Published: 2021-05-26

Serum uric acid is no more a by-stander for risk of cardiovascular diseases in metabolic syndrome: a prospective study

Anirudh Kumar Allam, Chandrakant Chavan, Rahul Mandole, Jagdish Hiremath, Vikrant Khese


Background: Cardiovascular diseases have become the fastest growing health issue in India and worldwide. Population with metabolic syndrome is known to be pre-disposed to several chronic disorders along with higher risk of experiencing cardiovascular events. The role of uric acid as a cardiovascular risk factor in metabolic syndrome was not well studied in the literature, which made us to undertake the present study.

Methods: All the patients aged between 18 to 75 years (both gender) who approached Madhavbaug cardiac care clinics located in Maharashtra, India for assessing risk of heart disease from January 2015 to January 2017 were screened. Risk factors for metabolic syndrome have been evaluated among the study population and categorised into metabolic syndrome positive (³3 risk factors) and negative groups (<3 risk factors). Statistical analysis was done using SPSS software version: 21.0.

Results: Our study includes 2294 subjects who met the inclusion and exclusion criteria. Males outnumbered the females and sex ratio was 2.89:1. Females had lower serum uric acid levels compared to males irrespective of metabolic component. Gender and serum uric acid levels (high and low) were used stratification of the subjects. Serum uric acid is an independent predictor of cardiovascular diseases with an Odds ratio of 1.13 (95% confidence interval).

Conclusions: Serum uric acid level is one of the important predictor for cardiovascular risk in metabolic syndrome. Raised uric acid is not an innocent by-stander and one of the major contributors in development of cardiovascular diseases.


Hyperuricemia, Metabolic syndrome, Cardiovascular diseases

Full Text:



Hediger MA, Johnson RJ, Miyazaki H, Endou H. Molecular physiology of uratetransport. Physiology. 2005;20:125-33.

Mahomed FA. On chronic Bright’s disease, and its essential symptoms. Lancet. 1879;1:399-40 .

Gertler MM, Garn SM, Levine SA. Serum uric acid in relation to age and physique in health and in coronary heart disease. Ann Intern Med. 1951;34 (6):1421-31.

Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, et al. Harmonizing the metabolic syndrome: a joint interim statement of the international diabetes federation task force on epidemiology and prevention; national heart, lung, and blood institute; american heart association; world heart federation; international atherosclerosis society; and international association for the study of obesity. Circulation. 2009;120(16):1640-5.

Johnson RJ, Stenvinkel P, Martin SL, Jani A, Sánchez-Lozada LG, Hill JO, et al. Redefining metabolic syndrome as a fat storage condition based on studies of comparative physiology. Obesity. 2013;21(4):659-64.

Choi HK, Ford ES. Prevalence of the metabolic syndrome in individuals with hyperuricemia. Am J Med. 2007;120(5):442-7.

Sun HL, Pei D, Lue KH, Chen YL. Uric acid levels can predict metabolic syndrome and hypertension in adolescents: a 10-year longitudinal study. PLoS ONE. 2015;10(11):e0143786.

Zurlo A, Veronese N, Giantin V, Maselli M, Zambon S, Maggi S, et al. High serum uric acid levels increase the risk of metabolic syndrome in elderly women: the PRO.V. A study. Nutr Metab Cardiovasc Dis. 2016;26 (1):27-35.

Babio N, Martínez-González MA, Estruch R, Wärnberg J, Recondo J, Ortega Calvo M, et al. Associations between serum uric acid concentrations and metabolic syndrome and its components in the PREDIMED study. Nutr Metab Cardiovasc Dis. 2015;25(2):173-80.

Wu AH, Gladden JD, Ahmed M, Ahmed A, Filippatos G. Relation of serum uric acid to cardiovascular disease. Int J Cardiol. 2016;15(213): 4-7

Dogan M, Uz O, Aparci M, Atalay M. Confounders of uric acid level for assessing cardiovascular outcomes. J Geriatr Cardiol. 2016;13(2):197-8.

Liu P, Wang H, Zhang F, Chen Y, Wang D, Wang Y. The effects of allopurinol on the carotid intima-media thickness in patients with Type 2 diabetes and asymptomatic hyperuricemia: a three-year randomized parallel-controlled study. Intern Med. 2015;54(17):2129-37.

Reschke LD, Miller 3rd ER, Fadrowski JJ, Loeffler LF, Holmes KW, Appel LJ,et al. Elevated uric acid and obesity-related cardiovascular disease risk factors among hypertensive youth. Pediatr Nephrol. 2015;30 (12):2169-76.

Culleton BF, Larson MG, Kannel WB, Levy D. Serum uric acid and risk for cardiovascular disease and death: the Framingham Heart Study. Ann Intern Med. 1999;131(1):7-13.

Ekici B, Kütük U, Alhan A, Töre HF. The relationship between serum uric acid levels and angiographic severity of coronary heart disease. Kardiol Pol. 2015;73(7):533-8.

von Lueder TG, Girerd N, Atar D, Agewall S, Lamiral Z, Kanbay M, et al. Serum uric acid is associated with mortality and heart failure hospitalizations in patients with complicated myocardial infarction: findings from the High-Risk Myocardial Infarction Database Initiative. Eur J Heart Fail. 2015;17 (11):1144-51.

Huang H, Huang B, Li Y, Huang Y, Li J, Yao H, et al. Uric acid and risk of heart failure: a systematic review and meta-analysis. Eur J Heart Fail 2014;16 (1):15-24.

Shimizu T, Yoshihisa A, Kanno Y, Takiguchi M, Sato A, Miura S, et al.Relationship of hyperuricemia with mortality in heart failure patients with preserved ejection fraction. Am J Physiol Heart Circ Physiol. 2015;309: 1123-9.

Okazaki H, Shirakabe A, Kobayashi N, Hata N, Shinada T, Matsushita M, et al.The prognostic impact of uric acid in patients with severely decompensated acute heart failure. J Cardiol. 2016; 68(5):384-91.

Palazzuoli A, Ruocco G, Pellegrini M, Beltrami M, Giordano N, Nuti R, et al. Prognostic significance of hyperuricemia in patients with acute heart failure. Am J Cardiol. 2016;117(10):1616-21.

Clarson LE, Chandratre P, Hider SL, Belcher J, Heneghan C, Roddy E, et al. Increased cardiovascular mortality associated with gout: a systematic review and meta-analysis. Eur J Prev Cardiol. 2015;22(3):335-43.

Stack AG, Hanley A, Casserly LF, Cronin CJ, Abdalla AA, Kiernan TJ, et al. Independent and conjoint associations of gout and hyperuricaemia with total and cardiovascular mortality. QJM. 2013; 106(7):647-58.

Wu CY, Hu HY, Chou YJ, Huang N, Chou YC, Lee MS, et al. High serum uric acid levels are associated with all-cause and cardiovascular, but not cancer, mortality in elderly adults. J Am Geriatr Soc. 2015; 63(9):1829-36.