2007 Donald Seldin Lecture—Fructose, Uric Acid, and the Pathogenesis of the Epidemic of Hypertension and Metabolic Syndrome
There has been a remarkable increase in the frequency of hypertension, obesity, diabetes, and kidney disease since the early 1900s, and this is largely responsible for the dramatic rise in cardiovascular disease during the past century. While physical inactivity and excessive energy intake play an important role, there is also concern that specific foods in the Western diet may contribute. In this lecture, we revisit the hypothesis that sugar, and in particular fructose, may have a key role in the epidemic. We will review the experimental and clinical evidence linking fructose to the epidemic, as well as recent data suggesting that the effects may be driven in part by the unique ability of fructose to raise uric acid. We will also briefly discuss the evidence that uric acid may be a true cardiovascular risk factor, with attention to its actions on the kidney and vasculature. Although more definitive studies need to be performed, the resurrection of these 2 old risk factors (fructose and uric acid) may allow for new insights into how to both prevent and interrupt the ongoing cardiorenal epidemic.