Could uric acid to high-density lipoprotein cholesterol ratio be used to predict late-stage saphenous vein graft disease after coronary artery bypass graft surgery?

Year 2023, Volume: 9 Issue: 1, 14 - 21, 04.01.2023

Orhan Güvenç , Mesut Engin , Ömer Furkan Demir , Filiz Ata , Senol Yavuz

https://doi.org/10.18621/eurj.1205252

Abstract

Objectives: Various vascular grafts are used in coronary artery bypass graft (CABG) surgeries, however, the most commonly used one is the saphenous vein graft (SVG). Various studies conducted on this topic have found a relationship between uric acid to HDL-C (UHR) and cardiovascular diseases. In this current study, we aimed to investigate the predictive importance of UHR value in predicting long-term SVG disease in patients who underwent CABG surgery.

Methods: Patients who had a history of CABG surgery at least one year prior, had stable angina pectoris, and underwent coronary angiography between January 01, 2016 and January 01, 2020, were included in the study retrospectively. Patients with open saphenous veins were defined as Group 1, and patients who had 50% or more stenosis in at least one SVG after coronary angiography, were defined as Group 2.

Results: The median age of the 204 patients included in Group 1 and 292 patients in Group 2 were 65 (38-77) years and 66 (45-79) years, respectively (p = 0.251). The two groups were similar in terms of gender, hypertension, chronic obstructive pulmonary disease rates, history of cerebrovascular events, ejection fraction, body mass index, and current medical treatments. In univariate analysis, SVG disease was found to significantly correlate with diabeter mellitus (odds ratio [OR]: 1.644, 95% confidence interval [CI]: 1.190-1.985, p = 0.008), current smoking (OR: 0.875, 95% CI: 0.669-0.940, p = 0.030), number of patients with target artery diameter < 1.5 mm (OR: 1.945, 95% CI: 1.221-2.398, p < 0.001), age of SVG (OR: 2.960, 95% CI: 1.980-4.168, p < 0.001), uric acid (OR: 1.241, 95% CI: 1.078-1.592, p = 0.004), triglyceride (OR: 0.780, 95% CI: 0.569-0.935, p = 0.044) and UHR (OR: 1.894, 95% CI: 1.384-2.896, p < 0.001).

Conclusions: In this study, we showed that we can predict saphenous vein graft occlusion with serum UHR value.

Keywords

Coronary artery bypass graft, inflammation, cholesterol, saphenous vein, occlusion

