The combination of elevated uric acid and vitamin D deficiency increases the risk of cardiovascular disease

Elevated blood levels of uric acid (hyperuricemia) is a common metabolic disorder that can lead to the formation of crystals in the joints and gout. Elevated uric acid also increases the risk of cardiovascular disease, and it appears that patients who are deficient in vitamin D have an even greater risk of developing cardiovascular disease, including atherosclerosis and narrowing of the coronary arteries, according to a large Chinese population study published in PLOS ONE.

Uric acid is a waste product formed primarily through the normal breakdown of the body’s own cells and purine-rich foods. Uric acid should normally be excreted through the kidneys, and there should be a proper balance between the body’s production and excretion of uric acid. Nevertheless, elevated uric acid is one of the most common metabolic disorders. In gout, uric acid crystals form from the blood and settle in one or more joints, often causing a very painful inflammatory condition. Elevated uric acid occurs more frequently in people who are overweight and in those with type 2 diabetes, high blood pressure, and impaired kidney function. In addition, diuretics and blood pressure medications can trigger elevated uric acid levels.
Elevated uric acid is associated with the development of cardiovascular disease. This is partly because elevated uric acid activates a system called RAAS (renin-angiotensin-aldosterone system), which regulates fluid balance and blood pressure. Elevated uric acid can also inhibit the production of nitric oxide (NO), which dilates blood vessels and lowers blood pressure. Overall, elevated uric acid is characterized by chronic inflammation and oxidative stress, in which cascades of free radicals can attack and cause dysfunction in endothelial cells lining the blood vessels. This further promotes the development of atherosclerosis.
Because cardiovascular disease remains the leading cause of death worldwide, the researchers behind the new study wanted to investigate whether vitamin D deficiency in patients with elevated uric acid increases the risk of these conditions.

Vitamin D supports cardiovascular health in several ways

The study included clinical data from 483 patients with elevated uric acid who were associated with Harbin University Hospital in China between September 1, 2023, and November 1, 2024.
The patients were divided into three groups based on their blood levels of vitamin D. A definite deficiency was defined as a level below 30 nmol/L, an insufficient level as 20–50 nmol/L, and an adequate level as above 50 nmol/L. During the study, the occurrence of atherosclerosis and other cardiovascular diseases was measured and recorded. The study revealed the following:

• The prevalence of cardiovascular disease was higher in the group with vitamin D deficiency compared with the group with adequate vitamin D levels
• The Gensini score, which reflects the degree of atherosclerosis, was higher in the group with vitamin D deficiency compared with the group with adequate vitamin D levels
• According to an analysis method called Spearman’s rank correlation, vitamin D deficiency was negatively associated with glycated hemoglobin (HbA1c), total cholesterol, and triglycerides
• Older age also increased the risk of cardiovascular disease.

Based on these findings, the researchers conclude that patients with elevated uric acid who are also deficient in vitamin D have a greater risk of developing cardiovascular disease, including calcification of the coronary arteries, compared with patients with elevated uric acid who have adequate vitamin D levels. In addition, the risk of cardiovascular disease increases further with age in the presence of vitamin D deficiency.

Why is vitamin D deficiency associated with cardiovascular disease?

In the introduction to the study, the researchers describe how vitamin D deficiency has shifted from being viewed primarily as a nutritional issue to being considered a hormonal issue. This is because the form of vitamin D produced from sunlight or obtained from supplements is converted through enzymatic processes in the liver, kidneys, and other tissues into its active form (calcitriol/1,25-dihydroxyvitamin D), which functions as a steroid hormone.
Most of the body’s cells have receptors for active vitamin D, which regulates a range of gene activities. This also applies to cells in the cardiovascular system, such as cardiomyocytes, the specialized muscle cells of the heart, vascular smooth muscle cells, and endothelial cells, which line the inside of the heart, blood vessels, and lymphatic vessels and are responsible for the exchange of substances such as oxygen, nutrients, and waste products.
In addition, vitamin D plays a role in the immune system and, in particular, in regulating inflammatory processes that occur with elevated uric acid and many chronic diseases.

Vitamin D deficiency is a worldwide health problem

We can only produce vitamin D from a cholesterol precursor in the skin when the sun sits sufficiently high in the sky. This means that populations living at northern latitudes cannot produce vitamin D from sunlight during the winter months. In addition, darker skin and the aging process, which causes the skin to become thinner, reduce the body’s ability to produce vitamin D. The global prevalence of vitamin D deficiency ranges from 20% to 90%, affecting more than one billion people. The high prevalence of vitamin D deficiency is also seen at southern latitudes with abundant sunshine because many people prefer to stay in the shade or use too much sunscreen.
Nor is there any guarantee that health authorities’ recommendations for vitamin D supplementation during the winter months or year-round for vulnerable groups will optimize blood levels. For reference, blood levels should ideally be between 75 and 125 nmol/L according to other studies concerning cardiovascular health and overall health.

References:

Huan Lei et al. Association between serum vitamin D levels and cardiovascular disease risk in patients with hyperuricemia: A cross-sectional study. PLoS One 2026

Cem Ekmekcioglu, Michale Poteser. The optimal Protective 25-Hydroxyvitamin D Level for Different Health Outcomes in Adults: A Brief Summary of Dose-Response Meta-Analysis. Metabolites 2025