The main findings of this study are as follows: (1) The proportion of male patients with coronary heart disease was higher than that of female patients, and the proportion of hypertension, diabetes, hyperlipidemia, smoking, and drinking was significantly higher than that of the control group (P < 0.01). (2) The levels of SUA and Gensini score in the CHD group were significantly higher than those in the control group (P < 0.05), and the level of SUA increased with the increase of the number of coronary artery lesions. Smoking, drinking, hypertension, diabetes, hyperlipidemia, BMI, TG, Lp (a), hsCRP, HbA1C, UA were positively correlated with CHD and Gensini score (P < 0.05). Gender and HDL-c were negatively correlated with CHD and Gensini score (P < 0.05), suggesting that the above indicators may be involved in the pathogenesis of coronary heart disease as risk factors. SUA level affects the severity of coronary artery disease, with the increase of SUA level, the severity of coronary artery disease increases. (4) The levels of uric acid and Gensini score in patients with multi-vessel coronary heart disease were significantly higher than those in patients with double-vessel and single-vessel coronary heart disease, and the serum uric acid level in patients with multi-vessel coronary heart disease was the highest. (5) Multivariate logistic regression analysis showed that when multiple risk factors were involved, the partial regression coefficients of hs-CRP, BMI, HDL-C and SUA were statistically significant. It is suggested that the above indicators are still closely related to the degree of coronary artery stenosis after comprehensive consideration of multiple factors.
Uric acid levels have been shown to be positively correlated with the severity of coronary artery disease[22–24]. Patients with higher levels of uric acid have higher Gensini scores and more diseased vessels, critical lesions, and total occlusive vessels. In our study, further breakdown of uric acid by gender confirmed this conclusion. The incidence of coronary heart disease in China is increasing day by day, and the age of onset of patients also shows a trend of younger[18]. With the gradual improvement of medical technology and the change of medical diagnosis and treatment ideas in China, the inpatient diagnosis, treatment, and treatment of coronary heart disease are gradually transformed into the pre-hospital prevention and treatment of coronary heart disease. Some studies have shown that uric acid, as the product of purine metabolism, is an independent biomarker capable of predicting morbidity and mortality in patients with various CVD[25]. The mechanism by which elevated uric acid causes and aggravates coronary heart disease is currently believed to be related to oxidative stress and inflammatory response caused by uric acid. Uric acid produces many oxygens free radicals through xanthine dehydrogenase and xanthine oxidase[26, 27], which participate in a series of inflammatory reactions and destroy the endothelium-mediated vasodilation function, leading to vascular endothelial dysfunction[17, 28, 29]. In addition, uric acid can also activate platelets, release a variety of cytokines, activate the coagulation system, and aggravate the adhesion and aggregation of platelets, thus increasing the risk of thrombosis and shedding, which is easy to cause coronary embolism and increase the incidence of cardiovascular events[30]. Uric acid can interfere with the synthesis of nitric oxide, inhibit the bioavailability of nitric oxide, activate the renin-angiotensin system, promote vascular smooth muscle cell proliferation and platelet aggregation, and eventually cause endothelial dysfunction[13, 31]. These pathways not only explain how hyperuricemia affects and promotes the occurrence and development of atherosclerosis, but also provide a rich theoretical basis for the predictive value of serum uric acid in the degree of coronary heart disease.
This study is a cross-sectional survey of suspected coronary heart disease (CHD) population at high risk of coronary angiography. Coronary heart disease was accurately judged by the gold standard of coronary angiography and the severity of coronary artery disease was evaluated by Gensini score, which is the latest data to objectively reflect the correlation between serum uric acid level and CHD and the severity of coronary artery disease in western China. But there are potential limitations: 1. This study was limited by its single-center and retrospective nature, and all patient information came from the electronic medical record system of the tertiary hospitals. The sample size of the study was still relatively small, and the lack of randomness was prone to bias. (2) In this study, there was no control of diet and some potential confounding factors before blood collection, which may affect UA metabolism due to purine intake, and the serum uric acid results did not reach two measurements in different days; (3) The control group of this study was the patients whose coronary angiography results did not meet the standard of coronary heart disease, and they were not completely healthy people. Moreover, the multiple metabolic abnormalities of patients with coronary heart disease may confound the analysis results, which may lead to inevitable statistical errors.
In summary, this study provides new insights into the correlation between uric acid and Gensini score and its gender differences. Uric acid, as a biomarker, may have potential clinical value in cardiovascular risk assessment. Meanwhile, studies on gender differences are of great significance for further understanding the relationship between uric acid and coronary artery disease and the gender specificity of cardiovascular disease. Future studies need to further explore the predictive value of uric acid and consider gender factors more comprehensively to provide more accurate basis for individualized cardiovascular risk assessment and intervention.