Uric acid and serum lipids in cerebrovascular disease; 2. Uric acid--plasma lipid correlations.

A significant proportion of patients suffering from atherosclerotic coronary artery disease have elevated levels of lipid fractions in the blood (Schrade, Boehle, and Biegler, 1960; Albrink, Meigs, and Man, 1961; Albrink, 1962). Similar observations in patients with cerebrovascular disease have been sparse, and have yielded conflicting results. Of studies measuring serum cholesterol, Heyman, Nefzger, and Estes (1961) showed significantly higher cholesterol levels in patients with cerebral infarction than in patients with 'non-atherosclerotic illnesses'. Robinson, Higano, and Cohen (1963) described higher f lipoprotein cholesterol concentrations and fi:m lipoprotein ratios in patients with cerebral thrombosis than in matched controls. However, others have failed to demonstrate significant elevation of serum cholesterol in cerebral thrombosis (Meyer, Waltz, Hess, and Zak, 1959). Considering other serum lipids, Katsuki, Uzawa, Fujimi, Shiratsuchi, and Ito (1964) reported significantly higher triglyceride concentrations in patients with cerebrovascular disease than in normal controls. Feldman and Albrink (1964) studied 63 male patients, aged 37 to 73, with transient ischaemic attacks and with completed strokes. They found serum concentrations of cholesterol and triglycerides to be increased. The elevated triglyceride concentration was more closelyassociated with cerebrovascular disease than was the serum cholesterol concentration. Furthermore, arelatively highserum cholesterol was usually not associated with cerebrovascular disease unless the triglyceride was also elevated, while a low serum cholesterol concentration could be associated with cerebrovascular disease if the triglyceride was increased. This finding of a relationship between serum triglycerides and strokes, but less striking correlation with other lipid fractions, is in agreement with the findings of Katsuki et al. (1964) in Japanese subjects. In a related study (Pearce and Aziz, 1969), we have been able to show that about 25% of patients suffering from strokes have hyperuricaemia. This accords with the known predisposition to atherosclerosis observed in subjects suffering from gout (Bauer and Klemperer, 1947). Gertler, Gain, and Levine (1951) have shown that there is some relationship between serum cholesterol, lipid phosphorus, and uric acid in determining the occurrence of coronary artery disease. They were able to produce a simple formula relating these three fractions, and they produced an index (uric acid ratio) incorporating these observations which was effective in separating the coronary heart disease group from control subjects in 94% of cases. Against this background, the present study was designed to investigate the relationship of plasma uric acid and various lipid fractions in patients with cerebrovascular disease. The index mentioned above has been applied to these patients, and the values obtained for the various lipid fractions have been subjected to a statistical analysis, applying correlation coefficients calculated by a computer.