A CROSS-SECTIONAL STUDY ON CORRELATION BETWEEN SERUM URIC ACID LEVEL AND CAROTID ATHEROSCLEROSIS IN PATIENTS OF TYPE 2 DIABETES
DOI:
https://doi.org/10.22159/ajpcr.2023.v16i4.47936Keywords:
Serum uric acid, Carotid intima media thickness, Glycated hemoglobin, Carotid atherosclerosisAbstract
Objective: The objective of the study was to assess correlation between uric acid (UA) level and carotid intima media thickness (CIMT) in type 2 diabetes mellitus (DM) patients.
Methods: The study was conducted in the Department of Medicine, SMS Medical College and Attached Hospital, among adults with type 2 DM. It was cross-sectional study conducted from April 1, 2019, to December 31, 2020. Sample size is calculated 60 patients of Type 2 DM. As per previous study show correlation coefficient between serum UA (SUA) level and CIMT (r=0.779)52 (For 90% power and 1% α error). CIMT and carotid artery plaques were measured through Doppler ultrasound. The thickness was measured at 1 cm proximal to the dilatation of the carotid bulb. The mean of maximum IMT of both the common carotid artery is taken as the average CIMT.
Results: Most patients (60%) were diabetics since 5 years and nearly 30% had diabetes since 5–15 years while only 10% had diabetes since more than 15 years. Mean duration of diabetes was 6.91±5.88 years. Two thirds of diabetic individuals (67%) had HDL cholesterol level above 40 mg/dL. About 42% of diabetic individuals had triglyceride level <150 mg/dL and 5% of diabetic individuals had LDL cholesterol level <100 mg/dL. Mean HDL cholesterol, Triglycerides, and LDL cholesterol were 47.4±15.49 mg/dL, 153.78±81.56 mg/dL, and 92.33±57.28 mg/dL, respectively. Mean bilirubin and serum creatinine in study population were 0.65±0.48 mg/dL and 0.96±0.18 mg/dL, respectively. Mean CRP was 3.95±2.40 mg/L. Mean SUA level in study population was 5.78±2.18 mg/dL. Mean of average CIMT was found to be 8.0±1.16 mm. Glycated hemoglobin (HbA1c) and UA had negative weak linear correlation which was statistically significant. HbA1c and average CIMT had no or week negative correlation which was not statistically significant and SUA and average CIMT showed positive moderate linear correlation which was statistically significant.
Conclusion: Carotid atherosclerosis as measured by IMT is associated with SUA levels in patients with type 2 DM. In type 2 DM patients, HbA1C is negatively correlated with UA while HbA1C has no correlation with CIMT.
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References
IDF Diabetes Atlas. 8th ed; 2017. Available from: https://www.idf.org/ elibrary/epidemiology-research/diabetes-atlas/134-idf-diabetes-atlas- 8th-edition.html [Last accessed on 2019 Jun 02].
Göksan B, Erkol G, Bozluolcay M, Ince B. Diabetes as a determinant of high-grade carotid artery stenosis: Evaluation of 1,058 cases by Doppler sonography. J Stroke Cerebrovasc Dis 2001;10:252-6. doi: 10.1053/jscd.2001.123773, PMID 17903835
Kiechl S, Willeit J. The natural course of atherosclerosis. Part I: Incidence and progression. Arterioscler Thromb Vasc Biol 1999;19:1484-90. doi: 10.1161/01.atv.19.6.1484, PMID 10364079
Yang B, Li TD, Wang JS, Zhi G, Jin WS, Xu Y. Insulin resistance and carotid atherosclerosis in 221 patients with potential hyperglycemia. Chin Med Sci J 2005;20:108-11. PMID 16075748
Inzitari D, Eliasziw M, Gates P, Sharpe BL, Chan RK, Meldrum HE, et al. The causes and risk of stroke in patients with asymptomatic internal-carotid-artery stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators. N Engl J Med 2000;342:1693-700. doi: 10.1056/NEJM200006083422302, PMID 10841871
Clausen JO, Borch-Johnsen K, Ibsen H, Pedersen O. Analysis of the relationship between fasting serum uric acid and the insulin sensitivity index in a population-based sample of 380 young healthy Caucasians. Eur J Endocrinol 1998;138:63-9. doi: 10.1530/eje.0.1380063, PMID 9461318
Wun YT, Chan CS, Lui CS. Hyperuricaemia in Type 2 diabetes mellitus. Diabetes Nutr Metab 1999;12:286-91. PMID 10782755
