Angiology
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The Association of Serum Uric Acid Level With Coronary Collateral Circulation Should Be Interpreted Together With Renal Function and Cardiovascular Medications in Stable Coronary Artery Disease Ugur Canpolat, Kumral Çagli, Dursun Aras, Halil Lütfi Kisacik and Sinan Aydogdu ANGIOLOGY 2014 65: 236 originally published online 6 November 2013 DOI: 10.1177/0003319713509003 The online version of this article can be found at: http://ang.sagepub.com/content/65/3/236
Published by: http://www.sagepublications.com
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Letter
The Association of Serum Uric Acid Level With Coronary Collateral Circulation Should Be Interpreted Together With Renal Function and Cardiovascular Medications in Stable Coronary Artery Disease
Angiology 2014, Vol. 65(3) 236-237 ª The Author(s) 2013 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/0003319713509003 ang.sagepub.com
Ug˘ur Canpolat, MD1, Kumral C ¸ ag˘lı, MD1, Dursun Aras, MD1, Halil Lu¨tfi Kısacık, MD1, and Sinan Aydog˘du, MD1
We read with interest the study by Uysal et al1 evaluating the association between serum uric acid (SUA) level and coronary collateral circulation (CCC) in patients with stable coronary artery disease (CAD). Several studies reported a relationship between SUA and CCC in acute coronary syndrome2-4 but none had previously addressed stable CAD. As a simple, widely available noninvasive marker, SUA is a useful indicator of inflammation and oxidative stress that have been studied in several cardiovascular diseases.5-7 So, for the first time, Uysal et al1 demonstrated a relationship between SUA level and CCC in stable CAD. However, the study has limitations. First, the study lacks data regarding some of the components of metabolic syndrome like dyslipidemia and waist circumference which correlate with SUA levels.8,9 Second, the study has no data regarding cardiovascular medications. Among these drugs, the beneficial effects of statins are not only due to the improvement in plasma lipid levels but also due to the action on the vasculature including the improvement in endothelial function, anti-inflammatory, and antithrombotic actions.10,11 Animal studies have shown that statins promote angiogenesis and CCC development.12,13 However, there are conflicting data in clinical trials.14,15 Another study16 reported that the dosage and duration of statin therapy (10 mg atorvastatin-equivalent dose for > 3 months) were associated with enhanced CCC. Also, there have been several reports on the SUA-lowering effect of statins,17,18 which may impact on the study results. Third, renal function has not been reported in the study. Impaired renal function has effects on both the SUA levels and the poor CCC development.19 In conclusion, Uysal et al1 showed that higher SUA levels were associated with poor CCC in stable CAD, but these results should be interpreted with some limitations.
2. Duran M, Kalay N, Akpek M, et al. High levels of serum uric acid predict severity of coronary artery disease in patients with acute coronary syndrome. Angiology. 2012;63(6):448-452. 3. Duran M, Ornek E, Murat SN, et al. High levels of serum uric acid impair development of coronary collaterals in patients with acute coronary syndrome. Angiology. 2012;63(6):472-475. 4. Kasapkara HA, Topsakal R, Yarlioglues M, et al. Effects of serum uric acid levels on coronary collateral circulation in patients with non-ST elevation acute coronary syndrome. Coron Artery Dis. 2012;23(7):421-425. 5. Kaya EB, Yorgun H, Canpolat U, et al. Serum uric acid levels predict the severity and morphology of coronary atherosclerosis detected by multidetector computed tomography. Atherosclerosis. 2010;213(1):178-183. 6. Nyrnes A, Toft I, Njolstad I, et al. Uric acid is associated with future atrial fibrillation: an 11-year follow-up of 6308 men and women—the Tromso Study [published online August 30, 2013]. Europace. 2013. 7. Huang H, Huang B, Li Y, et al. Uric acid and risk of heart failure: a systematic review and meta-analysis [published online August 9, 2013]. Eur J Heart Fail. 2013. 8. Lin SD, Tsai DH, Hsu SR. Association between serum uric acid level and components of the metabolic syndrome. J Chin Med Assoc. 2006;69(11):512-516. 9. Yoo TW, Sung KC, Shin HS, et al. Relationship between serum uric acid concentration and insulin resistance and metabolic syndrome. Circ J. 2005;69(8):928-933. 10. Sowers JR. Effects of statins on the vasculature: Implications for aggressive lipid management in the cardiovascular metabolic syndrome. Am J Cardiol. 2003;91(4A):14B-22B.
1
Cardiology Clinic, Tu¨rkiye Yu¨ksek Ihtisas Training and Research Hospital, Ankara, Turkey
References 1. Uysal OK, Sahin DY, Duran M, et al. Association Between Uric Acid and Coronary Collateral Circulation in Patients With Stable Coronary Artery Disease. Angiology. 2014;65(3):227-231.
