Association of uric acid with stenosis of intracranial and extracranial arteries in elderly patients with cerebral infarction

  • Mimi LiEmail author
  • Yinhui Huang
  • Huasong Lin
  • Yafang Chen
Original Article



To determine whether uric acid (UA) and intracranial and extracranial atherosclerosis stenosis of elderly patients suffering from ischaemic stroke are inter-related.


Elderly patients with ischaemic stroke underwent computed tomography angiography (CTA) were enrolled between October 2015 and December 2017. We collected clinical assessment, image data, and laboratory tests, and divided patients into four groups: (1) intracranial stenosis atherosclerosis (ICAS) group, (2) combined intracranial and extracranial atherosclerosis stenosis (COAS) group, (3) extracranial carotid stenosis atherosclerosis (ECAS) group, and (4) non-cerebral stenosis atherosclerosis (NCAS) group. We used univariate and multiple logistic regression analyses to explore potential predictors.


We included 408 patients in this study, then divided them into elder group (n = 196) and young- and middle-aged group (n = 212). In old stroke patients, 72 cases (36.73%) were classified as the ICAS group, 45 cases (22.96%) as the COAS group, 21 cases (10.71%) as the ECAS group, and 58 cases (29.59%) as the NCAS group. The level of UA was comparatively higher (p = 0.033) in ICAS than in NCAS. Compared with the group which had only one stenosis artery, UA was substantially increased in patients with more than one stenosis intracranial artery (p < 0.001). With a multivariable analysis, UA was an independent predictor for intracranial stenosis of elderly patients (OR = 1.003, p = 0.042), but the relationship between extracranial artery stenosis and uric acid was negative.


Hyperuricaemia is a risk factor of intracranial artery stenosis rather than of ECAS in elderly patients with cerebral infarction.


Atherosclerotic Cerebral infarction Arterial stenosis Uric acid 


Compliance with ethical standards

This study was approved by the Ethics Committees of Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian Province, China. Informed consents were signed by patients or their family members.


