Metabolic and renal predictors of coronary artery calcification: the independent role of the uric acid/estimated glomerular filtration rate (UA/eGFR) ratio and Castelli indices

<p><strong>ABSTRACT</strong></p> <p><strong>Aim </strong>To examine the association between metabolic parameters and novel cardiometabolic indices with the coronary artery calcium score (CACS).</p> <p><strong>Methods: </strong>This retrospective cross-sectional study included 130 patients who underwent coronary computed tomography angiography (CCTA) at the Radiology Clinic of the Clinical Centre of the University of Sarajevo between January and June 2024.<strong> </strong>Patients were classified into two groups: those with CACS ≤100 and those with CACS >100.<strong> </strong>Platelet count, mean platelet volume (MPV), estimated glomerular filtration rate (eGFR), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), uric acid (UA), and novel cardiometabolic indices, including Castelli risk index I and II (CRI-I and CRI-II), non-high-density lipoprotein cholesterol (non-HDL-C), were compared between the groups.</p> <p><strong>Results </strong>Patients with CACS >100 had significantly higher MPV, TC, LDL-C, UA, non-HDL-C, CRI-I, CRI-II, and the UA/eGFR ratio. Older age, increased platelet activity, dyslipidemia, hyperuricemia, and the higher UA/eGFR ratio correlated positively with CACS, whereas eGFR correlated negatively. In multivariate regression analysis, the UA/eGFR ratio emerged as an independent predictor of higher CACS (OR = 2.37; 95% CI 1.18–4.78; p=0.017).</p> <p><strong>Conclusion </strong>Elevated UA levels and adverse cardiometabolic indices are associated with greater coronary artery calcification. The UA/eGFR ratio independently predicts higher CACS, highlighting its potential prognostic value.</p> <p><strong>Keywords: </strong>coronary angiography, glomerular filtration rate, uric acid, vascular calcification</p>