Corresponding Author: Ug˘ur Canpolat, Cardiology Clinic, Tu¨rkiye Yu¨ksek _Ihtisas Training and Research Hospital, Sıhhiye, 06100, Ankara, Turkey. Email: [email protected]
Downloaded from ang.sagepub.com at UNIVERSITY OF WINDSOR on August 28, 2014
Canpolat et al
237
11. Aikawa M. Effects of statin therapy on vascular dysfunction. Coron Artery Dis. 2004;15(5):227-233. 12. Skaletz-Rorowski A, Walsh K. Statin therapy and angiogenesis. Curr Opin Lipidol. 2003;14(6):599-603. 13. Walter DH, Zeiher AM, Dimmeler S. Effects of statins on endothelium and their contribution to neovascularization by mobilization of endothelial progenitor cells. Coron Artery Dis. 2004;15(5):235-242. 14. Nishikawa H, Miura S, Zhang B, et al. Pravastatin promotes coronary collateral circulation in patients with coronary artery disease. Coron Artery Dis. 2002;13(7):377-381. 15. Zbinden S, Brunner N, Wustmann K, Billinger M, Meier B, Seiler C. Effect of statin treatment on coronary collateral flow in patients with coronary artery disease. Heart. 2004;90(4):448-449. 16. Dincer I, Ongun A, Turhan S, Ozdol C, Kumbasar D, Erol C. Association between the dosage and duration of statin treatment
with coronary collateral development. Coron Artery Dis. 2006; 17(6):561-565. 17. Athyros VG, Mikhailidis DP, Liberopoulos EN, et al. Effect of statin treatment on renal function and serum uric acid levels and their relation to vascular events in patients with coronary heart disease and metabolic syndrome: a subgroup analysis of the GREek Atorvastatin and Coronary heart disease Evaluation (GREACE) Study. Nephrol Dial Transplant. 2007;22(1):118-127. 18. Ogata N, Fujimori S, Oka Y, Kaneko K. Effects of three strong statins (atorvastatin, pitavastatin, and rosuvastatin) on serum uric acid levels in dyslipidemic patients. Nucleosides Nucleotides Nucleic Acids. 2010;29(4-6):321-324. 19. Kadi H, Ceyhan K, Sogut E, et al. Mildly decreased glomerular filtration rate is associated with poor coronary collateral circulation in patients with coronary artery disease. Clin Cardiol. 2011;34(10): 617-621.
Downloaded from ang.sagepub.com at UNIVERSITY OF WINDSOR on August 28, 2014
http://ang.sagepub.com/
The Association of Serum Uric Acid Level With Coronary Collateral Circulation Should Be Interpreted Together With Renal Function and Cardiovascular Medications in Stable Coronary Artery Disease Ugur Canpolat, Kumral Çagli, Dursun Aras, Halil Lütfi Kisacik and Sinan Aydogdu ANGIOLOGY 2014 65: 236 originally published online 6 November 2013 DOI: 10.1177/0003319713509003 The online version of this article can be found at: http://ang.sagepub.com/content/65/3/236
Published by: http://www.sagepublications.com
Additional services and information for Angiology can be found at: Email Alerts: http://ang.sagepub.com/cgi/alerts Subscriptions: http://ang.sagepub.com/subscriptions Reprints: http://www.sagepub.com/journalsReprints.nav Permissions: http://www.sagepub.com/journalsPermissions.nav
>> Version of Record - Jan 30, 2014 OnlineFirst Version of Record - Nov 6, 2013 What is This?
Downloaded from ang.sagepub.com at UNIVERSITY OF WINDSOR on August 28, 2014
Letter
The Association of Serum Uric Acid Level With Coronary Collateral Circulation Should Be Interpreted Together With Renal Function and Cardiovascular Medications in Stable Coronary Artery Disease
Angiology 2014, Vol. 65(3) 236-237 ª The Author(s) 2013 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/0003319713509003 ang.sagepub.com
Ug˘ur Canpolat, MD1, Kumral C ¸ ag˘lı, MD1, Dursun Aras, MD1, Halil Lu¨tfi Kısacık, MD1, and Sinan Aydog˘du, MD1
We read with interest the study by Uysal et al1 evaluating the association between serum uric acid (SUA) level and coronary collateral circulation (CCC) in patients with stable coronary artery disease (CAD). Several studies reported a relationship between SUA and CCC in acute coronary syndrome2-4 but none had previously addressed stable CAD. As a simple, widely available noninvasive marker, SUA is a useful indicator of inflammation and oxidative stress that have been studied in several cardiovascular diseases.5-7 So, for the first time, Uysal et al1 demonstrated a relationship between SUA level and CCC in stable CAD. However, the study has limitations. First, the study lacks data regarding some of the components of metabolic syndrome like dyslipidemia and waist circumference which correlate with SUA levels.8,9 Second, the study has no data regarding cardiovascular medications. Among these drugs, the beneficial effects of statins are not only due to the improvement in plasma lipid levels but also due to the action on the vasculature including the improvement in endothelial function, anti-inflammatory, and antithrombotic actions.10,11 Animal studies have shown that statins promote angiogenesis and CCC development.12,13 However, there are conflicting data in clinical trials.14,15 Another study16 reported that the dosage and duration of statin therapy (10 mg atorvastatin-equivalent dose for > 3 months) were associated with enhanced CCC. Also, there have been several reports on the SUA-lowering effect of statins,17,18 which may impact on the study results. Third, renal function has not been reported in the study. Impaired renal function has effects on both the SUA levels and the poor CCC development.19 In conclusion, Uysal et al1 showed that higher SUA levels were associated with poor CCC in stable CAD, but these results should be interpreted with some limitations.
