Uric acid in atherosclerosis and cardiovascular diseases - innocent bystander or ruthless killer? - Open Access Review

Aug 27, 2026

Medical attention to uric acid (UA) has increased due to consistent associations with cardiovascular risk in the general population and in hypertensive patients. Clinical and experimental evidence links UA to oxidative stress, chronic inflammation, and other harmful changes that may promote hypertension, atherosclerosis, atrial fibrillation, and metabolic disorders including diabetes, metabolic syndrome, non-alcoholic fatty liver disease, and kidney failure. Despite mechanistic data, current international cardiology guidelines provide limited, non-specific recommendations, prompting this review’s focus on hyperuricemia as an emerging cardiovascular risk factor.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages19

Reading Time48 min

AccessFree to download

Abstract

Introduction

Mechanisms of hyperuricemia

Links between UA and cardiovascular risk

Exploration of Musculoskeletal Diseases Open Access Review Uric acid in atherosclerosis and cardiovascular diseases: innocent bystander or ruthless killer? Giovanni Cimmino1,2* , Francesco Natale3 , Rosa Franzese1, Mariarosaria Morello1, Gisella Titolo1, Noemi Mollo1, Valentina Maria Caso4, Paolo Golino1,3 , Plinio Cirillo5 1Department of Translational Medical Sciences, Section of Cardiology, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy 2Cardiology Unit, Azienda Ospedaliera Universitaria Luigi Vanvitelli, 80138 Naples, Italy 3Vanvitelli Cardiology Unit, Monaldi Hospital, 80131 Naples, Italy 4Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy 5Department of Advanced Biomedical Sciences, Division of Cardiology, University of Naples “Federico II”, 80131 Naples, Italy *Correspondence: Giovanni Cimmino, Department of Translational Medical Sciences, Section of Cardiology, University of Campania “Luigi Vanvitelli”, 80131 Naples, [Italy.](Italy. giovanni.cimmino@unicampania.it)[ giovanni.cimmino@unicampania.it](Italy. giovanni.cimmino@unicampania.it) Academic Editor: Blanka Stiburkova, Charles University and General University Hospital, Czech Republic Received: January 9, 2024 Accepted: February 22, 2024 Published: June 3, 2024 Cite this article: Cimmino G, Natale F, Franzese R, Morello M, Titolo G, Mollo N, et al. Uric acid in atherosclerosis and cardiovascular diseases: innocent bystander or ruthless killer? Explor Musculoskeletal Dis. 2024;2:189–207. [https://doi.org/](https://doi.org/)[ ](https://doi.org/)[10.37349/emd.2024.00048](10.37349/emd.2024.00048) Abstract Medical attention to uric acid (UA) has been increasing in recent years, mainly because this molecule has been shown to be associated with increased cardiovascular risk, both in the general population and in the hypertensive patients. A growing body of clinical and experimental data supports this view and prompts reconsideration of the role of UA in the development of atherosclerosis and the genesis of cardiovascular disease. It is known that this substance, in certain plasma concentrations, induces increased oxidative stress, a chronic inflammatory state, and a whole series of other modifications that are potentially deleterious at the cardiovascular level leading to hypertension, atherosclerosis, atrial fibrillation (AF), and other metabolic changes such as diabetes, metabolic syndrome, non-alcoholic fatty liver disease and kidney failure. Despite this epidemiologic and mechanistic evidence, the current guidelines from international cardiology scientific societies do not give precise indications in this regard, and some of them only suggest UA evaluation as part of an initial screening of the hypertensive patient. The purpose of this review is to briefly describe the main clinical and epidemiological evidence supporting the role of hyperuricemia as a possible emerging cardiovascular risk factor and to analyze the potential pathophysiological mechanisms through which elevated UA levels may exert a detrimental effect on the cardiovascular system. Keywords Hyperuricemia, inflammation, cardiovascular risk, atherosclerosis, cardiovascular diseases © The Author(s) 2024. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License ([https://creativecommons.org/licenses/by/4.0/](https://creativecommons.org/licenses/by/4.0/)), which permits unrestricted use, sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. Explor Musculoskeletal Dis. 2024;2:189–207 | [https://doi.org/10.37349/emd.2024.00048](https://doi.org/10.37349/emd.2024.00048) Page 189 Introduction Uric acid (UA) is the end product of purine catabolism in th

FAQs

What does the review suggest about uric acid’s role in cardiovascular diseases?

The review discusses evidence that hyperuricemia may act as an emerging cardiovascular risk factor, with UA potentially contributing to oxidative stress and chronic inflammation that worsen cardiovascular outcomes.

How are hyperuricemia mechanisms described?

Hyperuricemia is explained as resulting from increased purine/fructose-related production or decreased elimination, with reduced excretion being responsible for most cases.

What cardiovascular conditions does the review connect to elevated uric acid?

Elevated UA is associated with hypertension, atherosclerosis, atrial fibrillation, and broader metabolic changes such as diabetes and metabolic syndrome, alongside kidney impairment.

Aug 27, 2026

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