatston score, total plaque volume, LAP volume, SSS and SIS.

On receiver operating characteristic curve analysis, serum uric acid had an area under curve of 0.86 (95 percent CI, 0.83–0.88; p<0.001) for predicting high-risk plaques, with a sensitivity of 91 percent and specificity of 82 percent at a cutoff of 566 µmol/L.

Subgroup analyses showed no effect modification by sex, diabetes mellitus, smoking status, alcohol use, obstructive coronary artery disease (CAD), and Agatston score (p>0.05 for all).

The findings suggest that information on serum uric acid levels, when added to clinical characteristics, might improve discrimination and reclassification for CAD.