The Complex Relationship Between Serum Uric Acid, Endothelial Function and Small Vessel Remodeling in Humans

Stefano Masi, Georgios Georgiopoulos, George Alexopoulos, Konstantinos Pateras, Javier Rosada, Gino Seravalle, Carolina De Ciuceis, Stefano Taddei, Claudio Borghi, Guido Grassi, Damiano Rizzoni, Agostino Virdis, The Study Groups On The Uric Acid Right For heArt Health Urrah, Micro-And Macro-Circulation Of The Italian Society Of Hypertension Siia

Research output: Contribution to journalArticlepeer-review


AIMS: The relationship between serum uric acid (SUA) and microvascular remodeling in humans remains largely unexplored. We assessed whether SUA provides additional information on the severity of microvascular remodeling than that obtained from the European Heart Score (HS), the patterns of microvascular remodeling associated with changes in SUA levels and the mediation by endothelial function and nitric oxide (NO) availability on this relationship.

METHODS: A total of 162 patients included in the microvascular dataset of the Italian Society of Hypertension with available information on SUA, media-to-lumen (M/L) ratio, media cross-sectional area (MCSA), endothelial function, NO availability and HS were included in the analysis. The top tertile of M/L ratio and MCSA were used to define severe microvascular remodeling.

RESULTS: A U-shaped association was observed between SUA and both M/L ratio and MCSA. Adjustment for HS did not affect these associations. SUA was able to reclassify a significant number of subjects without, and with, severe M/L ratio and MCSA remodeling over the HS alone. The microvascular remodeling associated with SUA levels presented a predominant hypertrophic pattern. SUA was inversely associated with endothelial function and NO availability. Structural equation modeling analysis controlling for the HS suggested that the association of SUA with M/L ratio and MCSA was mediated through changes in endothelial function and NO availability.

CONCLUSIONS: The addition of SUA to the HS improves the identification of subjects with greater microvascular remodeling. The relationship between SUA and microvascular remodeling is mediated by endothelial function and NO availability.

Original languageEnglish
JournalJournal of Clinical Medicine
Issue number7
Publication statusPublished - Jun 28 2020


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