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Serum uric acid and cardiovascular risk: state of the art and perspectives
Goël Fenech1, Gérald Rajzbaum2, Mikaël Mazighi3
1Paris Descartes University, Faculty of Medicine, AP-HP, Diagnosis and Therapeutic Center, Hôtel-Dieu University Hospital, place du Parvis-Notre-Dame, Paris, France.
Insights
High serum uric acid (SUA) is linked to cardiovascular disease, but its causal role remains debated. Further research and therapeutic trials are needed to clarify SUA
Area of Science:
- Cardiovascular Medicine
- Nephrology
- Metabolic Diseases
Background:
- Hyperuricemia, or high serum uric acid (SUA), is frequently observed in patients with cardiovascular disease (CVD).
- The precise role of SUA in CVD pathogenesis is controversial, with evidence suggesting it may be a marker or a causal factor.
- SUA's biological activity and potential role in atherogenesis are under investigation, with complex interactions with established cardiovascular risk factors.
Purpose of the Study:
- To review the association between serum uric acid and cardiovascular risk factors.
- To explore potential mechanisms linking SUA to cardiovascular events.
- To discuss the need for therapeutic trials to establish causality and evaluate urate-lowering treatments in CVD.
Main Methods:
- Literature review of studies examining the relationship between SUA and cardiovascular disease.
- Analysis of existing data on SUA as a predictor of cardiovascular risk factors and events.
- Discussion of potential pathophysiological mechanisms and confounding factors.
Main Results:
- SUA is independently associated with cardiovascular risk factors like hypertension and metabolic syndrome.
- SUA may predict myocardial infarction and stroke, but its direct causative role in CVD is not definitively established.
- Limited data exist on the cardiovascular impact of urate-lowering therapies.
Conclusions:
- The link between hyperuricemia and cardiovascular disease is complex and warrants further investigation.
- Understanding the causative role of SUA in CVD is crucial for risk stratification and management.
- Designing collaborative therapeutic trials is essential to resolve the causality debate and explore treatment benefits.
Abstract:
Hyperuricaemia is commonly found in subjects with cardiovascular disease, but its role as risk factor is very controversial. Although several studies reported serum uric acid as a marker of an underlying pathophysiological process, other studies hypothesis a potential causal link between serum uric acid and cardiovascular diseases. Some studies suggest that uric acid is biologically active and may have an atherogenesis role in development of cardiovascular diseases, although the mechanisms are not fully understood. Other studies have shown that uric acid can independently predict the development of some cardiovascular risk factors such as hypertension and metabolic syndrome, as well as myocardial infarction and stroke. The relations between serum uric acid and established cardiovascular risk factors are complex, and these latter could be considered as confounding factors. In this report, we review the inextricably link of serum uric acid to known cardiovascular risk factors, and we describe the possible mechanisms and potential causative role between serum uric acid and cardiovascular events in the general population, in subjects with cardiovascular risk factors and in those with pre-existing cardiovascular diseases. Limited information however is available concerning the impact of urate-lowering treatments on cardiovascular events, whereas only a positive therapeutic trial could give definite answers to the difficult problem of causality of uric acid in relation to cardiovascular risk. Thus, it is time to propose the design of a therapeutic trial, integrating cardiologists and rheumatologists, in order to further decrease cardiovascular risk.
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