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The interaction between hyperuricemia and low-density lipoprotein cholesterol increases the risk of 1-year post-discharge all-cause mortality in ST-segment elevation myocardial infarction patients

Published:September 25, 2022DOI:https://doi.org/10.1016/j.numecd.2022.09.011

      Highlights

      • Hyperuricemia is associated with higher post-discharge mortality in STEMI patients.
      • Low-density lipoprotein cholesterol modified the prognostic role of uric acid.
      • Uric acid aids in risk stratification in STEMI patients with higher LDL-c levels.

      Abstract

      Background and aims

      Hyperuricemia is a known risk factor for cardiovascular diseases, but little is known on whether the association between hyperuricemia and poor outcomes in ST-segment elevation myocardial infarction (STEMI) is modified by low-density lipoprotein cholesterol (LDL-c). This study aimed to investigate the effect of the interaction between hyperuricemia and LDL-c on the risk of 1-year post-discharge all-cause mortality in STEMI patients.

      Methods and results

      A total of 1396 STEMI patients were included. Cox proportional hazards models were used to determine the association between hyperuricemia and 1-year all-cause mortality in the overall population and subgroups stratified based on LDL-c levels (<3.0 mmol/L or ≥3.0 mmol/L). Multivariate analysis indicated that hyperuricemia was associated with 1-year mortality (HR: 2.66; 95% CI: 1.30–5.47; p = 0.008). However, the prognostic effect of hyperuricemia was only observed in patients with LDL-c level ≥3.0 mmol/L (HR: 12.90; 95% CI: 2.98–55.77; p < 0.001), but not in those with LDL-c level <3.0 mmol/L (HR: 0.91, 95% CI: 0.30–2.79, p = 0.875). The interaction between hyperuricemia and LDL-c levels had a significant effect on 1-year mortality.

      Conclusion

      Hyperuricemia was associated with increased 1-year post-discharge mortality in patients with LDL-c level≥ 3.0 mmol/L, but not in those with LDL-c level< 3.0 mmol/L.

      Keywords

      Abbreviations:

      CAD (coronary artery disease), ACS (acute coronary syndrome), STEMI (ST-segment elevation myocardial infarction), SUA (Serum uric acid), CCU (cardiac care unit), HRs (hazard ratios), CI (confidence interval), PPCI (primary percutaneous coronary intervention), CABG (coronary artery bypass grafting), SBP (systolic blood pressure), DBP (diastolic blood pressure), EGFR (estimated glomerular filtration rate), HDL-c (high-density lipoprotein cholesterol), LDL-c (low-density lipoprotein cholesterol), Hs-cTnI (high-sensitivity troponin I), ACEI (angiotensin-converting enzyme inhibitor), ARB (angiotensin receptor blocker), XOR (xanthine oxidoreductase), MACE (major adverse cardiac events), sdLDL-c (small dense low-density lipoprotein-cholesterol)
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