References

• 1. Kaya U, Koza Y. Predictive value of mean platelet volume in saphenous vein graft disease. Braz J Cardiovasc Surg 2018;33:317-22.
• 2. Kulik A, Abreu AM, Boronat V, Ruel M. Impact of lipid levels and high-intensity statins on vein graft patency after CABG: Midterm results of the ACTIVE trial. J Card Surg 2020;35:3286-93.
• 3. Liu Y, Li CP, Wang YY, Dong YN, Liu HW, Xiao JY, et al. Prediction of major adverse cardiovascular events and slow/no-reflow by virtual histology imaging after percutaneous interventions on saphenous vein grafts. Angiology 2020;71:263-73.
• 4. Gagliardi ACM, Miname MH, Santos RD. Uric acid: a marker of increased cardiovascular risk. Atherosclerosis 2009;202:11-7.
• 5. Thacker SG, Zarzour A, Chen Y, Alcicek MS, Freeman LA, Sviridov DO, et al. High-density lipoprotein reduces inflammation from cholesterol crystals by inhibiting inflammasome activation. Immunology 2016;149:306-19.
• 6. Tani S, Matsumoto M, Anazawa T, Kawamata H, Furuya S, Takahashi H, et al. Development of a model for prediction of coronary atherosclerotic regression: evaluation of high-density lipoprotein cholesterol level and peripheral blood monocyte count. Heart Vessels 2012;27:143-50.
• 7. Aydın C, Emlek N. The relationship between uric acid to high-density lipoprotein cholesterol ratio and collateral index in patients with chronic total occlusion. Kardiologiia 2021;61:61-5.
• 8. Metin N, Turan Ç. Increases in uric acid and monocyte-high-density lipoprotein ratio as possible atherosclerotic indicators in acne patients using isotretinoin. J Cosmet Dermatol 2021;20:2945-9.
• 9. Aydın C, Engin M. The value of inflammation indexes in predicting patency of saphenous vein grafts in patients with coronary artery bypass graft surgery. Cureus 2021;13:e16646.
• 10. Aktas G, Kocak MZ, Bilgin S, Atak BM, Duman TT, Kurtkulagi O. Uric acid to HDL cholesterol ratio is a strong predictor of diabetic control in men with type 2 diabetes mellitus. Aging Male 2020;23:1098-102.
• 11. Ma M, Wang L, Zhong X, Zhong L, Chen R, Li L, et al. Age and gender differences between carotid intima-media thickness and serum uric acid. Am J Cardiol 2022;172:137-43.
• 12. Theofilis P, Tsimihodimos V, Vordoni A, Kalaitzidis RG. Serum uric acid levels and cardiometabolic profile in middle-aged, treatment-naïve hypertensive patients. High Blood Press Cardiovasc Prev 2022;29:367-74.
• 13. Xiong J, Shao W, Yu P, Ma J, Liu M, Huang S, et al. Hyperuricemia is associated with the risk of atrial fibrillation independent of sex: a dose-response meta-analysis. Front Cardiovasc Med 2022;9:865036.
• 14. Tavil Y, Sen N, Hizal F, Açikgöz SK, Taşoğlu I, Topal S, et al. Relationship between elevated levels of serum uric acid and saphenous vein graft disease. Turk Kardiyol Dern Ars 2008;36:14-8.
• 15. Sirtori CR, Corsini A, Ruscica M. The role of high-density lipoprotein cholesterol in 2022. Curr Atheroscler Rep 2022;24:365-77.
• 16. White J, Swerdlow DI, Preiss D, Fairhurst-Hunter Z, Keating BJ, Asselbergs FW, et al. Association of lipid fractions with risks for coronary artery disease and diabetes. JAMA Cardiol 2016;1:692-9.
• 17. Rubins HB, Robins SJ, Collins D, Iranmanesh A, Wilt TJ, Mann D, et al. Distribution of lipids in 8,500 men with coronary artery disease. Department of Veterans Affairs HDL Intervention Trial Study Group. Am J Cardiol 1995;75:1196-201.
• 18. Jerzewski K, Ruel M, Voisine P, Le May MR, Kulik A. Does high-density lipoprotein influence the development of saphenous vein graft disease after coronary bypass surgery?: exploratory analysis from the CASCADE trial. J Cardiothorac Surg 2013;8:172.
• 19. Kosekli MA, Kurtkulagii O, Kahveci G, Duman TT, Tel BMA, Bilgin S, et al. The association between serum uric acid to high density lipoprotein-cholesterol ratio and non-alcoholic fatty liver disease: the abund study. Rev Assoc Med Bras (1992) 2021;67:549-54.
• 20. Liu R, Peng Y, Wu H, Diao X, Ye H, Huang X, et al. Uric acid to high-density lipoprotein cholesterol ratio predicts cardiovascular mortality in patients on peritoneal dialysis. Nutr Metab Cardiovasc Dis 2021;31:561-9.
• 21. Aktas G, Khalid A, Kurtkulagi O, Duman TT, Bilgin S, Kahveci G, et al. Poorly controlled hypertension is associated with elevated serum uric acid to HDL-cholesterol ratio: a cross-sectional cohort study. Postgrad Med 2022;134:297-302.
• 22. Yayla C, Gayretli Yayla K. C-reactive protein to albumin ratio in patients with saphenous vein graft disease. Angiology 2021;72:770-5.
• 23. Zhao Q, Zhu Y, Xu Z, Cheng Z, Mei J, Chen X, et al. Effect of ticagrelor plus aspirin, ticagrelor alone, or aspirin alone on saphenous vein graft patency 1 year after coronary artery bypass grafting: a randomized clinical trial. JAMA 2018;319:1677-86.
• 24. Yavuz S, Engin M, Yazgan E, Demir OF, Turk T. Letter: potential predictors of saphenous vein graft disease after coronary artery bypass operations. Angiology 2022;73:689-90.
• 25. Bayam E, Öztürkeri B, Yıldırım E, Kalçık M, Küp A, Çakmak EÖ, et al. The relationship between dual antiplatelet treatment (DAPT) score and saphenous venous grafts patency after coronary artery bypass grafting surgery. Acta Cardiol 2021;76:785-91.
• 26. Taşoğlu I, Turak O, Nazli Y, Ozcan F, Colak N, Sahin S, et al. Preoperative neutrophil-lymphocyte ratio and saphenous vein graft patency after coronary artery bypass grafting. Clin Appl Thromb Hemost 2014;20:819-24.