Uric Acid and Heart Attacks

March 15, 2011Uric Acid and Heart Attacks Reference:  Current Opinion Rheumatology 2011;23(2):174 Uric acid and heart attacks?  What has that got to do with heart attacks?  Uric acid has been all about gout!  You have a high uric acid in your blood and you are likely going to have an aching big toe and have a gout attack.  That’s what we thought uric acid was all about.  So, what’s the connection to heart disease?  I have images of old Englishmen clutching their big toes going off to Bath to soak in the hot mud and relieve their pain.  We now know they had gout from being lead poisoned by Port wine that came in clay jars from Portugal, the first historical proof of lead toxicity. This paper by Sokolove is very interesting.  He weaves together all the evidence that has emerged in the last 10 years from animal models and small human studies to show that uric acid is an independent and equally valid marker of risk for heart disease.  There has been a bit of trouble showing this, because there are so many risks for heart disease and they all travel together.  Teasing one out from the others is tricky.  But the first hint came with our national nutrition study called NHANES in 1992 when 5926 subjects with high uric acid were shown to demonstrate a 77% increased risk of heart disease if their uric acid was over 7 mg/dl compared to those under 5.4 mg/dl (men).  In women, it was a 300% risk difference.  That’s big! The human evidence is short term but also interesting.  For example, a study following 9924 veterans with gout on uric acid lowering therapy showed that they reduced their mortality 77% by lowering uric acid.  Another study on folks getting heart surgery showed that allopurinol, the drug that lowers uric acid, reduced risk of death around heart surgery.  Or, 65 people with stable angina, given allopurinol and then tested again with a treadmill test, all had an improvement in their stress tests with the allopurinol.  In folks with high blood pressure, uric acid lowering therapy lowers their blood pressure, but also improves the function of a dilated, damaged heart.  Goodness.  Virtually every risk group of hearts gets better. This is all cool stuff.  It seems to be making the case that uric acid is a marker for risk for heart disease.  It may not be causal, but it sure looks like something we have to watch.  And just what is the connection to take home?  Remember last week’s email about fructose and sugar causing hypertension?  It did it by raising uric acid. Remember that?  (Of course you do!)  Well, here is the linked hypothesis.  If these guys would just talk to each other!  Sugar, fructose in particular, raises your uric acid.  And the fructose researchers are showing that when that happens, the uric acid wipes clean the Nitric Oxide in your blood.  Nitric oxide is the chemical your blood vessels use to relax and dilate.  That lowers your blood pressure, lowers the work of your heart.  Getting rid of uric acid is getting rid of the sponge that is wiping out the uric acid.  See the connection?  So, it’s not just taking allopurinol that will lower your risk.  Sure, you can lower your uric acid by taking another pill.  But you can do it also be eating less sugar.  Get the point!  Eating less sugar pops up again. WWW: What will work for me.  This is another nail in the coffin of sugar.  I’m going to get my uric acid checked next time I have my annual physical exam.  My goal is to keep it down in the 3-5 range.  And I will be sorely disappointed if it’s not down there naturally because I eat very little sugar.  Well, there were those 4 Dove chocolates last night.  Oh dear.  Forgot.  I stand corrected.  I eat LESS sugar than I used to.  I need to practice cutting down on Dove chocolates.  How about 2 next time?  Perfect practice makes for perfect.

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