cardiovascular diseases ( cvds ) are a set of multiple disorders of the heart and blood vessels , including coronary heart disease , cerebrovascular disease , peripheral arterial disease , rheumatic heart disease , congenital heart disease , deep vein thrombosis , and pulmonary embolism . according to who data , approximately 17.3 million people world - wide died from cvds in 2008 , over 80% of which lived in low- and middle - income countries . in 2012 , cardiovascular diseases were the leading cause of non - communicable disease deaths ( 17.5 million deaths ) , and it has been predicted that there will be more than 23 million people world - wide dying annually from cvds by 2030 . there are various risk factors involved for cvds , including heredity / family history , sex , race / ethnicity , age , hypertension , hypercholesterolemia , diabetes mellitus , obesity , smoking / tobacco , stress / depression , and risk behaviors [ 48 ] . genetic risk factors such as carotid intima - media thickness are related to cardiovascular morbidity and mortality , and socioeconomic factors and social environment also affect the deterioration and prognosis of cvds . hyperuricemia has been viewed as being connected with cvds risk factors since the last century . hyperuricemia was observed with an increased morbidity and mortality of cvds such as hypertension , coronary heart disease ( chd ) , and myocardial infarction ( mi ) [ 1113 ] . many cvds risk factors were thought to be associated with increased serum uric acid ( sua ) , such as : indicators of obesity , including body mass index ( bmi ) , waist circumference ( wc ) , and waist - to - hip ratio ( whr ) ; indicators of hyperlipidemia including cholesterol , triglyceride , low - density lipoprotein ( ldl ) , and high - density lipoprotein ( hdl ) ; and indicators of hypertension , including systolic blood pressure ( sbp ) , and blood glucose and insulin level [ 1321 ] . these results indicate that sua - lowing treatment may be useful in offering a possible novel target for controlling cvds [ 20,2224 ] . however , the relationship between hyperuricemia and cvds risk factors is controversial and conflicting . first , the debate focuses on whether hyperuricemia is an independent risk factor for cvds or is only associated with cvds because of confounding factors . some studies reported that increased sua was an independent risk factor contributing to cvds , but other studies found that sua was not a truly independent risk factor for cvds . increased sua appeared to be an integral part of the cluster of risk factors associated with cvds , including obesity , raised serum triglycerides , and cholesterol . some studies found that the significant association between hyperuricemia and cvds only existed in women but not in men . third , the prevalence of hyperuricemia was different in different racial populations [ 14,2527 ] . however , there are few studies on this relationship in the chinese population . we designed the present study to investigate the relationship between hyperuricemia and cvds risk factors in chinese men and women . the data analyzed in the present study were based on chinese hyperuricemia and gout database , provided by the chinese national scientific data sharing platform for population and health . the participants were composed of health checkup residents in the beijing xiehe hospital and part of the community population in beijing , china . there were 940 participants in total , including 599 men , 288 women , and other 53 participants without sex information , ranging from 18 to 90 years old . indicators of sua level , height , weight , sbp , dbp , fatty liver , smoking status , alcohol consumption , blood glucose , cholesterol , and triglycerides were measured in the participants . hyperuricemia was defined as sua 7.0 mg / dl for men and sua 6.0 mg / dl for women . complications were analyzed by the diagnostic history , including chd , hypertension , stroke , hyperlipidemia , dm , and gout . smoking status was divided into 3 groups : current smoker , non - smoker , and former smoker . alcohol consumption was classified into current drinker , non - drinker , and former drinker . among current drinkers , the frequency of alcohol consumption was recorded as frequency / week , and the alcoholic beverage classifications ( spirits , beer , and wine ) were also recorded . physical activities were recorded by frequency per week , light activity defined as less than 2 times / week , mediate activity defined as 35 times / week , and heavy activity defined as more than 6 times / week . height was measured to the nearest 1 cm , weight was measured to the nearest 