Role of uric acid in heart disease

In this month's premier open access medical journal PLoS Medicine, John Danesh and colleagues from the University of Cambridge, along with investigators from the Icelandic Heart Association, report the single largest prospective study addressing the role of uric acid in heart disease.

The debate over the role of uric acid in heart disease has been going on for more than 50 years, starting with a paper published in 1951 which found higher serum uric acid concentrations in patients with coronary heart disease (CHD) compared with controls. Since then, measurement of serum uric acid has been suggested as a predictor of CHD. But many of the studies on serum uric acid are epidemiologic studies and have come to different conclusions about how useful measurement of uric acid is.

This study, along with a systematic review which combines their findings with those of 15 previously published prospective studies of serum uric acid - 9,458 cases of CHD and 155,084 controls in all - answers the question of the role of uric acid in prediction of CHD. Using all studies, they show that there is a very small role for uric acid in the prediction of disease but in the eight studies where all possible confounders had been removed this predictive role was lost.

What this paper does not do is directly address the question of whether or not serum uric acid is involved in causing CHD although it does suggest that serum uric acid levels are unlikely to be a major determinant of CHD. So although improving diet, losing weight, and controlling blood pressure may all contribute to reducing both one's risk of CHD and one's serum levels of uric acid, uric acid levels do not help to usefully predict the risk of CHD.