2. Duran M, Kalay N, Akpek M, et al. High levels of serum uric acid predict severity of coronary artery disease in patients with acute coronary syndrome. Angiology. 2012;63(6):448-452. 3. Duran M, Ornek E, Murat SN, et al. High levels of serum uric acid impair development of coronary collaterals in patients with acute coronary syndrome. Angiology. 2012;63(6):472-475. 4. Kasapkara HA, Topsakal R, Yarlioglues M, et al. Effects of serum uric acid levels on coronary collateral circulation in patients with non-ST elevation acute coronary syndrome. Coron Artery Dis. 2012;23(7):421-425. 5. Kaya EB, Yorgun H, Canpolat U, et al. Serum uric acid levels predict the severity and morphology of coronary atherosclerosis detected by multidetector computed tomography. Atherosclerosis. 2010;213(1):178-183. 6. Nyrnes A, Toft I, Njolstad I, et al. Uric acid is associated with future atrial fibrillation: an 11-year follow-up of 6308 men and women—the Tromso Study [published online August 30, 2013]. Europace. 2013. 7. Huang H, Huang B, Li Y, et al. Uric acid and risk of heart failure: a systematic review and meta-analysis [published online August 9, 2013]. Eur J Heart Fail. 2013. 8. Lin SD, Tsai DH, Hsu SR. Association between serum uric acid level and components of the metabolic syndrome. J Chin Med Assoc. 2006;69(11):512-516. 9. Yoo TW, Sung KC, Shin HS, et al. Relationship between serum uric acid concentration and insulin resistance and metabolic syndrome. Circ J. 2005;69(8):928-933. 10. Sowers JR. Effects of statins on the vasculature: Implications for aggressive lipid management in the cardiovascular metabolic syndrome. Am J Cardiol. 2003;91(4A):14B-22B.
1
Cardiology Clinic, Tu¨rkiye Yu¨ksek Ihtisas Training and Research Hospital, Ankara, Turkey
References 1. Uysal OK, Sahin DY, Duran M, et al. Association Between Uric Acid and Coronary Collateral Circulation in Patients With Stable Coronary Artery Disease. Angiology. 2014;65(3):227-231.
Corresponding Author: Ug˘ur Canpolat, Cardiology Clinic, Tu¨rkiye Yu¨ksek _Ihtisas Training and Research Hospital, Sıhhiye, 06100, Ankara, Turkey. Email: [email protected]
Downloaded from ang.sagepub.com at UNIVERSITY OF WINDSOR on August 28, 2014
Canpolat et al
237
11. Aikawa M. Effects of statin therapy on vascular dysfunction. Coron Artery Dis. 2004;15(5):227-233. 12. Skaletz-Rorowski A, Walsh K. Statin therapy and angiogenesis. Curr Opin Lipidol. 2003;14(6):599-603. 13. Walter DH, Zeiher AM, Dimmeler S. Effects of statins on endothelium and their contribution to neovascularization by mobilization of endothelial progenitor cells. Coron Artery Dis. 2004;15(5):235-242. 14. Nishikawa H, Miura S, Zhang B, et al. Pravastatin promotes coronary collateral circulation in patients with coronary artery disease. Coron Artery Dis. 2002;13(7):377-381. 15. Zbinden S, Brunner N, Wustmann K, Billinger M, Meier B, Seiler C. Effect of statin treatment on coronary collateral flow in patients with coronary artery disease. Heart. 2004;90(4):448-449. 16. Dincer I, Ongun A, Turhan S, Ozdol C, Kumbasar D, Erol C. Association between the dosage and duration of statin treatment
with coronary collateral development. Coron Artery Dis. 2006; 17(6):561-565. 17. Athyros VG, Mikhailidis DP, Liberopoulos EN, et al. Effect of statin treatment on renal function and serum uric acid levels and their relation to vascular events in patients with coronary heart disease and metabolic syndrome: a subgroup analysis of the GREek Atorvastatin and Coronary heart disease Evaluation (GREACE) Study. Nephrol Dial Transplant. 2007;22(1):118-127. 18. Ogata N, Fujimori S, Oka Y, Kaneko K. Effects of three strong statins (atorvastatin, pitavastatin, and rosuvastatin) on serum uric acid levels in dyslipidemic patients. Nucleosides Nucleotides Nucleic Acids. 2010;29(4-6):321-324. 19. Kadi H, Ceyhan K, Sogut E, et al. Mildly decreased glomerular filtration rate is associated with poor coronary collateral circulation in patients with coronary artery disease. Clin Cardiol. 2011;34(10): 617-621.
Downloaded from ang.sagepub.com at UNIVERSITY OF WINDSOR on August 28, 2014
