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July 21, 1993

Uric AcidA Risk Factor for Coronary Heart Disease

JAMA. 1993;270(3):378-379. doi:10.1001/jama.1993.03510030102044

Uric acid metabolism is an important concern in many clinical disciplines. Just as "all that wheezes is not asthma," all hyperuricemia is not gout. Clearly, altered urate metabolism is intimately associated with gout. But abnormal serum uric acid concentrations are encountered regularly in such varied pathophysiological problems as hypertension, coronary artery disease, obesity, hyperlipidemia, diabetes mellitus, polycythemia, and toxemia of pregnancy. How can this alteration be related to such a disparate collection of diseases, none of which is gout? Of course, several of these problems are otherwise linked: coronary artery disease, hypertension, diabetes mellitus, and obesity. But this linkage still does not explain the fundamental cause of the altered uric acid levels.

Uric acid is a circulating end product of purine metabolism whose concentration may be elevated in gout where uric acid may be deposited in the synovial joint to result in arthritis or in other tissues (eg, kidney) to