The Relationship Between URIC ACID Levels and Cardiovascular Deaths

An Underappreciated Blood Value – Uric Acid!

High blood uric acid is known to be associated with gout and kidney disease. Recent studies also identified high levels as an important risk factor for cardiovascular disease . However, at what levels this risk rises was unclear.

Recently, an important cardiology journal, Hypertension, published a study by the Italian Society of Hypertension across Italian centers, following people for at least 20 years, totaling 22.714 participants. Its aim was to identify the uric acid threshold increasing all-cause and cardiovascular mortality. All-cause meant death from any cause; cardiovascular meant fatal myocardial infarction, heart attack, stroke, sudden cardiac death, or heart failure.

What Is Uric Acid?

Uric acid is an organic compound with molecular weight 168 g/mol, consisting of carbon, oxygen, nitrogen, and hydrogen. It is the final purine metabolism product in humans and advanced primates, a natural waste from digesting purine-containing, high-protein foods... It closely relates to sudden-onset joint gout, and gout is noninfectious joint inflammation with pain, redness, swelling, and tenderness. It was formerly called the disease of kings or the wealthy.

Participants averaged 57 years and were mildly overweight (BMI: 27), over half had hypertension, %10 diabetes, and %17 chronic kidney disease (eGFR %83). Common medicines were diuretics, ACE inhibitors, ARBs, and statins for cholesterol reduction.

The study found that all-cause mortality was affected at an average uric acid threshold of 4.7 mg/dL .

The cardiovascular mortality threshold differed by sex: 5.1 mg/dL in women, 5.6 mg/dL in men .

Interestingly, these levels were substantially below clinical hyperuricemia definitions. This suggests uric-acid-lowering treatment may need more serious implementation to prevent all-cause deaths rather than gout alone.

Limitations include no dietary assessment or menopause information, important because women's cardiovascular risk rises after menopause. These constrain interpretation.

Nevertheless, recent European Hypertension Guidelines (ESC/ESH guidelines) identify uric acid among factors improving risk stratification in arterial hypertension. These study results also confirm that blood uric acid, relative to other cardiovascular risk factors, independently, is associated with increased all-cause mortality and cardiovascular disease risk.