Cervical-Intracranial Atherosclerosis and Serum Uric Acid Level Association in Acute Stroke

Authors

  • Devran Suer
  • Ipek Midi Marmara University, School of Medicine, Department of Neurology
  • Gazanfer Ekinci

Abstract

Objective: We aimed to identify whether high uric acid levels were associated with atherosclerotic intracranial/extracranial arterial stenosis and atrial fibrillation (AF) and to determine if serum uric acid (SUA) levels were an independent risk factor.

Methods: One hundred seventy-four patients who presented with acute stroke within 24 hours of onset and were admitted to our hospital between December 2016 and September 2017 were included in the study. Bamford classification was used for Stroke classification. The degree of vascular stenosis was classified as lumen contour irregularity, mild, moderate and severe stenosis using the The North American Symptomatic Carotid Endarterectomy Trial (NASCET) criteria.

Results: The average age of 174 patients was 69 ± 12.7 years. Elevated serum uric acid levels were found in 66 patients. The mean SUA level was 7.33±1.02 mg/dL in these patients. Thirty-six patients were examined with AF and 14 of these patients had high SUA levels. It was found that high SUA levels were mostly related with lacunar infarct (LACI) and partial anterior circulation infarct (PACI), respectively. High SUA levels were seen more commonly in the anterior circulation, especially in the extracranial part of the carotid artery, but this was not statistically significant (p>0.05).  We found a statistically significant relation between high SUA levels in moderate and severe stenosis of the extracranial portion of the posterior circulation in women (p=0.01). There was a relationship between atrial fibrillation and extracranial atherosclerosis of the anterior circulation as contour irregularity and moderate stenosis (p=0.05).

Conclusions: In our study, it was found that high SUA levels were related to LACI and PACI, respectively. Further studies with larger groups are needed.

References

REFERENCES

- Chin JH, Vora N. The global burden of neurologic diseases. Neurology 2014; 22; 83(4):349–351.

- Iranmanesh F, Sheykholeslami NZ, Gadari F, Ahmady J. Acute ischemic non- embolic stroke and serum level of uric acid. Iran J Neurol. 2012;11(1):1-5.

- Sautin Y, Johnson R. Uric acid: The oxidant-antioxidant paradox. Nucleosides Nucleotides Nucleic Acids. 2008; 27 (6):608-619.

- So A, Thorens B. Uric acid transport and disease. J Clin Invest. 2010;120:1791-9.

- J Lin SD, Tsai DH, Hsu SR. Association between serum uric acid level and components of the metabolic syndrome. Chin Med Assoc. 2006;69:512-6.

- Yang XL, Kim Y, Kim TJ, Jung S, Kim CK, Lee SH. Association of serum uric acid and cardioembolic stroke in patients with acute ischemic stroke. J Neurol Sci. 2016; 370:57–62.

- Nakagawa T, Hu H, Zharikov S, Tuttle KR, Short RA, Glushakova O, et al. A causal role for uric acid in fructose- induced metabolic syndrome. Am J Physiol Renal Physiol. 2006;290:F625-31.

- Mazzali M, Hughes J, Kim YG, Jefferson JA, Kang DH, Gordon KL, et al. Elevated uric acid increases blood pressure in the rat by a novel crystal-independent mechanism. Hypertension. 2001;38:1101-6.

- Dimitroula HV, Hatzitolios AI, Karvounis HI. The role of uric acid in stroke: the issue remains unresolved. Neurologist. 2008;14:238–242.

- Ginsberg MH, Kozin F, O'Malley M, McCarty DJ. Release of platelet constituents by monosodium urate crystals. J Clin Invest. 1977;60:999-1007.

- Weir CJ, Muir SW, Walters MR, Lees KR. Serum urate as an independent predictor of poor outcome and future vascular events after acute stroke. Stroke. 2003;34:1951-6.

- Neogi T, Ellison RC, Hunt S, Terkeltaub R, Felson DT, Zhang Y. Serum uric acid is associated with carotid plaques: The National Heart, Lung, and Blood Institute Family Heart Study. J Rheumatol. 2009; 36:378-384.

- Tavil Y, Kaya MG, Oktar SO, Sen N, Okyay K, Yazici HU, et al. Uric acid level and its association with carotid intima-media thickness in patients with hypertension. Atherosclerosis 2008;197: 159-63.

