This Article Full Text Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Johnson, R. J. Articles by Levy, D. Search for Related Content PubMed PubMed Citation Articles by Johnson, R. J. Articles by Levy, D.

(Hypertension. 2000;35:e10.)
© 2000 American Heart Association, Inc.

Hypertension Electronic Pages

Much Ado About Nothing, or Much to Do About Something? The Continuing Controversy Over the Role of Uric Acid in Cardiovascular Disease

Richard J. Johnson, MD; Katherine R. Tuttle, MD

University of Washington Medical Center, Seattle, Washington, The Heart Institute of Spokane, Spokane, Washington

	Introduction

 
To the Editor:

Recently, an update from the Framingham study could not find uric acid to be an independent risk factor for cardiovascular disease.¹ While serum uric acid levels correlated significantly with the risk for cardiovascular events and mortality in women, this relationship became insignificant after factoring for 11 additional variables including hypertension, body mass index, and diuretic use.¹ Both the authors¹ and an accompanying editorial² interpreted these findings as showing that uric acid is not a true risk factor for cardiovascular disease and that it should not be routinely measured to assess cardiovascular risk.

The careful analysis of the Framingham study is to be commended, but one must be cautious in the interpretation of the findings. While some epidemiologic studies such as the current one have not been able to show uric acid to be an independent risk factor for cardiovascular disease, other studies using multivariate analyses^{3 4 5 6} came to an opposite conclusion. Another recently completed study, the Worksite,⁷ also found uric acid to be an independent risk factor for cardiovascular events and mortality, especially in women. One might look for subtle explanations to account for the differences in these various studies, as Culleton et al¹ have attempted, but most of the studies examined the very same variables.

A more central issue is whether one should interpret the finding that a risk factor is not statistically independent to mean that it should not be considered biologically important. We would argue that this is not true in several situations. First, if . . . [Full Text of this Article]

Bruce Culleton, , MD, FRCPC

Division of Nephrology, University of Calgary, Calgary, Alberta, Canada

Daniel Levy, MD

National Heart, Lung, and Blood Institutes Framingham Heart Study Framingham, Massachusetts

This article has been cited by other articles:

				J.-G. Wang, J. A. Staessen, R. H. Fagard, W. H. Birkenhager, L. Gong, and L. Liu Prognostic Significance of Serum Creatinine and Uric Acid in Older Chinese Patients With Isolated Systolic Hypertension Hypertension, April 1, 2001; 37(4): 1069 - 1074. [Abstract] [Full Text] [PDF]