High uric acid precursor of obesity, metabolic syndrome

By Sally Robertson, B.Sc.Sep 20 2012

The relationship between uric acid (UA) and early cardiometabolic risk may precede obesity and the metabolic syndrome, show study findings.

In an analysis of 3518 individuals who were free of cardiovascular diease (CVD), elevated UA levels were independently associated with the cardiometablic risk markers dyslipidemia and hepatic steatosis.

Increased UA was also associated with a marker for systemic inflammation independently of the metabolic syndrome, although not independently of obesity, report Raul Santos (University of São Paulo Medical School Hospital, Brazil) and colleagues.

Controversy exists about whether UA is a causative risk factor or merely a marker for other proatherogenic processes, explain the researchers in the American Journal of Cardiology. Some studies have found the association between UA and cardiometabolic risk factors is largely decreased or eliminated after body mass index (BMI) and metabolic syndrome components are adjusted for.

However, in the current study, Santos et al found significant independent associations between elevated UA and an increased ratio of triglycerides to high-density lipoprotein cholesterol (TG/HDL cholesterol ≥3), sonographically detected hepatic steatosis, and elevated levels of high-sensitivity C-reactive protein (hsCRP ≥3 mg/L).

After adjustment for traditional CV risk factors, obesity, and the metabolic syndrome, individuals in the highest quartile for UA (6.8-11.1 mg/dL) were a significant 3.29 times more likely to have increased TG/HDL cholesterol, 3.10 times more likely to have hepatic steatosis, and 1.52 times more likely to have elevated levels of hsCRP, compared with those in the lowest UA quartile (1.9-4.9 mg/dL).

Further analysis of the UA quartiles showed that in the presence and absence of the metabolic syndrome, those in the fourth versus first UA quartile were significantly more likely to have each of the three risk conditions, after adjustment for traditional CVD risk factors and other confounders.

When stratified by obesity, those in the fourth versus first quartile were also more likely to have increased TG/HDL and hepatic steatosis, but not increased hs-CRP.

"This analysis suggests a role for UA in early cardiometabolic risk before the development of obesity and metabolic syndrome," say the researchers.

The strengths of the study are its large population-based cohort, comprehensive adjustment for confounders, and investigation of risk condition clustering, notes the team.

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