Abstract 1646: Serum Uric Acid Predicts Progression of Coronary Artery Calcification in Adults With Type 1 Diabetes
Serum uric acid has been associated with cardiovascular and renal disease. We examined uric acid as a possible predictor of progression of coronary artery calcification (CAC) using data from the Coronary Artery Calcification in Type 1 Diabetes Study. CAC was measured by electron beam tomography twice at the baseline and twice at a follow-up 6.0±0.5 years later and averaged at each visit. The study population included 472 participants with type 1 diabetes (T1D) and 548 controls, free of coronary artery disease. Progression was defined by an increase in square-root transformed CAC volume of >2.5. In the entire group, CAC progressed in 369 participants (205 with T1D). Progressors were more frequently male, with T1D and with higher CAC at baseline than non-progressors. Uric acid levels were higher in progressors 5.6 (geometric mean) (3.1–11 mg/dl) than in non-progressors 5.1 (2.7–13.4 mg/dl), p <0.0001. Non diabetic subjects had higher levels 5.6 (2.9 –13.4 mg/dl) than T1D subjects 5.0 (2.7–11 mg/dl), p <0.0001. A stepwise multiple regression analysis was performed with a p<0.1 for entry and removal from the model (Table⇓). Model 1 including only variables statistically associated with CAC progression, suggested that serum uric acid was an independent predictor of CAC progression, especially in T1D patients. Adjustment for HbA1c and BMI (model 2), glomerular filtration rate (by Cockcroft-Gault formula or by Modification of Diet in Renal Disease equation) or serum creatinine did not diminish the strength of this association. However, adjustment for cystatin C (model 3) or urinary albumin/creatinin (AC) ratio (model 4) reduced the strength of the association between serum uric acid and CAC progression in T1D. In conclusion, elevated serum uric acid levels predict progression of coronary atherosclerosis and this relationship appears to be modified by renal function status.