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New Heart Disease Test

May 2, 2012 Written by JP    [Font too small?]

Cholesterol, C-reactive protein, homocysteine and triglycerides are probably the best known biomarkers used to assess cardiovascular risk. Uric acid typically isn’t included in this group of heart disease indicators. In the coming years, this may very well change. However, you and your doctors don’t have to wait for an official stamp of approval from the American Heart Association or any other organization in order to benefit from what’s currently known about uric acid.

Of late, the role of high uric acid or hyperuricemia in relation to cardiovascular outcomes has become increasingly evident. Elevated uric acid (UA) is no longer the exclusive domain of those living with gout and kidney disease. Over the past several years, some researchers have established that hyperuricemia contributes to impaired circulation by promoting endothelial dysfunction. Population studies add weight to the case against high UA. Recent inquiries have determined that excess concentrations of UA is “associated with MetS (metabolic syndrome) and is an independent risk factor for carotid atherosclerosis”. What’s more, a popular drug (allopurinol) primarily used to lower uric acid is now being viewed as a potential treatment option for patients with cardiovascular disease.

Thankfully, medications are not the only way to address hyperuricemia. According to numerous publications, a Mediterranean-style diet that is low in beer, fructose and soy should also be helpful. One class of foods to include in any UA lowering protocol is dairy products. A trial published in September 2010 reported that milk consumption is capable of acutely reducing UA by approximately 10%. Also significant is the role of overweight. Losing as little as 5% of excess weight can lead to meaningful improvements in serum uric acid and several other cardiometabolic risk factors including high blood sugar, C-reactive protein and triglycerides.

The good news about uric acid is that it is one of the substances which is routinely tested during physical examinations – as part of a blood test known as a chemistry panel. Therefore, it shouldn’t cost extra for you or your doctor to determine your UA status. The reference range for UA in children is 2.0-5.5 mg/dL. In adult men and women, it is 3.4-7.0 mg/dL and 2.4-6.0 mg/dL respectively. Based on my current understanding of the link between cardiovascular vascular disease and UA, I believe that aiming for the lower end of the reference range is probably a judicious approach. If your uric acid is elevated or on the higher end of the reference range, I would consider adopting some of the natural approaches listed above.

Note: Please check out the “Comments & Updates” section of this blog – at the bottom of the page. You can find the latest research about this topic there!

To learn more about the studies referenced in today’s column, please click on the following links:

Study 1 – Uric Acid As One of the Important Factors in Multifactorial Disorders (link)

Study 2 – The Relationship Between Inflammation and Slow Coronary Flow (link)

Study 3 – Serum Uric Acid Level and Its Association with Metabolic Syndrome … (link)

Study 4 – Relationships Among Hyperuricemia, Metabolic Syndrome(link)

Study 5 – Allopurinol as a Cardiovascular Drug (link)

Study 6 – Uric Acid and Fructose: Potential Biological Mechanisms (link)

Study 7 – Incremental Weight Loss Improves Cardiometabolic Risk (link)

Study 8 – Long-Term Adherence to the Mediterranean Diet Reduces (link)

Study 9 – Acute Effect of Milk on Serum Urate Concentrations: A Randomized … (link)

Study 10 – Beer, Liquor, and Wine Consumption and Serum Uric Acid Level (link)

High Uric Acid May Increase Metabolic Syndrome Risk

Source: Cardiovascular Diabetology 2011, 10:72 (link)

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Posted in Food and Drink, Heart Health, Nutrition

11 Comments & Updates to “New Heart Disease Test”

  1. Martin Schiele Says:

    That sounds pretty convincing.

    So it’s not just higher uric acid levels being more common in alcoholics causing these statistics then? There’s a definite mechanism by which the uric acid itself can increase your risk of circulatory problems?

  2. JP Says:

    Hi Martin,

    This association has been found in non-alcoholic populations as well. Also, not all forms of alcohol use appear to increase the likelihood of high uric acid.

    I think the word “definite” is stating the case a bit too strongly, IMO. However, I do think it’s worth striving for lower-normal uric acid levels via healthy dietary and lifestyle choices.

    Be well!


  3. liverock Says:

    Just to point out that uric acid does have a good side. It scavenges peroxynitrite, which can cause many CNS problems particularly MS. You will never see anybody with gout get MS.


  4. JP Says:

    Hi Liverock,

    The uric acid oxidant question isn’t very clear cut, IMO. In most instances, I think the probable harm of excess UA outweighs the potential benefit.



    Be well!


  5. Mary Brighton Says:

    Interesting article. Just wondering if you found any info on drinking pure cherry juice (diluted in water) to decrease uric acid.
    I advise this for some people who have an active bout of gout. It seems to work for them to decrease symptoms.