  1. 1.
    Van den Wijngaard IR, Holswilder G, van Walderveen MA, Algra A, Wermer MJ, Zaidat OO, Boiten J (2016) Treatment and imaging of intracranial atherosclerotic stenosis: current perspectives and future directions. Brain Behav 6:536Google Scholar
  2. 2.
    Xu Y, Yuan C, Zhou Z, He L, Mi D, Li R, Cui Y, Wang Y, Wang Y, Liu G4, Zheng Z, Zhao X (2017) Co-existing intracranial and extracranial carotid artery atherosclerotic plaques and recurrent stroke risk: a three-dimensional multicontrast cardiovascular magnetic resonance study. J Cardiovasc Magn Reson 18:90CrossRefGoogle Scholar
  3. 3.
    Glantzounis GK, Tsimoyiannis EC, Kappas AM, Galaris DA (2005) Uric acid and oxidative stress. Curr Pharm Des 11:4145–4151CrossRefGoogle Scholar
  4. 4.
    Sciacqua A, Perticone M, Tassone EJ, Cimellaro A, Miceli S, Maio R, Sesti G, Perticone F (2015) Uric acid is an independent predictor of cardiovascular events in post-menopausal women. Int J Cardiol 197:271–275CrossRefGoogle Scholar
  5. 5.
    Liu M, Zhang SM, Rao ML; Cerebral vascular disease group of the Chinese Medical Association neurology branch. The 2010 Guidelines for the Chinese Diagnosis and Treatment of Acute Ischemic Stroke. Chin J Neurol 2010;43:146–153Google Scholar
  6. 6.
    Logallo N, Naess H, Idicula TT, Brogger J, Waje-Andreassen U, Thomassen L (2011) Serum uri acid: neuroprotection in thrombolysis. The Bergen NORSTROKE study. BMC Neurol 11:114CrossRefGoogle Scholar
  7. 7.
    Huang YH, Zhuo ST, Chen YF, Li MM, Lin YY, Yang ML, Chen ZJ, Cai RW (2013) Factors influencing clinical outcomes of acute ischemic stroke treated with intravenous recombinant tissue plasminogen activator. Chin Med J 126:4685–4690Google Scholar
  8. 8.
    Bos MJ, Koudstaal PJ, Hofman A, Witteman JC, Breteler MM (2006) Uric acid is a risk factor for myocardial infarction and stroke: the Rotterdam study. Stroke 37:1503–1507CrossRefGoogle Scholar
  9. 9.
    Wang Z, Lin Y, Liu Y, Chen Y, Wang B, Li C, Yan S, Wang Y, Zhao W (2016) Serum uric acid levels and outcomes after acute ischemic stroke. Mol Neurobiol 53:1753–1759CrossRefGoogle Scholar
  10. 10.
    Charan Reddy KV, Ghanekar J, Charan Reddy KV, Ghanekar J (2014) Prognostic significance of serum uric acid and mortality outcomes in patients with acute cerebrovascular ischemic stroke. Int J Stroke Res 2:6–14Google Scholar
  11. 11.
    Abuja PM (1999) Ascorbate prooxidant effects of urate in oxidation of human low density lipoprotein. FEBS Lett 446:305–308CrossRefGoogle Scholar
  12. 12.
    Kawamoto R, Tomita H, Oka Y, Kodama A, Ohtsuka N, Kamitani A (2005) Association between uric acid and carotid atherosclerosis in elderly persons. Inter Med 44:787–793CrossRefGoogle Scholar
  13. 13.
    Suarna C, Dean RT, May J, Stocker R (1995) Human atherosclerotic plaque contains both oxidized lipids and relatively large amounts of alpha-tocopherol and ascorbate. Arterioscler Thromb Vasc Biol 15:1616–1624CrossRefGoogle Scholar
  14. 14.
    Kanellis J1, Feig DI, Johnson RJ (2004) Does asymptomatic hyperuricaemia contribute to the development of renal and cardiovascular disease? An old controversy renewed. Nephrology (Carlton) 9:394–399CrossRefGoogle Scholar
  15. 15.
    Kang DH, Han L, Ouyang X, Kahn AM, Kanellis J, Li P, Feng L, Nakagawa T, Watanabe S, Hosoyamada M, Endou H, Lipkowitz M, Abramson R, Mu W, Johnson RJ (2005) Uric acid causes vascular smooth muscle cell proliferation by entering cells via a functional urate transporter. Am J Nephrol 25:425–433CrossRefGoogle Scholar
  16. 16.
    Mazzali M, Hughes J, Kim YG, Jefferson JA, Kang DH, Gordon KL, Lan HY, Kivlighn S, Johnson RJ (2001) Elevated uric acid increases blood pressure in the rat by a novel crystal-independent mechanism. Hypertension 38:1101–1106CrossRefGoogle Scholar
  17. 17.
    Li MM, Lin YY, Huang YH, Zhuo ST, Yang ML, Lin HS, Cai RW (2015) Association of apolipoprotein A1, B with stenosis of intracranial and extracranial arteries in patients with cerebral infarction. Clin Lab 59:1727–1735Google Scholar
  18. 18.
    Kumral E, Karaman B, Orman M, Kabaroglu C (2014) Association of uric acid and carotid artery disease in patients with ischemic stroke. Acta Neurol Scand 130:11–17CrossRefGoogle Scholar
  19. 19.
    Bang OY, Saver JL, Liebeskind DS, Pineda S, Yun SW, Ovbiagele B (2009) Impact of metabolic syndrome on distribution of cervicocephalic atherosclerosis: data from a diverse race-ethnic group. J Neurol Sci 284:40–45CrossRefGoogle Scholar
  20. 20.
    Lammie GA, Sandercock PA, Dennis MS (1999) Recently occluded intracranial and extracranial carotid arteries. Relevance of the unstable atherosclerotic plaque. Stroke 30:1319–1325CrossRefGoogle Scholar
  21. 21.
    D’armiento FP1, Bianchi A, de Nigris F, Capuzzi DM, D’Armiento MR, Crimi G, Abete P, Palinski W, Condorelli M, Napoli C (2001) Age-related effects on atherogenesis and scavenger enzymes of intracranial and extracranial arteries in men without classic risk factors for atherosclerosis. Stroke 32:2472–2479CrossRefGoogle Scholar
  22. 22.
    Malek AM, Alper SL, Izumo S (1999) Hemodynamic shear stress and its role in atherosclerosis. JAMA 282:2035–2042CrossRefGoogle Scholar
  23. 23.
    Wang Y, Zhao X, Liu L, Soo YO, Pu Y, Pan Y, Wang Y, Zou X, Leung TW, Cai Y, Bai Q, Wu Y, Wang C, Pan X, Luo B, Wong KS, CICAS Study Group (2014) Prevalence and outcomes of symptomatic intracranial large artery stenoses and occlusions in China. Stroke 45:663–669CrossRefGoogle Scholar
  24. 24.
    O’Donnell MJ, Xavier D, Liu L, Zhang H, Chin SL, Rao-Melacini P, Rangarajan S, Islam S, Pais P, McQueen MJ, Mondo C, Damasceno A, Lopez-Jaramillo P, Hankey GJ, Dans AL, Yusoff K, Truelsen T, Diener HC, Sacco RL, Ryglewicz D, Czlonkowska A, Weimar C, Wang X, Yusuf S; INTERSTROKE investigators. Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study. Lancet 2010;376:112–123Google Scholar

Copyright information

© Fondazione Società Italiana di Neurologia 2019

Authors and Affiliations

  1. 1.Department of NeurologySecond Affiliated Hospital of Fujian Medical UniversityQuanzhouChina
  2. 2.Department of NeurologyJinjiang Municipal HospitalJinjiangChina

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