Panminerva medica
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Uric acid has long been considered responsible for a single specific disease, namely gout. In recent years, novel knowledge has emerged linking serum uric acid with a variety of conditions and related risk factors, from hypertension, metabolic syndrome, and type 2 diabetes, to fatal/nonfatal cardiovascular diseases and all-cause death, with the underlying mechanisms involving disrupted neurohormonal and metabolic signaling as well as oxidative stress and inflammation. Importantly, the cut-off value of serum uric acid that predicts the risk of incident events is within the range of normality and below the threshold for increased risk of gout. A large contribution to the advancement in knowledge in the cardiovascular implications of uric acid derives from the Italian study URic acid Right for heArt Health (URRAH). ⋯ The results of studies from the URRAH database further strengthen the role of uric acid in cardiovascular disease, including heart failure, and total mortality. The identified cut-off values support clinicians in investigating serum uric acid levels in their patients and to consider uric acid as an additional cardiovascular risk factor. Taken together, the published papers deriving from the URRAH database emphasize the role of uric acid in favoring cardiovascular events, and strongly suggest the existence of "grey" areas, i.e. close but lower than the "traditional" threshold for hyperuricemia, which deserve further characterization.