Uric Acid to Albumin Ratio,A Novel Biomarker of Cardiovascular Disease

Dear editor

We read with great interest the article entitled “Relation Between Serum Uric Acid to Albumin Ratio and Severity of Chronic Coronary Artery Disease” by Yalcinkaya et al. ¹ We congratulate the authors and would like to discuss some points about the relationship between uric acid (UA) to albumin ratio (UAR) and cardiovascular disease (CVD).

Yalcinkaya et al. divided patients with coronary artery disease (CAD) into high and low Syntax score (SS) groups. ¹ UAR was significantly higher in the high SS group. They also found that UAR above 1.34 was an independent predictor of high SS with an odds ratio of 3.86 (95% confidence interval: 2.39-6.23 P < .05). They concluded that UAR is an independent predictor of CAD severity.

Interestingly, Li and colleagues ² reported that UAR was independently correlated with long-term cardiac mortality in patients with unstable angina pectoris treated by percutaneous coronary intervention (PCI). Similarly, a study by Çınar and colleagues ³ showed that UAR has a predictive value of no-reflow in ST elevation myocardial infarction patients. Furthermore, study by Selçuk et al. demonstrated UAR to be an independent predictor of new onset AF in patients with ST-elevation myocardial infarction. ⁴ These findings suggested that UAR may be a beneficial tool to be used in the risk evaluation of CAD.

The mechanisms by which UAR participates in CAD and affect the severity of coronary artery remain unclear. High UA levels may be associated with the activation of the renin-angiotensin system, the inhibition of nitric oxide system, as well as enhancing oxidative stress. ⁵ Also, albumin involves a series of biological functions in the body, including antioxidant and anti-inflammatory properties. ⁶ All of these is involved in the process of atherosclerosis. We infer that the real mechanisms may be multifactorial.

In summary, the work by Yalcinkaya et al. ¹ demonstrated that UAR is a useful tool to be used in the risk stratification of CAD. Further studies on the mechanisms of UAR in affecting CAD are warranted.