title: Uric acid in cachectic and noncachectic patients with chronic heart failure: relationship to leg vascular resistance.
abstract: BACKGROUND
  Chronic heart failure (CHF) is a hyperuricemic state, and capillary endothelium is the predominant site of xanthine oxidase in the vasculature. Upregulated xanthine oxidase activity (through production of toxic free radicals) may contribute to impaired regulation of vascular tone in CHF. We aimed to study the relationship between serum uric acid levels and leg vascular resistance in patients with CHF with and without cachexia and in healthy control subjects.
  
  
  METHODS
  In 23 cachectic and 44 noncachectic patients with CHF (age, 62 +/- 1 years, mean +/- SEM) and 10 healthy control subjects (age, 68 +/- 1 years), we assessed leg resting and postischemic peak vascular resistance (calculated from mean blood pressure and leg blood flow by venous occlusion plethysmography).
  
  
  RESULTS
  Cachectic patients, compared with noncachectic patients and control subjects, had the highest uric acid levels (612 +/- 36 vs 459 +/- 18 and 346 +/- 21 micromol/L, respectively, both P <.0001) and the lowest peak leg blood flow and vascular reactivity (reduction of leg vascular resistance from resting to postischemic conditions: 83% vs 88% and 90%, both P <.005). In all patients, postischemic vascular resistance correlated significantly and independently of age with uric acid (r = 0.61), creatinine (r = 0.47, both P <.0001), peak VO2 (r = 0.34), and New York Heart Association class (r = 0.33, both P <.01). This correlation was not present in healthy control subjects (r = -0.04, P =.9). In multivariate and stepwise regression analyses, serum uric acid emerged as the strongest predictor of peak leg vascular resistance (standardized coefficient = 0.61, P <.0001) independent of age, peak VO2, creatinine, New York Heart Association class, and diuretic dose.
  
  
  CONCLUSIONS
  Hyperuricemia and postischemic leg vascular resistance are highest in cachectic patients with CHF, and both are directly related independent of diuretic dose and kidney function. The xanthine oxidase metabolic pathway may contribute to impaired vasodilator capacity in CHF.
authors.affiliation: Clinical Cardiology, National Heart and Lung Institute, Imperial College School of Medicine, London, UK. w.doehner@ic.ac.uk
authors.forename: W
authors.initials: W
authors.lastname: Doehner
authors.forename: M
authors.initials: M
authors.lastname: Rauchhaus
authors.forename: V G
authors.initials: VG
authors.lastname: Florea
authors.forename: R
authors.initials: R
authors.lastname: Sharma
authors.forename: A P
authors.initials: AP
authors.lastname: Bolger
authors.forename: C H
authors.initials: CH
authors.lastname: Davos
authors.forename: A J
authors.initials: AJ
authors.lastname: Coats
authors.forename: S D
authors.initials: SD
authors.lastname: Anker
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D001783:Blood Flow Velocity; D001794:Blood Pressure; D002100:Cachexia / Q000097:blood / Q000209:etiology / Q000503:physiopathology*; D016001:Confidence Intervals; D006333:Heart Failure / Q000097:blood / Q000150:complications / Q000503:physiopathology*; D006801:Humans; D007866:Leg / Q000098:blood supply*; D008875:Middle Aged; D012720:Severity of Illness Index; D014527:Uric Acid / Q000097:blood*; D014655:Vascular Resistance / Q000502:physiology; D014969:Xanthine Oxidase / Q000097:blood
chemical_list: D015415:Biomarkers; D014527:Uric Acid; D014969:Xanthine Oxidase