  6. JP Says:

    Hi Mary,

    The use of tart cherries to lower urate is established in the medical literature. Cherries also possess natural antiinflammatory properties which most likely contribute to a reduction in gout symptoms:


    Drinking coffee regularly and supplementing with Vitamin C may also assist those who are predisposed to gout.

    Be well!


  7. JP Says:

    Update 06/21/15:


    Eur J Clin Nutr. 2015 Jun 17.

    Consumption of sucrose-sweetened soft drinks increases plasma levels of uric acid in overweight and obese subjects: a 6-month randomised controlled trial.

    BACKGROUND/OBJECTIVES: Sucrose-sweetened soft drinks (SSSDs) are associated with the development of metabolic disorders. Fructose is a major component of SSSDs and is demonstrated to induce uric acid (UA) production and stimulate fat accumulation independent of excess caloric intake. UA induce insulin resistance and low-grade inflammation, suggesting that UA may have a causal role in the development of metabolic complications. The objective of this study is to investigate the long-term effects of consuming SSSDs on circulating levels of UA in overweight and obese subjects.

    SUBJECTS/METHODS: Using a previously published study, circulating UA levels were assessed at baseline and after 6 months using chromogenic enzymatic absorptiometry. The study included 47 overweight and obese subjects without diabetes, randomised to consume 1 l daily of either SSSD (regular cola), isocaloric semi-skimmed milk, diet cola or water for 6 months.

    RESULTS: Circulating UA levels increased ~15% (P=0.02) after the 6-month intervention in the SSSD group with no change in the other groups. In the SSSD group, circulating UA levels increased significantly after the intervention in both absolute (P=0.005) and relative values (P=0.004). The change in UA after the intervention correlated with changes in liver fat (P=0.005), triglycerides (P=0.02) and insulin (P=0.002).

    CONCLUSIONS: In this secondary analysis daily intake of 1 l SSSD for 6 months was found to increase circulating UA levels compared with isocaloric milk, diet cola and water. Thus, a high daily intake of SSSDs in overweight and obese subjects without overt diabetes may increase the risk of developing metabolic complications through the elevation of UA.

    Be well!


  8. JP Says:

    Updated 12/05/15:


    Arthritis Rheumatol. 2015 Dec 4.

    Effects of Lowering Glycemic Index of Dietary Carbohydrate on Plasma Uric Acid: The OmniCarb Randomized Clinical Trial.

    OBJECTIVE: The effects of carbohydrates on plasma uric acid levels are controversial. We determined the individual and combined effects of carbohydrate quality (glycemic index, GI) and quantity (proportion of total daily energy, %carb) on uric acid.

    METHODS: We conducted a randomized, crossover feeding trial in overweight or obese adults without cardiovascular disease (N=163). Participants were fed each of four diets over 5-week periods separated by 2-week washout periods. Body weight was kept constant. The four diets were: high GI (GI ≥65) with high %carb (58% kcal), low GI (GI ≤45) with low %carb (40% kcal), low GI with high %carb; and high GI with low %carb. Plasma uric acid was measured at baseline and after each feeding period for comparison between the 4 diets.

    RESULTS: Study participants were 52% women and 50% non-Hispanic black with a mean age of 52.6 years and a mean uric acid of 4.7 (SD, 1.2) mg/dL. Reducing GI lowered uric acid when the %carb was low (-0.24 mg/dL; P <0.001) or high (-0.17 mg/dL; P <0.001). Reducing the %carb marginally increased uric acid only when GI was high (P = 0.05). The combined effect of lowering GI and increasing the %carb was -0.27 mg/dL (P <0.001). This effect was observed even after adjustment for concurrent changes in kidney function, insulin sensitivity, and products of glycolysis.

    CONCLUSIONS: Reducing GI lowers uric acid. Future studies should examine whether reducing GI can prevent gout onset or flares.

    Be well!


  9. JP Says:

    Updated 07/18/16:


    Exp Gerontol. 2016 Jul 6. pii: S0531-5565(16)30178-4.

    Serum uric acid concentrations and risk of frailty in older adults.

    OBJECTIVES: To evaluate for the first time the longitudinal relationship between serum uric acid concentrations and risk of frailty.

    METHODS: Prospective cohort study of 2198 non-institutionalized individuals aged ≥60years recruited in 2008-2010. At baseline, information was obtained on socio-demographic factors, health behaviors and morbidity, while serum uric acid was determined in 12-h fasting blood samples. Study participants were followed-up through 2012 to assess incident frailty, defined as ≥2 of the following 4 Fried criteria: exhaustion, muscle weakness, low physical activity, and slow walking speed.

