Is serum uric acid a risk factor for atherosclerotic cardiovascular disease?: A review of the clinical evidence. Part 1

Although the initial reports linking raised levels of serum uric acid (SUA) with atherosclerotic cardiovascular disease (ASCVD) were published more than five decades back, interest remained dormant with attention being more focused towards the traditional risks for cardiovascular disease. But in spite of increasing knowledge about these “traditional” risk factors and ways and means to offer more optimal control, the pandemic associated with atherosclerotic cardiovascular disease not only continues unabated but is seen to be increasing with tsunamic speeds. This has lead to a rekindling of the efforts to seek out other risk factors whose optimisation may be of help. In the past two decades there have been numerous publications, many of them epidemiological, which have shown the possibility of a linkage between serum uric acid levels and ASCVD, but there have also been studies which have cast a doubt on a direct positive relationship between the two. More over there have been many reports which have shown the possibility of an association between raised levels of serum uric acid and many of the traditional risk factors of ASCVD, especially hypertension. In order to come to some sort of a conclusion about the about the association between hyperuricemia and ASCVD, it is imperative that one also examines the links, if any between serum uric acid levels and these confounders. At the same time, the question does remain that even if there is a linkage between SUA and ASCVD, which still needs more “hard” evidence, is this direct or does it work indirectly through the effect of the raised serum uric acid levels in either leading to, or increasing the severity and rate of progression of the confounding traditional risk factors. In part I of this review, we look at the clinical evidence for the association between levels of serum uric acid and atherosclerotic cardiovascular disease as well as the linkage of the SUA levels with hypertension.