Harikrishnan J¹, Sujatha S^2*

{¹Assistant Professor, Department of General Medicine} {²Assistant Professor, Department of Community Medicine}

Chengalpattu Medical College and Hospital, Chengalpattu, INDIA.

Email: jharikrishnan81@gmail.com

RESULTS

Table 1: Descriptive Statistics of the Acute Ischemic Stroke Patients

Figure 1: Serum Uric acid Levels in Acute Ischemic Stroke Patients

Table 2: Association Between SUA level and CVA

*P value <0.05 is taken as statistically significant

Table 3: Association of Serum Uric Acid levels with risk factors of Acute Ischemic Stroke

*P value <0.05 is taken as statistically significant

The study revealed the strong association between the high serum uric acid levels and Cerebro Vascular Accident (p=0.000*), and various risk factors like Diabetes Mellitus(p=0.007*), Systemic Hypertension(p=0.042*), Coronary Artery Disease(p=0.029*), elevated LDL(p=0.046*) and Total Cholesterol levels(p=0.002*).

DISCUSSION

The study molecule Serum uric acid(SUA) cause stimulation of renin-angiotensin-aldosterone system and may contribute to the development of CAD apart from development of renal vascular constriction. In this study, there was a significant increase in the serum uric acid levels in acute ischemic stroke patients and the elevated SUA levels are strongly associated with the risk factor Coronary Artery Disease which was similar to the findings of the study done by Zhang et al in 2014³. In Diabetes Mellitus patients, SUA cause mitochondrial oxidative stress leads to fatty liver. This results in insulin resistance (IR) - Hepatic Effect; SUA in adipocytes promotes NADPH oxidase that cause lipid oxidation and release super oxide radicals, MCP1 and also reduces adiponectin. This results in increased IR and leptin overexpression in visceral fat-Adipose Effect. SUA cause reduced nitric oxide by blocking L-arginine results in IR and endothelial cell dysfunction- Vascular Effect SUA promote macrophage induced hyalinosis cause islet cell destruction by pro-inflammatory substances and results in type 2 DM- Islet Cell Effects. SUA block the ability of insulin to deliver glucose to skeletal muscle -Muscle effect. In this study the risk factor Diabetes Mellitus also has significant association with elevated SUA levels which was very similar to the study done by Bhole et al 2010⁴ The increase in the prevalence of hyperuricemia cases and the accumulated evidence that hyperuricemia increases the risk for hypertension (HT) onset and lack of optimal blood pressure (BP) control. Hyperuricemia leads to the increase in BP values by stimulating oxidative stress and inflammatory mechanisms through endothelial dysfunction and proliferation of smooth muscle cells in the blood vessels and stimulation of the Renin-Angiotensin-Aldosterone-System. SUA also cause Arteriolar wall thickening leading to Hypertension. In this study, there is a significant association between the Hypertension status and the Elevated SUA levels which was very identical to the study done by Roxana et al 2018.⁵ This study shows similar results of study done by Devajit et al 2013⁶ of significant association of elevated SUA levels with high Total Cholesterol. Due to the high prevalence of hyperuricemia in patients with acute stroke, and its accompanying increase in triglyceride and LDL cholesterol levels, it can be considered as a risk factor for acute stroke. In this study there was a strong association between Elevated LDL levels and elevated SUA levels and this study finding is similar to the study done by Masoud et al 2012⁷. Serum uric acid, the strong anti oxidant, under certain circumstances like absence of other anti-oxidants may act as pro-oxidant. Thus serum uric acid may be taken as a marker of elevated risk of cerebrovascular accident. The NHANES study concluded that uric acid is an independent risk factor for development of cardiovascular and cerebrovascular diseases⁸. Weir et al 2003 who studied 3731 patients and measured serum urate in 2498 reported that elevated urate level predict a lower chance of good 90-day outcome independent of stroke severity and other prognostic factor⁹. Serum uric acid may have a direct role in the atherosclerotic process, because human atherosclerotic plaque contains more uric acid than do control arteries. Inflammation is one of the features of atherosclerosis, and uric acid crystals may induce inflammatory responses that are reduced by lipoproteins which have an ability to bind uric acid crystals. Hyperuricemia may also promote thrombus formation.¹⁰

CONCLUSION

This study shows that elevated SUA is strongly associated with an increased risk for the development of acute ischemic/ non-embolic stroke in this study population. SUA is the substance with both anti inflammatory and pro-inflammatory activity. Elevated SUA can be considered as one of the risk factors for acute ischemic non-embolic stroke and also it is found to be strongly associated with various risk factors of non-communicable diseases. Lowering of SUA level can be considered as one of the preventive modalities for stroke while treating high risk population. It is also suggested that further studies are required to assess whether lowering of SUA level with drugs can actually reduce the risk of ischemic stroke. SUA is associated with all the risk factors of cerebrovascular disease, this study could be used to support the evidence that serum uric acid may be used as a early marker for development of cerebrovascular disease

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