Traditional Chinese Medicine Constitution Types and Apolipoprotein B in Hyperuricemia: Associations with Cardiovascular Risk
TCM Types and Apo B in Hyperuricemia
Abstract
Background: To explore the correlation between different traditional Chinese medicine (TCM) constitution types and apolipoprotein B (ApoB) in patients with hyperuricemia (HUA), and to investigate the relationships between TCM constitutions, uric acid levels, and various cardiovascular risk factors.
Methods: A cross-sectional study involving 683 patients diagnosed with HUA was conducted. Patients' TCM constitutions were classified using the standardized "Classification and Determination of TCM Constitution" questionnaire. Serum uric acid (UA), lipid profiles, ApoB, and homocysteine (Hcy) levels were measured.
Results: Among 683 HUA patients, phlegm-dampness (22.99%) and damp-heat constitution (20.06%) were the most common TCM constitution types. UA, ApoB, and Hcy levels in patients with phlegm-damp constitution were significantly higher than those in other constitutions (P<0.05). UA levels were negatively correlated with HDL-C (r=-0.472, P=0.027) and positively correlated with ApoB (r=0.618, P=0.012), and Hcy (r=0.492, P=0.018). Male gender, BMI, ApoB, Hcy, and phlegm-dampness constitution are independent factors associated with UA levels. Patients with high ApoB levels had a significantly higher incidence of cardiovascular diseases compared to those with low ApoB levels (male: 42.73% vs 22.81%, P<0.001; female: 37.82% vs 25.21%, P=0.036). Logistic regression analysis revealed that phlegm-dampness constitution (OR=2.18, 95% CI: 1.42-3.35, P<0.001) and damp-heat constitution (OR=1.86, 95% CI: 1.21-2.87, P=0.005) were independently associated with increased risk of cardiovascular diseases.
Conclusion: Phlegm-damp and damp-heat constitutions are the most common TCM constitution types in HUA patients and are associated with higher levels of UA, ApoB, and Hcy. These constitution types are independently associated with increased cardiovascular risk.
References
2. Zhu Y, Pandya BJ, Choi HK. Prevalence of gout and hyperuricemia in the US general population: the National Health and Nutrition Examination Survey 2007-2008. Arthritis Rheum 2011; 63(10): 3136-41.
3. Dehlin M, Jacobsson L, Roddy E. Global epidemiology of gout: prevalence, incidence, treatment patterns and risk factors. Nat Rev Rheumatol 2020; 16(7): 380-90.
4. Li C, Hsieh MC, Chang SJ. Metabolic syndrome, diabetes, and hyperuricemia. Curr Opin Rheumatol 2013; 25(2): 210-6.
5. Saito Y, Tanaka A, Node K, Kobayashi Y. Uric acid and cardiovascular disease: A clinical review. J Cardiol 2021; 78(1): 51-7.
6. Chen-Xu M, Yokose C, Rai SK, Pillinger MH, Choi HK. Contemporary Prevalence of Gout and Hyperuricemia in the United States and Decadal Trends: The National Health and Nutrition Examination Survey, 2007-2016. Arthritis Rheumatol 2019; 71(6): 991-9.
7. Liu R, Han C, Wu D, Xia X, Gu J, Guan H, et al. Prevalence of Hyperuricemia and Gout in Mainland China from 2000 to 2014: A Systematic Review and Meta-Analysis. Biomed Res Int 2015; 2015: 762820.
8. Borghi C, Agabiti-Rosei E, Johnson RJ, Kielstein JT, Lurbe E, Mancia G, et al. Hyperuricaemia and gout in cardiovascular, metabolic and kidney disease. Eur J Intern Med 2020; 80: 1-11.
9. Kanbay M, Jensen T, Solak Y, Le M, Roncal-Jimenez C, Rivard C, et al. Uric acid in metabolic syndrome: From an innocent bystander to a central player. Eur J Intern Med 2016; 29: 3-8.
10. Peng TC, Wang CC, Kao TW, Chan JY, Yang YH, Chang YW, et al. Relationship between hyperuricemia and lipid profiles in US adults. Biomed Res Int 2015; 2015: 127596.
11. Chen L, Luo Z, Wang M, Cheng J, Li F, Lu H, et al. The Efficacy and Mechanism of Chinese Herbal Medicines in Lowering Serum Uric Acid Levels: A Systematic Review. Front Pharmacol 2020; 11: 578318.
