Pitfalls in the Evaluation of Uric Acid as a Risk Factor for Vascular Disease

ABSTRACT

The association between serum uric acid (SUA) levels and the risk for vascular disease is controversial. Several studies in the general population suggested that elevated SUA levels are independently related to increased vascular morbidity and mortality. However, in other studies this relationship was not significant when other vascular risk factors were considered. Some evidence also suggests that uric acid might be implicated in the development of hypertension, renal disease and insulin resistance. We review the epidemiological data on the relationship between SUA levels and vascular disease and summarize the potential adverse vascular effects of uric acid. We also discuss the associations of SUA levels with established vascular risk factors and the potential benefits of lowering SUA concentration. It is unclear whether uric acid is a causal risk factor for vascular disease. Until more conclusive data are available, patients with elevated SUA levels should be evaluated for the presence of more established risk factors (including type 2 diabetes mellitus, metabolic syndrome and chronic kidney disease) and treatment should be targeted against these factors.