587
Atherosclerosis, 24 (1976) 587-590 @ Elsevier Scientific Publishing Company, Amsterdam - Printed in The Netherlands
Short Communication
_____
THE EFFECT OF HYPOLIPIDAEMIC CONCENTRATION
THERAPY
ON SERUM URIC ACID
R.S. ELKELES Northwick Park Hospital and Clinical Research Centre, Watford Road, Harrow, Middlesex HA 1 3 UJ (Great Britain) (Received 30th March, 1976) (Accepted 26th April, 1976)
Summary
In a group of 10 patients with hypertriglyceridaemia, there was a significant fall in serum uric acid concentration with hypolipidaemic therapy. Initial serum uric acid correlated with ponderal index, but there was no relation between weight lost on treatment and fall in serum uric acid. Key words:
Hypertriglyceridaemia
- Hyperuricaemia
Introduction
An association between hypertriglyceridaemia and coronary heart disease has been shown in retrospective studies [1,2], while in a prospective study [3] hypertriglyceridaemia has been shown to be risk factor in the development of coronary heart disease. Hyperuricaemia has been shown to be a frequent finding in survivors of myocardial infarction [4] while a raised serum uric acid concentration has been shown to be associated~ with an increased incidence of coronary heart disease [5]. The association between hypertriglyceridaemia and hyperuricaemia has previously been described [6]. Patients with hypertriglyceridaemia have a high incidence of hyperuricaemia, while 84% of patients with gout in the same series [6] had hypertriglyceridaemia. Lowering serum uric acid concentration with probenecid or allopurinol in patients with gout had little effect of serum triglyceride [7]. The aim of this study was to find out whether lowering serum triglyceride in patients with hypertriglyceridaemia had any effect on serum uric acid.
588
Patients
and Methods
Serum uric acid concentration was studied in 10 consecutive patients with hypertriglyceridaemia referred to a metabolic clinic in whom it was possible effectively and consistently to lower serum triglyceride. After an overnight fast, on 2 occasions, venous blood samples were taken for the measurement of serum triglyceride, cholesterol and uric acid. Serum triglyceride was measured by an enzymatic method (Boehringer Corporation), and serum cholesterol by a standard Technicon autoanalyser enzymatic method (Boehringer Corporation). Serum uric acid was determined by an autoanalyser calorimetric method [8]. Clinical and biochemical details of the patients are shown in Table I. Four had pure endogenous hypertriglyceridaemia and 6 had mixed hyperlipidaemia [ 91. Secondary causes of hyperlipidaemia were excluded and all subjects had normal renal function. All subjects had a normal 50 g oral glucose tolerance test. Patients were then treated with a diet reduced in carbohydrate (depending on their previous carbohydrate intake), low in cholesterol content (< 300 mg/ day), and enriched in polyunsaturated fats. Patients 4, 5 and 7 also required theray with clofibrate (1 g b.d.). The repeat measurements described are those obtained when serum triglyceride was satisfactorily lowered and when the patient’s weight was steady. The time taken to achieve this was on average 6.5 months. One patient W.P. with known primary gout and who was found to have hyperlipidaemia is also reported, but classified separately. Results Six out of 10 patients with hypertriglyceridaemia had hyperuricaemia. There was a significant fall in serum triglyceride, uric acid, cholesterol and body weight in the group as a whole. Only one patient showed a rise in serum uric acid. There was a significant correlation between initial serum uric acid and between % ponderal index (r = 0.65, P < 0.05). There was no correlation weight loss and % fall in serum uric acid (r = 0.07). The following correlations were found not to be significant: serum uric acid and serum triglyceride (r = 0.52), % fall in serum uric acid and % fall in serum triglyceride (r = 0.33), serum uric acid and serum cholesterol (r = 0.28), % fall in serum uric acid and % fall in serum cholesterol (r = 0.49). Patient W.P., who had known primary gout, showed no reduction of serum uric acid when his serum triglyceride reached the normal range. He continued to have attacks of gout and was treated with allopurinol. Discussion Hyperuricaemia is common in patients with both hypertriglyceridaemia and mixed hyperlipidaemia [ 61. Patients with pure hypercholesterolaemia (Type IIa, W.H.O. classification) [lo] do not have an increased incidence of hyperuricaemia [ 11. Hyperuricaemia has been associated with obesity [6,11], though no correlation was found between degree of obesity and serum uric acid [ll]. In the patients reported here serum uric acid did correlate with ponderal index. However, none could be classified as markedly obese [ 121, and there was
TABLE
1
M/26
10
0.02
