Time to redefine serum uric acid levels in women: A call for sex-specific cardiometabolic risk thresholds.

IF 3.9 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Nutrition Metabolism and Cardiovascular Diseases Pub Date : 2026-09-21 DOI:10.1016/j.numecd.2026.104986

Anna Vittoria Mattioli, Claudio Borghi

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引用次数: 0

Abstract

Aims: Serum uric acid (SUA) is routinely measured in clinical practice, but its interpretation remains largely anchored to conventional, gout-oriented or sex-neutral thresholds. This Viewpoint discusses why this approach may underestimate cardiometabolic and vascular risk in women.

Data synthesis: SUA in women is influenced by hormonal status, renal urate handling, age, adiposity, insulin resistance, inflammation, and menopause. Population-based evidence shows a marked sex- and age-specific trajectory of SUA, with a sharper increase in women after midlife, while outcome studies suggest that women may experience cardiovascular risk at lower SUA concentrations than men. Emerging data also link SUA to arterial stiffness and microvascular dysfunction even within ranges traditionally considered physiological.

Conclusions: SUA should be interpreted as a dynamic, sex-sensitive cardiometabolic biomarker rather than as a fixed biochemical value. Redefining SUA levels in women does not imply urate-lowering therapy for all asymptomatic women, but rather the distinction between gout thresholds and cardiometabolic risk thresholds. Prospective studies are needed to validate sex-, age-, and hormone-specific SUA thresholds for cardiovascular prevention.

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是时候重新定义女性血清尿酸水平了：对性别特异性心脏代谢风险阈值的呼吁。

目的：血清尿酸（SUA）在临床实践中是常规测量，但其解释仍然主要依赖于传统的、痛风导向的或性别中立的阈值。本观点讨论了为什么这种方法可能低估了女性的心脏代谢和血管风险。数据综合：女性的SUA受激素状态、肾尿酸处理、年龄、肥胖、胰岛素抵抗、炎症和更年期的影响。基于人群的证据显示，SUA有明显的性别和年龄特异性轨迹，中年后女性的SUA增加更快，而结果研究表明，女性在SUA浓度低于男性时可能会经历心血管风险。新出现的数据也将SUA与动脉僵硬和微血管功能障碍联系起来，甚至在传统上被认为是生理的范围内。结论：SUA应被解释为一个动态的、性别敏感的心脏代谢生物标志物，而不是一个固定的生化值。重新定义女性的SUA水平并不意味着对所有无症状女性进行降尿酸治疗，而是要区分痛风阈值和心脏代谢风险阈值。需要前瞻性研究来验证性别、年龄和激素特异性SUA阈值对心血管预防的作用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Nutrition Metabolism and Cardiovascular Diseases 医学-内分泌学与代谢

CiteScore

6.80

自引率

2.60%

发文量

332

审稿时长

57 days

期刊介绍： Nutrition, Metabolism & Cardiovascular Diseases is a forum designed to focus on the powerful interplay between nutritional and metabolic alterations, and cardiovascular disorders. It aims to be a highly qualified tool to help refine strategies against the nutrition-related epidemics of metabolic and cardiovascular diseases. By presenting original clinical and experimental findings, it introduces readers and authors into a rapidly developing area of clinical and preventive medicine, including also vascular biology. Of particular concern are the origins, the mechanisms and the means to prevent and control diabetes, atherosclerosis, hypertension, and other nutrition-related diseases.