The findings indicate that each standard deviation increase in serum UA nearly tripled the odds of having high-risk plaques, with predictive models showing strong accuracy in identifying vulnerable lesions.
The study, published in BMJ Open Heart, was led by Dr. Xinguang Long and colleagues from the Cardiology Department at Yangzhongshi Renmin Yiyuan, Zhenjiang, Jiangsu, China. The researchers analyzed data from 1,411 outpatients who underwent coronary CT angiography (CCTA) to examine the link between serum UA and high-risk plaques (HRPs). HRPs were defined as plaques exhibiting at least two of the following characteristics: positive remodelling, low-attenuation plaque (LAP), napkin-ring sign, and spotty calcification.
The study led to the following notable findings:
- Higher serum uric acid (UA) levels were significantly associated with increased risk of high-risk plaques (HRPs) after adjusting for age, sex, type 2 diabetes, smoking, obstructive coronary artery disease, total plaque volume, and other plaque characteristics.
- Each standard deviation increase in serum UA nearly tripled the odds of having an HRP (OR 2.96).
- Receiver operating characteristic (ROC) analysis showed strong predictive ability of UA for HRPs, with an area under the curve (AUC) of 0.86.
- Subgroup analyses based on sex, diabetes, smoking, alcohol use, and Agatston score demonstrated consistent associations, with no significant effect modification.
The researchers emphasize that serum UA could serve as a practical biomarker for assessing coronary plaque instability, potentially aiding in risk stratification and management of patients with coronary artery disease (CAD). Incorporating UA measurement into routine clinical evaluations may enhance the prediction of high-risk plaques beyond traditional risk factors.
However, the study has several limitations. Being observational in nature, it cannot fully exclude residual confounding, although adjustments were made for multiple factors. The study focused on outpatients, excluding those with acute myocardial infarction, which may limit generalizability. Additionally, the identification of HRPs relied on expert interpretation of CCTA images, and family history data were not included. The researchers suggest that future prospective studies with follow-up are needed to evaluate the ability of serum UA to predict clinical events such as plaque rupture and acute coronary syndromes.
"The study demonstrates that elevated serum uric acid is an independent predictor of high-risk coronary plaques on CCTA. Measuring UA levels may improve the identification of patients at higher risk of cardiovascular events and guide more targeted preventive strategies, highlighting the potential of UA as a simple and informative biomarker in clinical practice," the authors concluded.
Long X, Jing Y, Haitao Z. Association between serum uric acid and high-risk plaques assessed by coronary CT angiography. Open Heart. 2025;12:e003579. https://doi.org/10.1136/openhrt-2025-003579
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