0.1 kg , and bmi was calculated as body weight / height ( kg / m ) . obesity was defined as bmi 30.0 kg / m , overweight was defined as 25.0 kg / m bmi 29.9 kg / m , normal was defined as 18.5 kg / m bmi 24.9 kg / m , and underweight was defined as bmi 18.4 kg / m . hypertension was defined as having blood pressure 140/90 mm hg , or currently undergoing anti - hypertensive pharmacologic treatment . diabetes mellitus ( dm ) was defined as fasting plasma glucose ( fpg ) 126 mg / dl or currently undergoing pharmacologic treatment , impaired fasting glucose ( ifg ) was defined as 110 mg / dl fpg < 126 mg / dl , and normal state was defined as fpg < 110 mg / dl . cholesterol and triglyceride were measured to the nearest 1 mg / dl . hyperlipidemia was defined as serum triglyceride level 150 mg / dl or total cholesterol level 200 mg / dl . the t test was used to detect the difference between men and women , or to compare patients with hyperuricemia and participants with normouricemia . one - way analysis of variance ( anova ) was used when there were more than 2 groups . pearson s correlation coefficients were calculated to detect the correlation between the level of sua and other cvds risk factors in both men and women . two multivariate linear regression models were applied to determine the different effects of different covariates contributed to the variation of the sua . the first model was a stepwise section procedure and the second model was an enter section procedure . also , for those categorical variables , multivariate logistic regression models ( adjusted by age and other confounding factors ) were used to determine the relationship between hyperuricemia and cvds risk factors . the data analyzed in the present study were based on chinese hyperuricemia and gout database , provided by the chinese national scientific data sharing platform for population and health . the participants were composed of health checkup residents in the beijing xiehe hospital and part of the community population in beijing , china . there were 940 participants in total , including 599 men , 288 women , and other 53 participants without sex information , ranging from 18 to 90 years old . indicators of sua level , height , weight , sbp , dbp , fatty liver , smoking status , alcohol consumption , blood glucose , cholesterol , and triglycerides were measured in the participants . hyperuricemia was defined as sua 7.0 mg / dl for men and sua 6.0 mg / dl for women . complications were analyzed by the diagnostic history , including chd , hypertension , stroke , hyperlipidemia , dm , and gout . smoking status was divided into 3 groups : current smoker , non - smoker , and former smoker . alcohol consumption was classified into current drinker , non - drinker , and former drinker . among current drinkers , the frequency of alcohol consumption was recorded as frequency / week , and the alcoholic beverage classifications ( spirits , beer , and wine ) were also recorded . physical activities were recorded by frequency per week , light activity defined as less than 2 times / week , mediate activity defined as 35 times / week , and heavy activity defined as more than 6 times / week . height was measured to the nearest 1 cm , weight was measured to the nearest 0.1 kg , and bmi was calculated as body weight / height ( kg / m ) . obesity was defined as bmi 30.0 kg / m , overweight was defined as 25.0 kg / m bmi 29.9 kg / m , normal was defined as 18.5 kg / m bmi 24.9 kg / m , and underweight was defined as bmi 18.4 kg / m . hypertension was defined as having blood pressure 140/90 mm hg , or currently undergoing anti - hypertensive pharmacologic treatment . diabetes mellitus ( dm ) was defined as fasting plasma glucose ( fpg ) 126 mg / dl or currently undergoing pharmacologic treatment , impaired fasting glucose ( ifg ) was defined as 110 mg / dl fpg < 126 mg / dl , and normal state was defined as fpg < 110 mg / dl . cholesterol and triglyceride were measured to the nearest 1 mg / dl . hyperlipidemia was defined as serum triglyceride level 150 mg / dl or total cholesterol level 200 mg / dl . the t test was used to detect the difference between men and women , or to compare patients with hyperuricemia and participants with normouricemia . one - way analysis of variance ( anova ) was used when there were more than 2 groups . pearson s correlation coefficients were calculated to detect the correlation between the level of sua and other cvds risk factors in both men and women . two multivariate linear regression models were applied to determine the different effects of different covariates contributed to the variation of the sua . the first model was a