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The aim of the study was to assess the independent contribution of hyperuricemia to coronary artery disease (CAD) confirmed by coronary angiography (CAG), and to explore associations between serum uric acid (SUA) level and CAD.We performed a retrospective cohort study of 5069 patients who underwent CAG. Patients were divided into groups: hyperuricemia (n = 1178) versus nonhyperuricemia (n = 3891) and CAD (n = 3433) versus non-CAD (n = 1636).The incidence of CAD was higher in the hyperuricemia group than in the nonhyperuricemia group (71.5% vs 66.6%, P = .002). Hyperuricemia and CAD were significantly correlated in women (odds ratio = 1.509, 95% confidence interval, 1.106–2.057, P = .009). And there were trends, higher SUA quartiles were associated with higher percentage of CAD (62.3%, 68.0%, 68.9%, and 71.7% for quartiles 1, 2, 3, and 4, respectively, P < .001), and the incidence of 3-vessel disease increased (25.2%, 26.4%, 27.2%, and 31.1% for quartiles 1, 2, 3, and 4, respectively, P = .001) and that of normal vessel decreased (37.7%, 32.0%, 31.1%, and 28.3% for quartiles 1, 2, 3, and 4, respectively, P < .001) across quartiles, these trends were found in female group, but not in male group. The SUA level significantly increased as the number of diseased vessels increased (P < .001).There was an independent correlation between hyperuricemia and CAD in women. A higher SUA level was associated with a higher incidence of 3-vessel disease in women.