Serum Uric Acid: An Independent Risk Factor for Vascular Injury

Hyperuricemia (serum uric acid levels >8mg/dl) has been associated with hypertension for a long time.1 At some point it was felt that elevated uric acid levels were the result of decreased kidney function, but recent clinical and experimental data have shown a direct correlation between high uric acid levels and progression of vascular injury, leading to increased cardiovascular morbidity and mortality, hypertension, and accelerated loss of kidney function. 2 The mechanism of action appears to be mediated by the profound effects of uric acid in human vascular cells, which include endothelial dysfunction, vascular proliferation, and nitric oxide release from vascular cells.3•5 Moreover, as a consequence of afferent arteriolar injury by hyperuricemia, chronic tubulointerstitial changes leading to progressive loss of kidney function and worsening hypertension can occur.⁶

Strategies to treat asymptomatic hyperuricemia should be considered in high-risk individuals to prevent progression of cardiovascular disease and chronic kidney disease.