stepwise section procedure and the second model was an enter section procedure . also , for those categorical variables , multivariate logistic regression models ( adjusted by age and other confounding factors ) were used to determine the relationship between hyperuricemia and cvds risk factors . we calculated the mean value of each indicator in chinese men and women , as shown in table 1 . by comparing the indicators between men and women , we found that , except for age and cholesterol , other indicators , such as sua , height , weight , bmi , sbp , dbp , the level of serum glucose , and triglyceride , were significantly different for men and women . these results indicated that the study should be implemented for each sex separately , instead of a mixed - sex study . in table 2 , the portions of different status were also calculated in both sexes . the comparison between the 2 sexes was similar with the results of table 1 , except for the dm , ifg , and normal state divided by the level of glucose . however , we noted that in chinese women , the numbers of current and former smokers were too small to be included as accurate factors . in table 3 , for both sexes , we compared the mean value of each indicator between patients with hyperuricemia and participants with normouricemia . in men , the age of hyperuricemic patients was not significantly different from that of normal participants ( p=0.644 ) . however , the height , weight , and bmi of patients with hyperuricemia were significantly higher than those of participants with normouricemia . also , both sbp and dbp of patients with hyperuricemia were significantly higher than those of normal participants . in addition , the level of cholesterol and triglyceride were also higher for patients . in women , hyperuricemic patients were older , with higher value of weight , bmi , sbp , dbp , glucose , and triglyceride . the sex - specific pearson s correlation coefficients of sua with those components of cvds risk factors are shown in table 4 . in both men and women , we observed that weight , bmi , and the level of triglyceride showed the strongest positive correlation . in men , the positive correlation coefficients were age , height , weight , bmi , sbp , dbp , cholesterol , and triglyceride . in women , the positive correlation coefficients were age , weight , bmi , sbp , dbp , glucose , cholesterol , and triglyceride . using the stepwise section procedure of multivariate linear regression models , we observed that for men , age , bmi , dbp , glucose , cholesterol , and triglyceride were the major determinants for the variation of the level of sua ( table 5 ) , but for women , the major determinants were only bmi and triglyceride . analyzed by multivariate linear regression models , table 6 shows the relationship between sua concentration and each cvds risk factor by adjusting for other potential confounding factors , including age , bmi , sbp , dbp , the level of glucose , cholesterol , and triglyceride . in men , after adjustment , sua concentration showed significant positive associations with bmi , cholesterol , and triglyceride , and an inverse association with glucose . the results indicate that , after adjustment , an increase of 1 mg / dl in sua concentration was associated with a 0.279 kg / m increase in bmi ( p<0.001 ) , a 2.438 mg / dl increase in cholesterol ( p<0.05 ) , a 10.358 mg / dl increase in triglyceride ( p<0.001 ) , and a 3.1 mg / dl decrease in glucose ( p<0.01 ) . in women , after adjustment , only bmi and triglyceride showed significant associations with the level of sua . the results indicated that , after adjustment , an increase of 1 mg / dl the level of sua was associated with a 0.168 kg / m increase in bmi ( p<0.01 ) and a 3.708 mg / dl increase in triglyceride ( p<0.01 ) . analyzed by multivariate logistic regression models , table 7 showed the odds ratio for hyperuricemia according to different status of smoking , drinking , physical activities and so on . in men , before adjustment or after age adjusted , drinking , overweight / obesity , hypertension , and hyperlipidemia all played positive roles in increasing the odds ratio of hyperuricemia . after adjustment for other potential confounding factors , drinking , overweight , and high level of triglyceride played positive roles in increasing the odds ratio of hyperuricemia . in women , before adjustment , heavy activities , overweight / obesity , hypertension , ifg / dm , and hyperlipidemia all played positive roles in increasing the odds ratio of hyperuricemia . after adjustment for age , only overweight / obesity and hyperlipidemia played positive roles in increasing the