Uric Acid for Cardiovascular Risk: Dr. Jekyll or Mr. Hide?

Area of Science:

• Biochemistry
• Cardiology
• Nephrology

Background:

• Uric acid (UA) functions as an endogenous antioxidant but high concentrations are linked to cardiovascular disease (CVD) and renal dysfunction.
• The dual role of UA as an antioxidant or pro-oxidant depends on its concentration and microenvironment.
• Existing patient data on hyperuricemia's role in CVD is controversial, with ongoing debate about its causative impact.

Purpose of the Study:

• To explore the controversial role of uric acid in cardiovascular disease.
• To investigate the potential of uric acid as a cardiovascular risk marker, especially in women.
• To identify critical uric acid thresholds indicating a shift from protective to harmful effects.

Main Methods:

• Review of experimental, in vitro, and patient data regarding uric acid levels and cardiovascular outcomes.
• Analysis of existing evidence on the mechanisms linking uric acid to oxidative stress, inflammation, and endothelial injury.
• Examination of gender-related differences in uric acid's association with CVD.

Main Results:

• Evidence suggests uric acid may be a more significant CVD indicator in women, requiring further study.
• The transition of uric acid from a protective to a harmful agent requires identification of specific thresholds.
• Uric acid is an accessible, inexpensive biomarker easily obtainable during hospitalization.

Conclusions:

• Uric acid is a readily available biomarker with potential as an additive cardiovascular risk marker.
• Progressive elevation of uric acid above 6 mg/dL may signal increased cardiovascular risk.
• Further investigation into gender-specific thresholds and the UA "biological shift" is warranted.