Mechanisms Linking Hyperuricemia to Increased Cardiovascular Risk.

Beyond gouty arthritis, hyperuricemia has been associated with increased risk of renal impairments1 and cardiovascular (CV) events.23 Despite robust epidemiologic evidence linking hyperuricemia and CV risk, the underlying mechanism has been unclear.

Park et al.4 observed a significant correlation of serum homocysteine levels with carotid intima-media thickness or renal impairments among hyperuricemic patients. The finding is not surprising based on the previous report that both metabolic syndrome and renal impairments are associated with homocysteinemia.5 Based on their results, the authors proposed a hypothesis where hyperuricemia induces homocysteinemia through renal impairments, which ultimately leads to atherosclerosis.4 However, appropriate mediation analysis to support the hypothesis is not sufficient by the cross-sectional study design. Further studies are required to fully illuminate the underlying mechanisms between hyperuricemia and CV risk.