With great interest, we read the article by Speliotes et al.,1 who studied a large community-based sample from the Framingham Heart Study and reported that fatty liver is associated with dyslipidemia and dysglycemia independently of visceral fat. Interestingly, the study demonstrated an association between fatty liver and increased blood pressure.1 Even though the mechanisms underlying this association may be complicated, we hypothesize that elevated uric acid levels potentially link fatty liver and high blood pressure on the basis of the risk relationships between hyperuricemia and chronic liver disease/hypertension.
With respect to hyperuricemia/chronic liver disease risk relationships, the association between elevated uric acid, the final oxidation product of purine metabolism in human beings, and the development of chronic liver diseases has been investigated in many studies.2-4 Increased levels of serum uric acid have been found to be an independent risk factor for nonalcoholic fatty liver disease, and the serum uric acid level may act as a useful clinical predictor for assessing the risk of nonalcoholic fatty liver disease.2, 3 A very recent study has indicated that the serum uric acid level is associated with the development of cirrhosis and the presence of elevated serum liver enzymes.4
With respect to hyperuricemia/hypertension risk relationships, accumulating evidence supports the notion that high levels of uric acid may be associated with high blood pressure.5-8 The serum uric acid level has been found to be an independent marker of risk for the development of hypertension.6-8 The pathogenic role of hyperuricemia in the development of hypertension has been proven with an experimental rat model of mild hyperuricemia.9
Therefore, the hyperuricemia/chronic liver disease and hyperuricemia/hypertension risk relationships make uric acid a potential link between fatty liver and high blood pressure. If this hypothesis can be verified by future studies, it has important implications: the treatment of hyperuricemia may have the beneficial effects of decreasing the risk of fatty liver and lowering blood pressure.