    RESULTS: During a mean 3.5-year follow-up, 256 cases of incident frailty were identified. After multivariate adjustment, the odds ratios (95% confidence interval) of frailty comparing the second and third tertiles of uric acid to the lowest tertile were, respectively: 1.18 (0.83-1.68) and 1.57 (1.11-2.22); p-linear trend=0.01. The corresponding result for a 1mg/dL increase in serum uric acid concentration was 1.12 (1.00-1.24). Similar associations were observed across subgroups defined by sex, age, body mass index, and physical activity. As regards each frailty component, the odds ratios (95% confidence interval) per 1mg/dL increase in serum uric acid were 1.10 (0.99-1.23) for low physical activity, 1.08 (0.95-1.23) for low walking speed, 1.08 (0.67-1.73) for exhaustion and 0.91 (0.81-1.02) for weakness.

    CONCLUSIONS: Serum uric acid concentrations are positively associated with the risk of frailty in older adults. Further studies are needed to evaluate whether specific dietary recommendations or pharmacological strategies aimed at lowering serum uric acid would be beneficial to prevent the development of this syndrome.

    Be well!


  10. JP Says:

    Updated 1/8/18:


    Int J Cardiol. 2018 Feb 15;253:167-173.

    Serum uric acid levels are associated with cardiovascular risk score: A post hoc analysis of the EURIKA study.

    BACKGROUND: Reports are conflicting on whether serum uric acid (sUA) levels are independently associated with increased cardiovascular (CV) death risk.

    METHODS: This post hoc analysis assessed the relationship between sUA levels and CV death risk score in 7531 patients from the cross-sectional, multinational EURIKA study (NCT00882336). Patients had at least one CV risk factor but no clinical CV disease. Ten-year risk of CV death was estimated using SCORE-HDL and SCORE algorithms, categorized as low (<1%), intermediate (1% to <5%), high (≥5% to <10%) or very high (≥10%).

    RESULTS: Mean serum sUA levels increased significantly with increasing CV death risk category in the overall population and in subgroups stratified by diuretics use or renal function (all P<0.0001). Multivariate ordinal logistic regression analyses, adjusted for factors significantly associated with CV death risk in univariate analyses (study country, body mass index, number of CV risk factors and comorbidities, use of lipid lowering therapies, antihypertensives and antidiabetics), showed a significant association between sUA levels and SCORE-HDL category in the overall population (OR: 1.39 [95% CI: 1.34-1.44]) and all subgroups (using diuretics: 1.32 [1.24-1.40]; not using diuretics: 1.46 [1.39-1.53]; estimated glomerular filtration rate [eGFR]<60ml/min/1.73m2: 1.30 [1.22-1.38]; eGFR≥60ml/min/1.73m2: 1.44 [1.38-1.51]; all P<0.0001). Similar results were obtained when using SCORE.

    CONCLUSIONS: Higher sUA levels are associated with progressively higher 10-year CV death risk score in patients with at least one CV risk factor but no CV disease.

    Be well!


  11. JP Says:

    Updated 2/18/18:


    Mod Rheumatol. 2018 Feb 15:1-17.

    Hypouricaemic effects of yogurt containing Lactobacillus gasseri PA-3 in patients with hyperuricaemia and/or gout: a randomized, double-blind, placebo-controlled study.

    PURPOSE: Lactobacillus gasseri PA-3 (PA-3) has been previously shown to decrease serum uric acid (SUA) levels in subjects with increased SUA. In this study, we investigated whether PA-3 is also capable of decreasing SUA levels in patients with hyperuricaemia and/or gout.

    METHODS: Twenty-five patients with hyperuricaemia and/or gout completed this study. Urate-lowering drugs were discontinued for 12 weeks (week -4 to week 8). After flushing of urate-lowering drugs for 4 weeks (week 0), patients were randomized equally to receive diets containing yogurt beverages with PA-3 or without PA-3 for a duration of 8 weeks (week 8). The intention to treat (ITT) population included all subjects who were randomized, and the per-protocol (PP) population included subjects who completed the experiment with compliance. We evaluated SUA levels at the end of the study as well as changes in SUA levels in comparison to week 0.

    RESULTS:In both ITT and PP analyses, there were no significant differences in SUA levels or in the changes in SUA levels compared to week 0 between the two groups. However, in a sub-population whose SUA levels at week 0 were within one SD of the mean of he whole PP population, changes in SUA levels in the group consuming PA-3-containing yogurt were significantly lower than those of the control group (P = 0.0378)

    CONCLUSION: PA-3-containing yogurt improves SUA levels, even in patients with hyperuricaemia and/or gout.

    Be well!


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