12. Wang J, Li Y, Ni C, Zhang H, Li L, Wang Q. Cognition research and constitutional classification in Chinese medicine. Am J Chinese Med 2011; 39(4): 651-60.
13. Huang TY, Ou SC, Huang WT, Lin YC, Hung HH, Chang CW, et al. Validation of the constitution in Chinese medicine questionnaires with the newly developed blood-vacuity category: a rare Taiwanese case study. Adv Tradit Med 2024; 24(4): 1205-13.
14. Sun Y, Liu P, Zhao Y, Jia L, He Y, Xue SA, et al. Characteristics of TCM constitutions of adult Chinese women in Hong Kong and identification of related influencing factors: a cross-sectional survey. J Transl Med 2014; 12: 140.
15. Li Y, Li XH, Huang X, Yin L, Guo CX, Liu C, et al. Individualized prevention against hypertension based on Traditional Chinese Medicine Constitution Theory: A large community-based retrospective, STROBE-compliant study among Chinese population. Medicine 2017; 96(46): e8513.
16. Wang J, Li Y, Ni C, Zhang H, Li L, Wang Q. Cognition research and constitutional classification in Chinese medicine. Am J Chinese Med 2011; 39(4): 651-60.
17. Li R, Kong D, Ye Z, Zong G, Hu K, Xu W, et al. Correlation of multiple lipid and lipoprotein ratios with nonalcoholic fatty liver disease in patients with newly diagnosed type 2 diabetic mellitus: A retrospective study. Front Endocrinol 2023; 14: 1127134.
18. Wang J, Ma Q, Li Y, Li P, Wang M, Wang T, et al. Research progress on Traditional Chinese Medicine syndromes of diabetes mellitus. Biomed Pharmacother 2020; 121: 109565.
19. Liu M, Cao B, Luo Q, Song Y, Shi Y, Cheng M, et al. A Gender-, Age-, and Weight Status-Specific Analysis of the High Prevalence of Hyperuricemia Among Chinese Children and Adolescents with Obesity. Diabet Metab Synd Ob 2024; 17: 381-91.
20. Shang H, Zhang L, Xiao T, Zhang L, Ruan J, Zhang Q, et al. Study on the differences of gut microbiota composition between phlegm-dampness syndrome and qi-yin deficiency syndrome in patients with metabolic syndrome. Front Endocrinol 2022; 13: 1063579.
21. Gherghina ME, Peride I, Tiglis M, Neagu TP, Niculae A, Checherita IA. Uric Acid and Oxidative Stress-Relationship with Cardiovascular, Metabolic, and Renal Impairment. Int J Mol Sci 2022; 23(6):
22. Ren W, Wang M, Liao J, Li L, Yang D, Yao R, et al. The Effect of Chinese Herbal Medicine Combined With Western Medicine on Vascular Endothelial Function in Patients With Hypertension: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Front Pharmacol 2020; 11: 823.
23. Johannesen C, Mortensen MB, Langsted A, Nordestgaard BG. Apolipoprotein B and Non-HDL Cholesterol Better Reflect Residual Risk Than LDL Cholesterol in Statin-Treated Patients. J Am Coll Cardiol 2021; 77(11): 1439-50.
24. Matos LC, Machado JP, Monteiro FJ, Greten HJ. Understanding Traditional Chinese Medicine Therapeutics: An Overview of the Basics and Clinical Applications. Healthcare-Basel 2021; 9(3): 257.
Copyright (c) 2025 Shuo Yang, Jinfeng Li, Hongli Zeng, Xueping Zhang, Deliang Xiong, Wenyi Tang, Bin Sun, Peng Yu, Xiaohong He, Weizheng Zhang
This work is licensed under a Creative Commons Attribution 4.0 International License.
The published articles will be distributed under the Creative Commons Attribution 4.0 International License (CC BY). It is allowed to copy and redistribute the material in any medium or format, and remix, transform, and build upon it for any purpose, even commercially, as long as appropriate credit is given to the original author(s), a link to the license is provided and it is indicated if changes were made. Users are required to provide full bibliographic description of the original publication (authors, article title, journal title, volume, issue, pages), as well as its DOI code. In electronic publishing, users are also required to link the content with both the original article published in Journal of Medical Biochemistry and the licence used.
Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.