Beyond gouty arthritis, hyperuricemia has been associated with increased risk of renal impairments1 and cardiovascular (CV) events.2,3 Despite robust epidemiologic evidence linking hyperuricemia and CV risk, the underlying mechanism has been unclear.
Park et al.4 observed a significant correlation of serum homocysteine levels with carotid intima-media thickness or renal impairments among hyperuricemic patients. The finding is not surprising based on the previous report that both metabolic syndrome and renal impairments are associated with homocysteinemia.5 Based on their results, the authors proposed a hypothesis where hyperuricemia induces homocysteinemia through renal impairments, which ultimately leads to atherosclerosis.4 However, appropriate mediation analysis to support the hypothesis is not sufficient by the cross-sectional study design. Further studies are required to fully illuminate the underlying mechanisms between hyperuricemia and CV risk.
Footnotes
Disclosure: The author has no potential conflicts of interest to disclose.
References
- 1.Richette P, Perez-Ruiz F, Doherty M, Jansen TL, Nuki G, Pascual E, et al. Improving cardiovascular and renal outcomes in gout: what should we target? Nat Rev Rheumatol. 2014;10(11):654–661. doi: 10.1038/nrrheum.2014.124. [DOI] [PubMed] [Google Scholar]
- 2.Li M, Hu X, Fan Y, Li K, Zhang X, Hou W, et al. Hyperuricemia and the risk for coronary heart disease morbidity and mortality a systematic review and dose-response meta-analysis. Sci Rep. 2016;6(1):19520. doi: 10.1038/srep19520. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Storhaug HM, Norvik JV, Toft I, Eriksen BO, Løchen ML, Zykova S, et al. Uric acid is a risk factor for ischemic stroke and all-cause mortality in the general population: a gender specific analysis from The Tromsø Study. BMC Cardiovasc Disord. 2013;13(1):115. doi: 10.1186/1471-2261-13-115. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Park JH, Song JS, Choi ST. Increased carotid intima-media thickness (IMT) in hyperuricemic individuals maby be explained by hyperhomocysteinemia associated with renal dysfunction: a cross-sectional study. J Korean Med Sci. 2019;34(37):e237. doi: 10.3346/jkms.2019.34.e237. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Fu S, Yao Y, Zhao Y, Luan F. Relationships of hyperhomocysteinemia and hyperuricemia with metabolic syndrome and renal function in Chinese centenarians. Front Endocrinol (Lausanne) 2018;9:502. doi: 10.3389/fendo.2018.00502. [DOI] [PMC free article] [PubMed] [Google Scholar]