In this solo presentation, Dr. David Perlmutter reviews a large epidemiological study (≈41,000 men and 48,000 women, age > 35, average 8.2‑year follow‑up) that examined serum uric acid levels as an independent predictor of all‑cause mortality, cardiovascular death, ischemic stroke, congestive heart failure, hypertension, and coronary heart disease. Hyperuricemia (≥7 mg/dL) was associated with a statistically significant rise in risk, with an adjusted 8‑13 % increase for each 1 mg/dL increment in uric acid. Survival curves for both men and women show markedly lower survival among participants with very high uric acid (≥7.1 mg/dL, especially >9 mg/dL). Dr. Perlmutter explains the likely mechanisms: elevated uric acid drives inflammation, insulin resistance, dyslipidemia (higher triglycerides and unfavorable HDL‑cholesterol ratios), and increased body‑fat accumulation, all established risk factors for cardiovascular disease and mortality. He concludes that maintaining lower uric acid is crucial for health and promotes his forthcoming book, “Drop Acid: The Secret to Losing Weight, Controlling Blood Sugar, and Achieving Extraordinary Health,” slated for February 2022, with the website DropAcidBook.com.
Chapters
Well, hi everyone, I'm Dr. David Perlmutter. Great to spend time with you. You know, we've been talking quite a bit about uric acid, how uric acid amps up inflammation, how it leads to the formation and the storage of body fat, how it relates to things like insulin resistance. And that said, you might consider then that there would be a relationship between elevation of uric acid and things like all-cause mortality and certainly cardiovascular disease and risk from death from cardiovascular disease, and in fact that is the case. Let's have a look at some of the research. We're actually going to explore this notion of elevation of uric acid as a risk factor for all-cause mortality, cardiovascular mortality, and even death from artery blockage causing a stroke in a a pretty extensive study entitled Serum Uric Acid Level as an Independent Risk Factor for These Things. And this study was really quite large, involved 41,000 men, 48,000 women, all over age 35 years, and it looked at all causes of mortality. In other words, death from any cause, as well as total cardiovascular disease, ischemic stroke, that's blockage of an artery, congestive heart failure, hypertensive disease, and coronary heart disease were all compared. to the level of uric acid in these individuals, and these subjects were followed for many years, an average of 8.2 years. And I want to just look at some of the graphs from the study because I think they're very, very telling. This is looking at males, and this is looking at how many over that period of time, average of 8 years and change, how the uric acid affects the risk for cardiovascular death. Did you die of a cardiovascular event? And you can look at the— these graphs chart the number of individuals who are surviving or the rate of survival. Again, this is 41,000 men that were studied, and you'll notice that those with a uric acid really high, like 7.1 to 9 or greater than 9, their risk of survival— is declining quite significantly. But I think what's even more telling about this graph is actually the next one that looks at women. Watch that red curve. These are women with very, very high uric acid levels. And what it's telling us is, you know, there's a significant decline in the women who are not going to survive or didn't survive dying from cardiovascular disease that is plotted against having a very high uric acid level. And in this study, hyperuricemia is defined as having a serum uric acid of 7 or greater, and that is determined in the study to be an independent risk factor for all-cause death from any reason, as well as cardiovascular death, not in all patients, or not only in all patients, but also— In all. in patients with hypertension and diabetes, and potentially even in low-risk subgroups. The adjusted risks increased 8 to 13% with every milligram per deciliter increase in serum uric acid. In other words, every point increase of uric acid, let's say going from 6 to 7 to 8, these are all a point, there is this substantial increased risk of death and other of the issues that they followed. But specifically in this case for these 2 major endpoints, And various other cardiovascular disease events, including stroke, congestive heart failure, and even hypertensive disease. So the question would then be, why? Why is this happening? Why is there such a downside in terms of overall risk of death, and certainly cardiovascular disease and stroke related to this elevation of uric acid? Well, what do we know about uric acid when it's elevated? It It significantly augments the production of inflammation in the human body. Now, inflammation is seen to correlate with heart disease, correlate with artery issues, with stroke and coronary vascular disease as well. In addition, elevated uric acid correlates with elevation of insulin resistance. Insulin resistance again correlates with cardiovascular disease and not mentioned in the study, is this relationship of both inflammation and insulin resistance to problems with respect to the brain, like Alzheimer's disease. Elevation of uric acid leads to what is called dyslipidemia, specifically increase not only in triglycerides, but changes in the cholesterol HDL ratio as well, which are disfavorable as it relates to the heart. The other thing that elevated uric acid is associated with that then has a downstream effect in terms of risk of overall death, and certainly cardiovascular disease, is elevation of uric acid is associated with increased production of body fat leading to obesity. So this was a very big study indeed, and it clearly shows strong correlations even with 1-point elevation of the uric acid. And again, we reviewed some of the mechanisms whereby elevation of uric acid can do its dirty work, including inflammation, including insulin resistance, Including increased body fat and certainly including dyslipidemia. These are all known risk factors, for example, for cardiovascular disease. So it's all about keeping our uric acid levels in check. These are things to consider, and we're going to be unpacking this in our new book, which is Drop Acid: The Secret to Losing Weight, Controlling Blood Sugar, and Achieving Extraordinary Health. We're going to be publishing that book in February of 2022. Want to learn more about it? DropAcidBook.com is the URL.