c P
Atherosclerosis, 24 (1976) 587-590 @ Elsevier Scientific Publishing Company, Amsterdam - Printed in The Netherlands
Short Communication
_____
THE EFFECT OF HYPOLIPIDAEMIC CONCENTRATION
THERAPY
ON SERUM URIC ACID
R.S. ELKELES Northwick Park Hospital and Clinical Research Centre, Watford Road, Harrow, Middlesex HA 1 3 UJ (Great Britain) (Received 30th March, 1976) (Accepted 26th April, 1976)
Summary
In a group of 10 patients with hypertriglyceridaemia, there was a significant fall in serum uric acid concentration with hypolipidaemic therapy. Initial serum uric acid correlated with ponderal index, but there was no relation between weight lost on treatment and fall in serum uric acid. Key words:
Hypertriglyceridaemia
- Hyperuricaemia
Introduction
An association between hypertriglyceridaemia and coronary heart disease has been shown in retrospective studies [1,2], while in a prospective study [3] hypertriglyceridaemia has been shown to be risk factor in the development of coronary heart disease. Hyperuricaemia has been shown to be a frequent finding in survivors of myocardial infarction [4] while a raised serum uric acid concentration has been shown to be associated~ with an increased incidence of coronary heart disease [5]. The association between hypertriglyceridaemia and hyperuricaemia has previously been described [6]. Patients with hypertriglyceridaemia have a high incidence of hyperuricaemia, while 84% of patients with gout in the same series [6] had hypertriglyceridaemia. Lowering serum uric acid concentration with probenecid or allopurinol in patients with gout had little effect of serum triglyceride [7]. The aim of this study was to find out whether lowering serum triglyceride in patients with hypertriglyceridaemia had any effect on serum uric acid.
588
Patients
and Methods
Serum uric acid concentration was studied in 10 consecutive patients with hypertriglyceridaemia referred to a metabolic clinic in whom it was possible effectively and consistently to lower serum triglyceride. After an overnight fast, on 2 occasions, venous blood samples were taken for the measurement of serum triglyceride, cholesterol and uric acid. Serum triglyceride was measured by an enzymatic method (Boehringer Corporation), and serum cholesterol by a standard Technicon autoanalyser enzymatic method (Boehringer Corporation). Serum uric acid was determined by an autoanalyser calorimetric method [8]. Clinical and biochemical details of the patients are shown in Table I. Four had pure endogenous hypertriglyceridaemia and 6 had mixed hyperlipidaemia [ 91. Secondary causes of hyperlipidaemia were excluded and all subjects had normal renal function. All subjects had a normal 50 g oral glucose tolerance test. Patients were then treated with a diet reduced in carbohydrate (depending on their previous carbohydrate intake), low in cholesterol content (< 300 mg/ day), and enriched in polyunsaturated fats. Patients 4, 5 and 7 also required theray with clofibrate (1 g b.d.). The repeat measurements described are those obtained when serum triglyceride was satisfactorily lowered and when the patient’s weight was steady. The time taken to achieve this was on average 6.5 months. One patient W.P. with known primary gout and who was found to have hyperlipidaemia is also reported, but classified separately. Results Six out of 10 patients with hypertriglyceridaemia had hyperuricaemia. There was a significant fall in serum triglyceride, uric acid, cholesterol and body weight in the group as a whole. Only one patient showed a rise in serum uric acid. There was a significant correlation between initial serum uric acid and between % ponderal index (r = 0.65, P < 0.05). There was no correlation weight loss and % fall in serum uric acid (r = 0.07). The following correlations were found not to be significant: serum uric acid and serum triglyceride (r = 0.52), % fall in serum uric acid and % fall in serum triglyceride (r = 0.33), serum uric acid and serum cholesterol (r = 0.28), % fall in serum uric acid and % fall in serum cholesterol (r = 0.49). Patient W.P., who had known primary gout, showed no reduction of serum uric acid when his serum triglyceride reached the normal range. He continued to have attacks of gout and was treated with allopurinol. Discussion Hyperuricaemia is common in patients with both hypertriglyceridaemia and mixed hyperlipidaemia [ 61. Patients with pure hypercholesterolaemia (Type IIa, W.H.O. classification) [lo] do not have an increased incidence of hyperuricaemia [ 11. Hyperuricaemia has been associated with obesity [6,11], though no correlation was found between degree of obesity and serum uric acid [ll]. In the patients reported here serum uric acid did correlate with ponderal index. However, none could be classified as markedly obese [ 121, and there was
TABLE
1
M/26
10
0.02
c P
