[Hyperuricemia and the metabolic syndrome].

Uric acid is the final product of purine metabolism in human beings. Despite the fact that uric acid was first identified approximately 2 centuries ago, certain pathophysiologic aspects of hyperuricemia are still not clearly understood. For years, hyperuricemia has been identified with or thought to be the same as gout, but uric acid has now been identified as a marker for a number of metabolic and hemodynamic abnormalities.The prevalence of the metabolic syndrome is very high in hyperuricemic patients. Recent epidemiologic studies support the view that asymptomatic hyperuricemia in patients at low cardiovascular risk is likely to result from diminished renal uric acid clearance and to be benign in outcome. In contrast, hyperuricemia in patients at high cardiovascular risk may promote or reflect alternative or additional pathogenetic factors promoting inflammatory, ischaemic or oxidative stresses to the heart and vessels. This hypothesis warrants testing, particularly in carefully designed randomized controlled urate-lowering interventional trials.