Objectives To assess the association between UA level and the prevalence, severity, plaque characteristics and calcium score (CACS) of coronary atherosclerosis in patients with suspected coronary artery disease undergoing 256-detector coronary computed tomography, and further assess in sex.
Methods A total of 1116 individuals with suspected CAD without known CAD were successful enrolled. The individuals were stratified into four groups according to their serum UA quartile in total, male and female, respectively. The baseline demographic and clinical characteristics of all population were collected, the prevalence, severity, characteristics and CACS of plaque were analysed by CCTA. The association the quartile of UA with the prevalence, severity, characteristics and CACS of plaque were assessed in total, male and female. The univariable and multivariable logistic regression were employ to find the association UA with significant stenosis, multivessel disease, high CACS and plaque characteristics in total, male and female.
Results In the study, 50.7% were men, the mean age was 58.05 ± 10.69 years. With increase in quartiles UA, the prevalence of any plaque in total and female significantly increased (Total: 56.8% vs 62.0% vs 70.0% vs 73.0%, p < 0.001; Female: 47.1% vs 57.7% vs 59.4% vs 69.8%, p = 0.002); the prevalence of significant stenosis in total and female significantly increased (Total: 25.5% vs 30.3% vs 39.6% vs 40.2 %, p < 0.001; Female: 16.9% vs 29.2% vs 30.4% vs 33.1%, p = 0.010); the prevalence of severe stenosis in total and female significantly increased (Total: 12.9% vs 18.2% vs 21.9% vs 25.6%, p = 0.001; Female: 8.1% vs 16.8% vs 17.4% vs 19.4%, p = 0.032). The incidence of double-vessel lesion only significantly increased with UA in female (9.6% vs 13.1% vs 14.5% vs 23.0%, p = 0.017). In the total and female, the proportions of triple vessel/left main artery lesion were highest in the fourth quartile (Total: 15.8% vs 19.3% vs 26.5% vs 28.8%, p < 0.001; Female: 13.2% vs 16.8% vs 24.6% vs 25.2%, p = 0.027). The prevalence of CACS = 0 decreased significantly as the quartiles of UA increases in total, male and female, the proportions of CACS = 0 in total, male and female at each UA quartiles were highest in the first quartile, and lowest in the fourth quartile (Total: 64.4% vs 59.1% vs 49.1% vs 46.6%, p < 0.001; Male: 55.7% vs 46.4% vs 41.0% vs 35.9%, p = 0.006; Female: 75.7% vs 72.3% vs 60.9% vs 51.8%, p < 0.001, respectively). When the analyses were made in CACS>10, increasing quartiles of UA were significantly associated with CACS > 10 in both total (30.6% vs 32.5% vs 41.7% vs 44.5%, p = 0.001) and female (22.1% vs 24.1% vs 31.2% vs 41.0%, p = 0.002). As the UA increases in female, the proportion of mixed plaques increased significantly (21.7% vs 22.7% vs 24.5% vs 30.5%, p = 0.022). After adjustment, UA was the significant predictor of significant stenosis (OR:1.004, 95% CI (1.001-1.007), P = 0.011), multivessel disease (OR:1.003, 95% CI (1.001-1.006), P < 0.001) and mixed plaque (OR:1.003, 95% CI (1.001-1.006), P = 0.015) in female; in total population, UA was only the strongest risk factor for mixed plaque (OR:1.002, 95% CI (1.001-1.003), P = 0.046).
Conclusions UA was the significant predictor of significant stenosis, multivessel disease and mixed plaque in female; UA was only the strongest risk factor for mixed plaque in total. however, UA was not a real independent risk factor for coronary atherosclerosis in male. The level of UA was significantly associated with coronary atherosclerosis of female but not male.