Emerging concepts in cardiovascular disease: should elevated serum uric acid be considered a risk factor?

Uric acid is the final breakdown product of purine metabolism in man. There is a growing body of evidence that indicates that elevated uric acid levels increase the probability of developing hypertension and cardiovascular disease. The frequency of hyperuricaemia in untreated hypertensive individuals ranges from 25 - 50%. Furthermore, elevated serum uric acid has been reported to increase the probability of developing hypertension by 87% and to increase the mortality rate from ischaemic heart disease. Several studies have reported that changes in serum cholesterol parallel changes in serum uric acid in both order and magnitude. Most recently, hyperuricaemia has been added to the constellation of abnormalities that comprise Syndrome X. The pathophysiology of hyperuricaemia and the link between hyperuricaemia, hypertension and cardiovascular disease are poorly understood. It is entirely possible that hyperuricaemia is part of a pathologic process that underlies fundamental alterations in renal function, as well as other metabolic pathophysiologies that ultimately lead to hypertension and cardiovascular disease.