Kodama S, Saito K, Yachi Y, Asumi M, Sugawara A, Totsuka K, et al. Association between serum uric acid and development of Type 2 diabetes. Diabetes Care 2009;32:1737-42. doi: 10.2337/dc09-0288, PMID 19549729
Bos MJ, Koudstaal PJ, Hofman A, Witteman JC, Breteler MM. Uric acid is a risk factor for myocardial infarction and stroke: The Rotterdam study. Stroke 2006;37:1503-7. doi: 10.1161/01.STR.0000221716.55088.d4, PMID 16675740
Franse LV, Pahor M, Di Bari M, Shorr RI, Wan JY, Somes GW, et al. Serum uric acid, diuretic treatment and risk of cardiovascular events in the Systolic Hypertension in the Elderly Program (SHEP). J Hypertens 2000;18:1149-54. doi: 10.1097/00004872-200018080-00021, PMID 10954008
Madsen TE, Muhlestein JB, Carlquist JF, Horne BD, Bair TL, Jackson JD, et al. Serum uric acid independently predicts mortality in patients with significant, angiographically defined coronary disease. Am J Nephrol 2005;25:45-9. doi: 10.1159/000084085, PMID 15724082
Brand FN, McGee DL, Kannel WB, Stokes J 3rd, Castelli WP. Hyperuricemia as a risk factor of coronary heart disease: The Framingham Study. Am J Epidemiol 1985;121:11-8. doi: 10.1093/ oxfordjournals.aje.a113972, PMID 3964986
Moriarity JT, Folsom AR, Iribarren C, Nieto FJ, Rosamond WD. Serum uric acid and risk of coronary heart disease: Atherosclerosis Risk in Communities (ARIC) Study. Ann Epidemiol 2000;10:136-43.
doi: 10.1016/s1047-2797(99)00037-x, PMID 10813506
Johnson RJ, Kang DH, Feig D, Kivlighn S, Kanellis J, Watanabe S, et al. Is there a pathogenetic role for uric acid in hypertension and cardiovascular and renal disease? Hypertension 2003;41:1183-90. doi: 10.1161/01.HYP.0000069700.62727.C5, PMID 12707287
Mazzali M, Kanellis J, Han L, Feng L, Xia YY, Chen Q, et al. Hyperuricemia induces a primary renal arteriolopathy in rats by a blood pressure-independent mechanism. Am J Physiol Renal Physiol 2002;282:F991-7. doi: 10.1152/ajprenal.00283.2001, PMID 11997315
Venishetty S, Bhat R, Rajagopal KV. Serum uric acid levels in Type 2 diabetes mellitus: Is there a linear relationship with severity of carotid atherosclerosis? Indian J Endocrinol Metab 2018;22:678-82. doi: 10.4103/ijem.IJEM_641_17, PMID 30294580
Li Q, Yang Z, Lu B, Wen J, Ye Z, Chen L, et al. Serum uric acid level and its association with metabolic syndrome and carotid atherosclerosis in patients with Type 2 diabetes. Cardiovasc Diabetol 2011;10:72. doi: 10.1186/1475-2840-10-72, PMID 21816063
Ishizaka N, Ishizaka Y, Toda EI, Hashimoto H, Nagai R, Yamakado M. Higher serum uric acid is associated with increased arterial stiffness in Japanese individuals. Atherosclerosis 2007;192:131-7. doi: 10.1016/j. atherosclerosis.2006.04.016, PMID 16716328
Sushilendu V, Kumar N, Kumari R. Serum uric acid level and its correlation with HbA1c in Type 2 Diabetes Mellitus. J Med Sci Clin Res 2019;54:42-5.
Shirsath A, Patil VC, Mane M, Patil S. A study of serum uric acid levels in Type 2 diabetes mellitus subjects: A cross sectional study. Int J Contemp Med Res 2019;6:A21-4. doi: 10.21276/ijcmr.2019.6.1.22
Ma X, Shen Y, Hu X, Hao Y, Luo Y, Tang J, et al. Associations of glycated haemoglobin A1c and glycated albumin with subclinical atherosclerosis in middle-aged and elderly Chinese population with impaired glucose regulation. Clin Exp Pharmacol Physiol 2015;42:582-7. doi: 10.1111/1440-1681.12394, PMID 25854289
Olt S, Şirik M, Baykan AH, Çeliker M. The relationship between HbA1c and carotid intima-media thickness in Type 2 diabetic patients. Pan Afr Med J 2016;23:224.
Kanellis J, Kang DH. Uric acid as a mediator of endothelial dysfunction, inflammation, and vascular disease. Semin Nephrol 2005;25:39-42. doi: 10.1016/j.semnephrol.2004.09.007, PMID 15660333
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Copyright (c) 2023 SURJEET SINGH RAJPOOT, RUPESH KUMAR GUPTA, GAURAV AGARWAL, SWATI SARAL
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