High Serum Uric Acid and Heart Disease
March 8th, 2009 by admin | Filed under Gout, Gout Diet, Uric acid.PLoS Med. 2005 March; 2(3): e90.
Published online 2005 March 29. doi: 10.1371/journal.pmed.0020090.
“Dissecting out the role of uric acid is further complicated by three things: high levels of uric acid are associated with hypertension and being overweight (other risk factors for CHD); levels of uric acid can be altered by drugs such as diuretics that people with CHD often take; and finally, alteration of renal function can affect uric acid levels.
Another problem is the type of studies that have been used to address the question of uric acid’s role in CHD. Retrospective studies may be unable to control adequately for other risk factors—hence prospective, ideally population-based, studies would be the best to answer the question of whether there really is an association between high uric acid and CHD.
In this month’s PLoS Medicine, John Danesh and colleagues from the University of Cambridge, along with investigators from the Icelandic Heart Association, report the single largest prospective study addressing the role of uric acid in heart disease. Further, their systematic review combines their findings with those of 15 previously published prospective studies of serum uric acid—9,458 cases of CHD and 155,084 controls in all.
The paper answers the question of the role of uric acid in prediction of CHD clearly: the risk ratio for prediction of disease was 1.13 (1.07–1.20), but it was only 1.02 (0.91–1.14) in the eight studies that had the most complete adjustment for possible confounders. What this paper does not do is directly address the question of whether or not serum uric acid is involved in causing CHD through intermediates; however, it does suggest that serum uric acid levels are unlikely to be a major determinant of CHD.
Where does such a result leave patients? Well, it is likely that improving diet, losing weight, and controlling blood pressure may all contribute to reducing both one’s risk of CHD and one’s serum levels of uric acid. The role of uric acid in CHD is now likely to be of interest only to those studying basic science; for now, the clinical question seems closed”.
The message here is, improve your diet, lose weight, and you will lower your BP, uric acid, and minimise your chance of CHD. However, if you lose weight too quickly, you’ll increase your serum levels of uric acid.
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