Emia was a new component of metabolic syndrome. Furthermore, in our
Emia was a new component of metabolic syndrome. Furthermore, in our study, the proportion of metabolic syndrome is in parallel with increasing serum uric acid quartiles. Thus, in order to explore whether elevated serum uric acid levels are associated with CVD independent of metabolic syndrome, we further analyzed the prevalence of CVD according to quartile of uric acid and the presence of metabolic syndrome. We found that prevalence of CVD is Vercirnon web significantly increased with increasing quartiles of uric acid in without MetS group (p trend < 0.001), but not necessarily increased in those with metabolic syndrome. Additional factors besides metabolic syndrome may also play a key role in the development of CVD in hyperuricemia subjects, which requires further research. The present study may have some implications. In particular, this study may strengthen the need for interventional studies with uric acid-lowering therapies to maintain UA levels in the lower safe range. Moreover, allopurinol ?a xanthine oxidase inhibitor ?has been shown recently to significantly improve endothelialfunction and abolish vascular oxidative stress [40], has a clinically relevant antiischaemic effect and has been well tolerated in patients with angina [41]. In analogy with homocysteine-lowering therapy interventional studies with UA-lowering agents, apart from exploring clinical benefits of these agents, may provide valuable additional information regarding causality in the uric acid ardiovascular disease relationship. The major strength of our present study was that the large sample size and representative sample with a relatively high response rate. Several limitations of our study have also to be addressed. First, due to the crosssectional nature of the present study, no causal relationships can be established. Large prospective studies are in urgent need to confirm the relationship between serum uric acid levels and CVD. Second, although most potential confounders were carefully controlled, since some of the study subjects may had several chronic disease, we could not eliminate the possible effect of underlying diseases and medications used for these diseases on the present findings.Conclusion In conclusion, the present study showed that elevated serum uric acid level was associated with CVD, independent of conventional CVD risk factors and the presence of metabolic syndrome. The study added more evidence to the notion that the risk of CVD increased in subjects with hyperuricemia.Qin et al. BMC Cardiovascular Disorders 2014, 14:26 http://www.biomedcentral.com/1471-2261/14/Page 7 ofCompeting interests The authors declare that they have no competing interests. 14. Authors' contributions Conceived and designed the experiments: QS. Analyzed the data: LQ, ZY. Contributed reagents/materials/analysis tools: LQ, ZY, HG, SL, QS, YX, XL, RL, GN. Wrote the paper: LQ, ZY. All authors read and approved the final manuscript. Acknowledgements This work was supported by the Shanghai Science and Technology Commission (10411956600), National Natural Science Foundation of China (81000332, 81370953, 81370935), Shanghai Health System Outstanding Young Talents Training Program (XYQ2013098), Chinesse Society of Endocrinology (13040580443). We thank the PubMed ID:https://www.ncbi.nlm.nih.gov/pubmed/28914615 field workers for their contribution and the participants for their cooperation. Author details 1 Department of Endocrinology, Xinhua hospital, School of medicine, Shanghai Jiaotong University, Kongjiang Road, Shanghai 1665, China. 2 Dep.