Uric Acid and Cardiovascular Disease

Hyperuricemia, a major metabolic abnormality following hyperglycemia, hypertension, and hyperlipidemia, represents a significant global public health issue. Complex pathological mechanisms can lead to hyperuricemia, which not only directly triggers gout but it is also closely involved with various chronic diseases, such as cardiovascular disease (CVD), diabetes, and chronic kidney disease, presenting a systemic risk to individual general and CV health. This metabolic disorder arises mainly from excessive uric acid (UA) production or compromised excretion that results in abnormal elevation of UA in extracellular fluids and tissues, leading to the emergence of gout, kidney diseases, and CV disorders. It may reflect residual risk in CVD patients, conferring a poor prognosis in these patients even when they attain control of the low-density lipoprotein cholesterol levels by receiving statins. Thus, hyperuricemia is not a benign biochemical finding and should be recognized as a relevant CV and renal risk factor. Serum urate measurement can improve risk stratification in selected high-risk populations. Although routine treatment of asymptomatic hyperuricemia is not advised, targeted urate-lowering strategies may be needed in patients with high CV risk, symptomatic disease, or very high serum UA levels. Importantly, nutrient intake and diet quality need significant improvement in individuals with hyperuricemia, as it has been shown to lack behind in terms of balanced macronutrient intake, quality and sources of macronutrients, and healthy eating. Data from future randomized trials are needed to determine whether urate-lowering treatment can improve hard CV and renal outcomes in these patient groups.