Is hyperuricaemia a predictor of cardiovascular risk?

Hyperuricaemia is commonly associated with essential hypertension and with dyslipidaemia and glucose intolerance, the central characteristics of syndrome X. Several epidemiological studies have found a relationship between uric acid and coronary heart disease or cardiovascular and noncardiovascular mortality. Whether hyperuricaemia represents an independent cardiovascular risk factor, however, has been debated for many decades. Recent studies performed in patients with essential hypertension suggest that uric acid is a predictor of hypertension and an independent risk factor for cardiovascular events, even after adjustments for covariates such as the use of diuretics. In patients with non-insulin-dependent diabetes mellitus, uric acid is also related to the occurrence of coronary heart disease and stroke. The pathogenic mechanisms whereby uric acid might contribute to increased cardiovascular morbidity and mortality are yet poorly understood and should be clarified. Indeed, a better understanding of the putative role of uric acid in the pathogenesis of cardiovascular diseases could lead to rethinking the actual recommendation not to treat asymptomatic hyperuricaemia. Curr Opin Nephrol Hypertens 8:167-172. (C) 1999 Lippincott Williams & Wilkins.