odds ratio of hyperuricemia . according to our results , there was a significant relationship between hyperuricemia and cvds risk factors in both chinese men and women . the participants with higher levels of serum uric acid tended to sustain more risk factors in cardiovascular diseases , and those patients with higher cvds risk factors were easier to diagnose with hyperuricemia . compared with normouricemic men , hyperuricemic men had greater height , weight , bmi , sbp , dbp , cholesterol , and triglyceride . compared with normouricemic women , hyperuricemic women were older and had higher weight , bmi , sbp , dbp , glucose , and triglyceride . in men , the associated cvds risk factors included age , alcohol consumption , bmi , dbp , glucose , cholesterol , and triglyceride . after adjustment , sua was strongly associated with alcohol consumption , obesity , and hyperlipidemia . in women , one possible reason is about the impaired kidney function , which was the main cause of hyperuricemia . patients sua levels increased mainly as a consequence of impaired renal excretion . in conditions of local ischemia , an increased production of uric acid occurred in parallel with that of reactive oxygen species ( ros ) . the pro - oxidant and pro - inflammatory effects of ros accumulation might further affect those cvds indicators . the second possible reason was the damage to endothelial cells ( ecs ) and vascular smooth muscle cells ( vsmcs ) caused by hyperuricemia . in vitro and in vivo research suggests that uric acid might contribute to endothelial dysfunction by inducing anti - proliferative effects on endothelium and impairing nitric oxide production . pro - inflammatory and proliferative effects of soluble uric acid have been described in vsmcs . in animal models of mild hyperuricemia , hypertension developed in association with intrarenal vascular disease . however , according many studies , the association between hyperuricemia and cvds risk factors is conflicting and complicated . some studies   reported that sua was not a truly independent risk factor for cvd , but was secondary to its association with the insulin resistance syndrome ( irs ) . also , there is research   showing that after additional adjustment for cvds risk factors , uric acid level was no longer associated with chd , death from cvds , or death from all causes . however , according to our results , after adjustment for other potential risk factors of cvd , there was still a strong and significant connection between the level of sua and obesity , as well as hyperlipidemia , in both men and women . our results were similar to and consistent with some additional studies . in adolescents with new - onset essential hypertension , the prevalence of elevated sua was more than 90% , and a preliminary clinical trial evidence suggested that agents that lower sua may also lower bp . for each increase of 1 mg / dl in uric acid level , the pooled multivariate risk ratio for chd mortality was 1.12 . in untreated subjects with essential hypertension , raised uric acid was a powerful risk marker for subsequent cvds and all - cause mortality . also , some studies noted that hypertriglyceridemia was related to hyperuricemia independent of obesity and central body fat distribution . children and young adults with hyperuricemia had significantly higher plasma glucose , insulin levels , cholesterol , triglyceride , very low - density lipoprotein cholesterol , low - density lipoprotein cholesterol , and total protein levels than subjects without hyperuricemia ; high - density lipoprotein cholesterol level was significantly lower in subjects with hyperuricemia than in those without it . besides the conflict on the relation itself , there were also debates on different sex patterns of this relationship . according to kim s study , there was no significant association between hyperuricemia and chd incidence / mortality in men , but an increased risk for chd mortality was found in women . culleton   reported that in men , after adjustment for age , elevated sua level was not associated with increased risk for an adverse outcome . in women , after adjustment for age , uric acid level was predictive of chd , and death from cvds . liese found   a strong positive association of elevated sua with all - cause mortality of cvds in men . according to wannamethee s study , when the association between sua and risk of chd was examined by the presence and grade of pre - existing chd , a positive association was seen only in men with previous definite mi , even after full adjustment . verdecchia   found that the relationship between uric acid and cvds event rate was j - shaped