Association of Serum Uric Acid Levels with Peripheral Arterial Disease
Authors: Sultan Heba , Shehata Hassan , AboElNeel Hamdy , Mansour Hazem , Shaheen Sameh 
Published: August 2023

Abstract

Background
Peripheral arterial disease (PAD) is a chronic atherosclerotic process that causes narrowing or aneurysms of the peripheral arterial vasculature, predominantly of the lower limbs. It has an estimated worldwide prevalence of up to 10%, increasing to nearly 30% in patients more than 50 years of age. Various risk factors are included in this process. This study will evaluate the relationship of increased serum uric acid levels with the prevalence of peripheral arterial disease.

Objective
In this study we aim to evaluate the relationship of increased serum uric acid level with peripheral arterial disease through evaluation of ABI & CIMT.

Patients and Methods
This was a case control study carried on 100 subjects, divided into two groups: The first group (the case group) composed of 50 subjects identified as having peripheral arterial disease (PAD), were recruited from vascular surgery department. The second group (the control group) composed of 50 subjects who matched the participants in group I in age & sex, had traditional cardio vascular risk factors, but free from PAD, they were recruited from the outpatient clinics, The study was held during the period between September 2019 & October 2020. An informed consent was done, the steps of research were explained for the subjects with the protection of their privacy and confidentiality. Moreover, the ethical committee of faculty of medicine of Ain Shams university approved the study.

Results
Uric acid (UA) & CIMT showed highly significant difference among both groups (P-values = 0.003). Low ABI was significantly associated with UA among the patients group (P-value = 0.003). After further subdividing UA levels among subjects into tertiles the negative relation with ABI remained highly significant, the highest tertile of UA showed the lowest ABI (P-value = 0.006) However, the correlation with CIMT remained non- significant (P-value = 0.159) although people in the highest tertile exhibited higher CIMT values than in the lowest one. Logistic regression analysis showed uric acid levels were significantly associated with PAD (OR = 1.3, P-value = 0.006). However, after adjustment of confounding risk factors, that correlation became nonsignificant (OR = 2.165 P-value = 0.227 CI 95%(& remained significant only for BMI, DM &dyslipidemia.

Conclusion
We concluded that ABI was decreased among UA tertiles (P-value = 0.006), denoting a probable relation of UA with lower limb atherosclerosis. CIMT was non-significantly correlated with UA (P-value = 0.651), however the highest UA tertile showed the highest CIMT values (P-value = 0.159). Among our subjects, Uric acid was significantly associated with PAD (Odds Ratio = 1.37, P-value = 0.006). However, after adjustment for other confounding factors that association became non-significant (Odds Ratio=2, P-value = 0.227).

Abbreviations
PAD: Peripheral Arterial Disease; XOR: Xanthine Oxidoreductase; TIA: Transient Ischemic Attack; ABI: Ankle Brachial Index; PVD: Peripheral Vascular Disease; CIMT: Carotid Intima-Media Thickness; CT: Computed Tomography; LL: Lower Limb; UL: Upper Limb; DM: Diabetes Mellitus; HTN: Hypertension; LS: Longitudinal Section; CCA: Common Carotid Artery; BMI: Body Mass Index; UA: Uric Acid; CAVI: Carotid Artery Velocity Index; ba-PWV: Brachial Ankle Pulsed Wave Velocity