# Elevated Uric Acid/Albumin Ratio Predicts Poor Coronary Collateral Circulation in Type 2 Diabetic Patients With Stable Coronary Artery Disease

## TL;DR

A high uric acid to albumin ratio is linked to poor heart blood flow in type 2 diabetes patients with stable heart disease.

## Contribution

The study shows that the uric acid/albumin ratio is a novel predictor of poor coronary collateral circulation in type 2 diabetic patients.

## Key findings

- Elevated UAR is independently associated with poor coronary collateral circulation in T2DM patients.
- UAR provides better prediction of poor collateral circulation than uric acid or albumin alone.
- The predictive value of UAR is stronger in patients with preserved kidney function.

## Abstract

The uric acid/albumin ratio (UAR) has been shown to correlate with coronary disease severity and clinical outcome. This study investigated the predictive value of UAR on coronary collateralization (CC) in patients with type 2 diabetes mellitus (T2DM) and stable coronary artery disease.

Serum levels of uric acid and albumin were determined and UAR was calculated in 1558 T2DM patients with chronic total occlusion of at least one major coronary artery. The degree of collaterals supplying to the distal occluded bed from the contra‐lateral vessel was graded by Rentrop scoring system.

Serum uric acid decreased and albumin increased gradually across Rentrop score 0 to 3, resulting in a higher UAR in patients with poor collaterals (Rentrop score 0 or 1) compared to those with good collaterals (Rentrop score 2 or 3) (9.74 [8.53–11.95] vs. 7.74 [6.61–8.84], p < 0.001). After adjusting for various confounders, elevated UAR was an independent factor for poor CC (adjusted OR 1.887, 95% CI 1.746–2.040, p < 0.001). UAR provided a better prediction for poor CC than uric acid and albumin alone (AUC 0.803 vs. 0.715 and 0.652; all p < 0.001). There existed an interaction between UAR and eGFR (p = 0.016); high UAR being associated with a greater risk (OR 2.253 vs. 1.776) and having a better predictive ability for poor CC (AUC 0.830 vs. 0.786; p = 0.041) in patients with eGFR ≥ 90 mL/min/1.73 m2 compared to those with eGFR < 90 mL/min/1.73 m2.

Elevated UAR predicts poor coronary collateral circulation in T2DM patients with stable coronary disease especially when renal function is preserved. These findings may help physicians better identify high‐risk patients and guide individualized management strategies.

ClinicalTrials.gov identifier: NCT06054126