Serum uric acid, lipid profile and alkaline phosphatase levels in ischemic cerebrovascular accident patients

Gaurav Gupta, Saurabh Kishor, Aditya Kumar


Background: Stroke or cerebrovascular accident (CVA) is noted as the second cause of mortality, especially in the elderly population. Recent studies indicated that higher concentrations of uric acid are involved in various vascular diseases. The findings of previous investigations suggest that, elevated serum alkaline phosphatase (ALP) levels may have a pathophysiological character in the occurrence of atherosclerotic vascular disease (AVD) of the heart and brain. This study evaluated the association between serum uric acid (SUA) levels, serum lipid levels, serum alkaline phosphatase (ALP) levels, and changes in ischemic cerebrovascular accident patients.

Methods: All patients with Ischemic cerebrovascular accident age >50 years were included based on their clinical, laboratory, and radiological findings (including computed tomography (CT)/magnetic resonance imaging (MRI)) those admitted in our hospital. As control group 200 healthy individuals matched for sex and age were recruited from the same demographic area.

Result: Multiple logistic regression analysis findings proposed four components as significant predictors in ischemic cerebrovascular accident (serum uric acid, serum ALP, LDL and HDL. In this study, it was found, that patients with ischemic cerebrovascular accident had significant difference (p<0.001) in serum uric acid and serum ALP than normal patients (non-ischemic cerebrovascular accident patients).

Conclusions: Patients with ischemic cerebrovascular accident had significant difference (p<0.001) in SUA and serum ALP than normal patients (non-ischemic cerebrovascular accident patients). High SUA levels were observed to be associated significantly with ischemic stroke. On the basis of our study design, we cannot clarify that the elevated levels are the risk of ischemic stroke and it requires further studies.


Serum uric acid, Serum lipid, Serum ALP, Ischemic cerebrovascular accident

Full Text:



Smith WS, English JD, Johnston SC. Cerebrovascular diseases. In: Longo DN, Kasper DL, Jameson JL, Fauci AS, Hauser S.L, Loscalzo J, editors. Harrison's principles of internal medicine, 18th edn. USA: Mc graw hill medical. 2012;3270.

Feigin VL, Krishnamurthi RV, Parmar P, Norrving B, Mensah GA, Bennett DA et al. Update on the global burden of ischemic and hemorrhagic stroke in 1990-2013: the GBD 2013 study. Neuroepidemiology. 2015;45(3):161-76.

Leira Y, Seoane J, Blanco M, Rodriguez-Yanez M, Takkouche B, Blanco J et al. Association between periodontitis and ischemic stroke: a systematic review and meta-analysis. Eur J Epidemiol. 2017;32(1):43-53.

Kuman E, Karaman B, Orman M, Kabaroglu C. Association of uric acid and carotid artery disease in patients with ischemic stroke. Actaneurologica Scandinavica. 2014;130:11-7.

Kutzing MK, Firestein BL. Altered uric acid level and disease states. J Pharmacol Exp Therapeutics. 2008; 324:1-7.

Emmerson BT. The management of gout. N Engl J Med. 1996;334:445-51.

Steele TH. Hyperuricemic nephropathies. Nephron. 1999;81(1):45-49.

Harmey D, Hessle L, Narisawa S. Concerted regulation of inorganic pyrophosphate and osteopontin by akp2, enpp1, and ank: an integrated model of the patho-genesis of mineralization disorders. Am J Pathol. 2004;164:1199.

Kim J, Song T J, Song D. Serum alkaline phosphatase and phosphate in cerebral atherosclerosis and functional outcomes after cerebral infarction. Stroke. 2013;44:3547.

Ryu W S, Lee S H, Kim C K. Increased serum alkaline phosphatase as a predictor of long-term mortality after stroke. Neurology. 2010;75:1995-2002.

Pinart M, Kunath F, Lieb V, Tsaur I, Wullich B, Schmidt S., German Prostate Cancer Consortium (DPKK). Prognostic models for predicting overall survival in metastatic castration-resistant prostate cancer: a systematic review. World J Urol. 2020;38(3):613-35.

