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Differences in urate metabolism between normouricemia and hyperuricemia in coronary heart disease in man
I Hisatome1, M Saitoh, K Ogino
1First Department of Internal Medicine, Tottori University School of Medicine, Yonago, Japan.
Insights
Hyperuricemia (high serum urate) is common in coronary heart disease patients. In coronary sclerosis, reduced urate clearance and increased tubular reabsorption contribute to high urate levels.
Area of Science:
- Cardiovascular Medicine
- Nephrology
- Metabolic Disorders
Background:
- Hyperuricemia is linked to cardiovascular disease.
- The specific mechanisms of urate metabolism in coronary sclerosis are not fully understood.
Purpose of the Study:
- To investigate the relationship between hyperuricemia and coronary sclerosis.
- To elucidate the urate metabolism pathways in patients with coronary sclerosis.
Main Methods:
- Coronary angiography was used to confirm coronary sclerosis in 85 patients.
- Serum urate levels were measured and compared between patients with and without coronary sclerosis.
- Urate metabolism was analyzed in hyperuricemic and normouricemic coronary sclerosis patients.
Main Results:
- Serum urate levels did not differ significantly between patients with and without coronary sclerosis.
- Hyperuricemia occurred in 26% of coronary sclerosis patients and correlated with diuretics, obesity, and hypertriglyceridemia.
- Normouricemic patients with coronary sclerosis showed decreased urate filtration and clearance.
- Hyperuricemic patients with coronary sclerosis had decreased urate clearance and reabsorption.
Conclusions:
- In coronary sclerosis, normouricemic patients exhibit reduced urate filtration.
- Hyperuricemic patients with coronary sclerosis demonstrate enhanced tubular reabsorption of urate.
- These findings suggest distinct urate handling mechanisms in coronary sclerosis patients with varying urate levels.
Abstract:
We examined hyperuricemia in patients with coronary heart disease. In 85 patients with coronary sclerosis confirmed by coronary angiography, the serum urate level (6.08 +/- 1.60 mg/dL) was not different from that in subjects with normal coronary arteries (6.47 +/- 1.69 mg/dL). The incidence of hyperuricemia in patients with coronary sclerosis was 26%, and was significantly correlated with diuretics, obesity and hypertriglyceridemia, but not with hypertension or hypercholesterolemia. To elucidate the mechanism of urate metabolism in coronary sclerosis, we separated coronary sclerosis patients without complicating factors into hyperuricemics and normouricemics, and studied urate metabolism in comparison with subjects with normal coronary arteries. We found that normouricemics with coronary sclerosis had decreases in the filtered urate load and urate clearance with a normal urate-creatinine clearance ratio. Hyperuricemics with coronary sclerosis had decreases in urate clearance and urate-creatinine clearance ratios, but the filtered urate load was similar to that in normouricemics. It is suggested that in coronary sclerosis patients, normouricemics had a low glomerular filtration of urate with normal tubular urate transport, whereas hyperuricemics had enhanced tubular reabsorption of urate without any difference of urate filtration from normouricemics.