Risk Factors for Cardiovascular Disease: One Down, Many More To Evaluate

• Cardiovascular diseases
• Risk factors
• Uric acid
• Outcome assessment (health care)
• Sex factors

Almost 50 years ago, investigators observed the association between uric acid and cardiovascular events. Subsequently, many epidemiologic studies have sought to clarify the role of this risk factor. In addition, laboratory studies have attempted to identify the mechanism by which an elevated uric acid level causes an increased risk for cardiovascular disease. Despite these efforts, the role of uric acid as a risk factor was never fully resolved.

In this issue, investigators from the Framingham Heart Study resolve the long-standing controversy surrounding the role of uric acid as a risk factor for cardiovascular disease (1). Taking advantage of careful measures and long-term follow-up of a cohort of 6763 Framingham Heart Study participants, Culleton and colleagues found that an elevated uric acid level was strongly associated with a higher age-adjusted risk for coronary heart disease, death from cardiovascular disease, and death from all causes in women but not in men. However, after adjustment for other cardiovascular disease risk factors, such as body mass index, blood pressure (and use of antihypertensive medications), diabetes, cholesterol, smoking, alcohol intake, left ventricular hypertrophy, and menopausal status, they found no association between uric acid levels and any of the outcomes in men or women.

The study is important beyond the resolution of the uric acid controversy. It is another example of the rigorous methods used by the Framingham investigators to expand our knowledge and …