Van der Doelen MJ, Mehra N, Hermsen R, Janssen MJR, Gerritsen WR, Van Oort IM. Patient Selection for Radium-223 Therapy in Patients With Bone Metastatic Castration-Resistant Prostate Cancer: New Recommendations and Future Perspectives. Clin Genitourin Cancer. 2019;17(2):79-87.

Kabootari M, Raee MR, Akbarpour S, Asgari S, Azizi F, Hadaegh F. Serum alkaline phosphatase and the risk of coronary heart disease, stroke and all-cause mortality: Tehran Lipid and Glucose Study. BMJ Open. 2018;8(11):e023735.

Hong JM, Bang OY, Chung CS. Influence of recanalization on uric acid patterns in acute ischemic stroke. Cerebrovasc Dis. 2010;29(5):431-9.

Amaro S, Urra X, Gómez-Choco M, et al. Uric acid levels are relevant in patients with stroke treated with thrombolysis. Stroke. 2011;42(1):S28-32.

Kim SY, Guevara JP, Kim KM. Hyperuricemia and risk of stroke: a systematic review and metaanalysis. Arthritis Rheum 2009; 61(7):885-92.

Holme I, Aastveit AH, Hammar N, Jungner I, Walldius G. Uric acid and risk of myocardial infarction, stroke and congestive heart failure in 417,734 men and women in the Apolipoprotein Mortality RISk study (AMORIS). J Intern Med. 2009;266(6):558-70.

Kanellis J, Johnson RJ. Editorial comment-Elevated uric acid and ischemic stroke: accumulating evidence that it is injurious and not neuroprotective. Stroke. 2003;34(8):1956-7.

Proctor PH. Uric acid: neuroprotective or neurotoxic? Stroke. 2008; 39(5):e88.

Talebi A, Amirabadizadeh A, Nakhaee S, Ahmadi Z, Mirzaei SMM. Cerebrovascular disease: how serum phosphorus, vitamin D, and uric acid levels contribute to the ischemic stroke. BMC Neurol. 2020;20:116.

Koppula R, Kaul S, A Rao V, Jyothy A, Munshi A. Association of serum uric acid level with ischemic stroke, stroke subtypes and clinical outcome. Neurol Asia. 2013;18(4):349-353.

Jia H, Lia H, Liub Y, Liua C, Xue M. Elevated serum alkaline phosphatase as a predictor of cognitive impairment in patients with acute ischaemic stroke: A retrospective cohort study. Arch Gerontol Geriatrics. 2020;89:1-8.

Squadrito GL, Cueto R, Splenser AE. Reaction of uric acid with peroxynitrite and implications for the mechanism of neuroprotection by uric acid. Arch Biochem Biophys. 2000;376:333-7.

Waring WS. Uric acid: an important antioxidant in acute ischaemic stroke QJM. An Int J Med. 2002;95:691-93.

Chamorro A, Obach V, Cervera A. Prognostic significance of uric acid serum concentration in patients with acute ischemic stroke. Stroke. 2002;33:1048-52.

Weir C, Muir S, Walters M, Lees KR. Serum urate as an independent predictor of poor outcome and future vascular events after acute stroke. Stroke. 2003;34:1951-7.

Logallo N, Naess H, Idicula TT. Serum uric acid: neuroprotection in thrombolysis. The Bergen NORSTROKE study. BMC Neurol. 2011;11:114

Miedema I, Uyttenboogaart M, Koch M, Kremer B, de Keyser J, Luijckx GJ. Lack of association between serum uric acid levels and outcome in acute ischemic stroke. J Neurol Sci. 2012;319:51-5.

Brouns R, Wauters A, Van De Vijver G. Decrease in uric acid in acute ischemic stroke correlates with stroke severity, evolution and outcome. Clin Chem Lab Med. 2010;48(3):383-90.

Chen YC, Su CT, Wang ST, Lee HD, Lin SY. A preliminary investigation of the association between serum uric acid and impaired renal function. Chang Gung Med J. 2009; 32(1):66-71.