- Kawamoto R, Tomita H, Oka Y, Kodama A, Ohtsuka N, Kamitani A. Association between uric acid and carotid athherosclerosis in elderly persons. Intern Med 2005;44:787-93.

- Iribarren C, Folsom AR, Eckfeldt JH, McGovern PJ, Nieto FJ. Correlates of uric acid and its association with asymptomatic carotid atherosclerosis: the ARIC Study. Atherosclerosis Risk in Communities. Ann Epidemiol. 1996;6:331-40.

- Kim SY, Guevara JP, Kim KM, Choi HK, Heitjan DF, Albert DA. Hyperuricemia and risk of stroke: A systematic Review and meta-analysis. Arthritis Rheum. 2009;15;61:885-92.

- Kang DH, Nakagawa T, Feng L, Watanabe S, Han L, Mazzali M, et al. A role for uric in the progressions of renal disease. J Am Soc Nephrol.2002 ;13 : 2888-2897

- Johnson RJ, Kang DH, Feig D, Kivlighn S, Kanellis S, Watanabe S, et al. Is there a pathogenetic role for uric acid in hypertension and cardiovascular and renal disease? Hypertension. 2003;41:1183-1189

- Kanellis J, Feig D, Johnson R. Does asymptomatic hyperuricaemia contribute to the development of renal and cardiovascular disease? An old controversy renewed. Nephrology (Carlton). 2004;9:394-399.

- Kang D, Han L, Ouyang X, Kahn AM, Kanellis J, Li P, et al·. Uric acid causes vascular smooth muscle cell proliferation by entering cells via a functional urate transporter. Am J Nephrol. 2005;25:425-433.

- Rao G, Corson M, Berk M. Uric acid stimulates vascular smooth cell proliferation by increasing platelet-derived growth factor A-chain expression. J Bio Chem. 1991;266:8604-8608.

- Kamisli O, Gonullu S, Kamisli S, Kaplan Y, Ozcan A. The evaluation of serum uric acid levels in the ischemic stroke subtypes. Turkish Journal of Cerebrovascular Disease. 2013;19:7-10.

- Chen LH, Zhong C, Xu T, Xu T, Peng Y, Wang A, et al. Sex-specific association between uric acid and outcomes after acute ischemic stroke: A Prospective Study from CATIS Trial. Nature. Scientific Reports. 2016; 6: 3835.

- Kivity S, Kopel E, Maor E, Abu-Bachar F, Segev S, Sidi Y, et al. Association of serum uric acid and cardiovascular disease in healthy adults. Am J Cardiol 2013;111: 1146–51.

- Zhang, W, Sun K, Yang Y, Zhang H, Hu FB, Hui R. Plasma uric acid and hypertension in a Chinese community: prospective study and metaanalysis. Clin Chem. 2009; 55:2026–34.

- Babio N, Martinez-Gonzalez MA, Estruch R, Warnberg J, Recondo J, Ortega-Calvo M, et al. Associations between serum uric acid concentrations and metabolic syndrome and its components in the PREDIMED study. Nutr Metab Cardiovasc Di. 2014; 25:173–80.

- Tamariz L, Agarwal S, Soliman EZ, Chamberlain AM, Prineas R, Folsom AR, et al. Association of serum uric acid with incident atrial fibrillation. J Am Cardiol.2011; 108(9):1272-1276.

- Carness CA, Chung MK, Nakayama T, Nakayama H, Baliga RS, Piao S, et al. Ascorbate attenuates atrial pacing-induced peroxinitrite formation and electrical remodeling and decreases the incidence of postopreative atrical fibrillation. Circ Res.2001;89:E 32-8D.

- Korantzopoulos P, Kolettis TM, Galaris D, Goudevenos JA. The role of oxidative stress in the pathogenesis and perpetuation of atrial fibrillation. Int J Cardiol. 2007;115:135-143.

- Kuwabara M, Niwa K, Niinuma H. Hyperuricemia is an independent risk factor of atrial fibrillation due to electrical remodeling through activation of uric acid transporter. Arrhythmias: 2013; Volume 59, Issue 13.

- Pasina L, Brucato AL, Djade CD, Di Corato P, Ghidoni S, Tetramanti M, et al. Inappropriate prescription of allopurinol and febuxostat and risk of adverse events in the elderly: results from the REPOSI registry. Eur J Clin Pharmacol 2014;70:1495-503.

Downloads

Published

29.02.2020