Uric Acid and Its Role in Ischemic Heart Disease

Ischemic heart disease (IHD) is a condition where the blood supply to the heart is reduced due to narrowed or blocked arteries. It can cause chest pain, shortness of breath, and even heart attack. IHD is one of the leading causes of death worldwide.

But what causes IHD? There are many risk factors, such as high blood pressure, high cholesterol, smoking, diabetes, obesity, and family history. However, there is another factor that is often overlooked: uric acid.

Uric acid is a waste product of purine metabolism. Purines are substances found in many foods, such as meat, seafood, beans, and beer. Normally, uric acid is dissolved in the blood and excreted by the kidneys. But sometimes, the level of uric acid in the blood becomes too high. This condition is called hyperuricemia.

Hyperuricemia can be caused by various factors, such as genetics, diet, medications, kidney disease, and dehydration. Hyperuricemia is well known to cause gout, a painful inflammation of the joints. But it can also affect the heart and blood vessels.

How does uric acid harm the heart? There are several mechanisms that have been proposed by researchers:

- Uric acid can increase oxidative stress, which damages the cells and tissues of the heart and blood vessels.

- Uric acid can cause inflammation, which triggers the immune system to attack the heart and blood vessels.

- Uric acid can impair nitric oxide production, which reduces the ability of the blood vessels to relax and dilate.

- Uric acid can activate the renin-angiotensin-aldosterone system (RAAS), which increases blood pressure and salt retention.

All these effects can lead to endothelial dysfunction, which is a loss of normal function of the inner lining of the blood vessels. Endothelial dysfunction is a key factor in the development of atherosclerosis, which is the buildup of fatty plaques in the arteries. Atherosclerosis can narrow or block the arteries that supply blood to the heart, causing IHD.

Several studies have shown that high levels of uric acid are associated with increased risk of IHD and its complications, such as angina, myocardial infarction, heart failure, and death. For example, a meta-analysis of 16 prospective studies involving more than 200,000 participants found that for every 1 mg/dL increase in uric acid level, there was a 12% increase in the risk of IHD.

So what can you do to lower your uric acid level and protect your heart? Here are some tips:

- Drink plenty of water to help flush out uric acid from your body.

- Limit your intake of purine-rich foods, such as red meat, organ meats, seafood, beer, and sugary drinks.

- Avoid alcohol and tobacco, which can increase uric acid production and impair kidney function.

- Maintain a healthy weight and exercise regularly, which can lower blood pressure and improve insulin sensitivity.

- Check your medications with your doctor. Some drugs, such as diuretics, aspirin, and niacin, can raise uric acid levels.

- Consider taking uric acid-lowering drugs, such as allopurinol or febuxostat. These drugs inhibit xanthine oxidase (XO), an enzyme that converts purines into uric acid. They can reduce uric acid levels by up to 50%. However, their effect on cardiovascular outcomes is still controversial. Therefore, they should be used only under medical supervision and in combination with lifestyle modifications.

Uric acid is not just a waste product. It can also be a risk factor for ischemic heart disease. By keeping your uric acid level under control, you can improve your cardiovascular health and prevent serious complications.

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