in both sexes . according to our study results , the relationship between sua and cvds risk factors exist in both sexes , but some details were different . in men , there were many related cvds risk factors , while in women only bmi and triglyceride were related . in both sexes , obesity and hyperlipidemia showed the strongest association with hyperuricemia . considering all these differences in various studies , we suggest there might be several explanations . first , the definition of hyperuricemia was not exactly the same among various studies . in some studies , the definition of hyperuricemia was described as sua > 7.7 mg / dl for men and sua > 6.6 mg / dl for women . in other studies , including the present one , hyperuricemia was defined as sua 7.0 mg / dl for men and sua 6.0 mg / dl for women . actually , the definition of hyperuricemia is currently arbitrary and varies from 5.6 to 7.7 mg / dl in men and from 4.7 to 7.0 mg / dl in women . for example , black men might have lower sua levels and a lower prevalence of hyperuricemia when compared with white men . third , since genes and environment can affect obesity and cardiovascular diseases , diet , genetics , and environmental factors of each population might explain the differences found in this association [ 3436 ] . first , we studied the relationship between hyperuricemia and cvds risk factors in a chinese population , which has rarely been studied . second , we detected and calculated many cvds risk factors , including : height , weight , and bmi , which reflect obesity ; sbp and dbp , which reflect hypertension ; the level of glucose , which reflects dm ; and the level of cholesterol and triglyceride , which reflect chd and mi . third , to better study the relationship between sua and each factor , we ran the adjustment to exclude the effect of other confounding factors . fourth , we studied the relationship in both sexes and compared the differences between men and women . second , the simple number of hyperuricemic women was too small , which might make the results disputable when we divided women into 2 groups : hyperuricemic and normouricemic . third , the population in our study was only chinese , which limits generalization of our results to other populations . we found that elevated serum uric acid concentration was strongly associated with obesity and hyperlipidemia in both men and women , indicating that , among hyperuricemic patients , we should pay more attention to the possibility of cardiovascular complications . these results might provide a novel target or a new treatment for cardiovascular diseases by lowering the level of serum uric acid .
backgroundto study the relationship between hyperuricemia and cardiovascular diseases ( cvds ) risk factors in a chinese population.material/methodsdata analyzed in this study were from the chinese hyperuricemia and gout database . 
 indicators of serum uric acid ( sua ) level , height , weight , systolic blood pressure ( sbp ) , diastolic blood pressure ( dbp ) , smoking status , alcohol consumption , blood glucose , cholesterol , and triglycerides were measured . 
 t test , one - way analysis of variance , pearson s correlation , multivariate linear regression , and multivariate logistic regression were used.resultscompared with normouricemic men , hyperuricemic men had greater height ( p<0.01 ) , weight ( p<0.001 ) , body mass index ( bmi ) ( p<0.001 ) , sbp ( p<0.01 ) , dbp ( p<0.001 ) , cholesterol ( p<0.01 ) , and triglyceride ( p<0.001 ) . compared with normouricemic women , 
 hyperuricemic women were older ( p<0.01 ) and had greater weight ( p<0.05 ) , bmi ( p<0.01 ) , sbp ( p<0.01 ) , dbp ( p<0.05 ) , glucose ( p<0.05 ) , and triglyceride ( p<0.001 ) . in men , an increase of 1 mg / dl in sua 
 was associated with a 0.279 kg / m2 increase in bmi ( p<0.001 ) , a 2.438 mg / dl increase in cholesterol ( p<0.05 ) , a 10.358 mg / dl increase in triglyceride ( p<0.001 ) , and a 3.1 mg / dl decrease in glucose ( p<0.01 ) . in women , an increase of 1 mg / dl 
 sua was associated with a 0.168 kg / m2 increase in bmi ( p<0.01 ) and a 3.708 mg / dl increase in triglyceride ( p<0.01 ) . after adjustment , 
 sua was strongly associated with obesity and hyperlipidemia in both sexes.conclusionselevated serum uric acid concentration was strongly associated with obesity and hyperlipidemia in both men and women . 
 these results indicated that , among hyperuricemia patients , we should pay more attention to the possibility of cardiovascular complications . 
 these results might provide a novel target or a possible new treatment for cardiovascular diseases by lowering the level of serum uric acid .