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Association of plasma uric acid with ischaemic heart disease and blood pressure: mendelian randomisation analysis of two large cohorts

BMJ 2013; 347 doi: https://doi.org/10.1136/bmj.f4262 (Published 18 July 2013) Cite this as: BMJ 2013;347:f4262

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Re: Association of plasma uric acid with ischaemic heart disease and blood pressure: mendelian randomisation analysis of two large cohorts

Uric acid is an end product of purine catabolism in humans. Its plasma level is used as a diagnostic marker for gout and plasma levels above 7mg/dL are categorized as hyperuricemia. Known genetic causes including Lesh-Nyhan syndrome, von-Gierke's disease and other enzyme deficiencies have been reported. Secondary causes include leukemia. But the search for more roles and relevance of serum uric acid in health and disease has implicated uric acid as an inflammatory marker and possibly related to inflammatory disorders including coronary artery disease as well as in non-alcoholic fatty liver disease (NAFLD).

Now genotyping and its association with certain forms of genotypes - serum uric acid is not found to be related to ischaemic heart disease. The human body is a metabolic cocktail - say metabolomics. With more sophistication and more instrumentation, the relevance or non-relevance of a parameter is delineated. Yet the clinical acumen of a physician and the patient's case history, including geographic and cultural influences, play a role in assigning a parameter specific for a particular health condition. We have universally acceptable biomarkers for say cardiovascular disorders. Serum Uric acid if taken as an inflammatory marker could be valuable as an adjunct to other inflammatory markers like hsC-reactive protein. In the age of molecular biology and molecular medicine, the relevance of biomarkers may be put on the genetic microscope. Yet the physician is the key to the management of such a patient.

Competing interests: No competing interests

19 July 2013
dhastagir s sheriff
Professor
Faculty of Medicine, Benghazi University
Benghazi, Libya

Re: Association of plasma uric acid with ischaemic heart disease and blood pressure: mendelian randomisation analysis of two large cohorts

The paper of Palmer et al proposes an interesting approach to the problem of plasma uric acid and CV disease by applying a Mendelian randomization analysis based on a specific genetic polymorphisms. They conclude that there is no relationship between SUA and either CHD or blood pressure and this is at variance when compared to several observational data.

However, the genetic probe that has been considered (SLC2A9) belongs to genes involved in renal urate transport at the renal levels and leads to an increase in SUA as a response to a decrease in renal excretion (1). As an alternative hypothesis, some data suggest that the increase in CV risk in patients with elevated levels of SUA might be investigated in those subjects with an overproduction of serum uric acid and where the pro-oxidative effect related to xantino-oxidase activity would be the leading cause of the increased RR of CV complications. In this case the serum urate levels would be only the "mirrored image" of the biochemical mechanisms relating hyperuricemia with CV diseases and the approach based on mendelian randomization should be proposed by using a classifying polymorphism involving the synthesis of serum uric acid.

1) Nehogi T. Gout. New Engl J Med 2011; 364: 443-452

Competing interests: No competing interests

19 July 2013
Claudio Borghi
Head Department of Internal Medicine
Arrigo F.G.Cicero
University of Bologna
Via Albertoni 15-40138-Bologna
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