Objective  Numerous studies focused upon the association of uric acid with cardiovascular and metabolic diseases. However, whether or not there are causal relationships with these chronic diseases has remained unclear. We conducted the study to explore the causal relationship between uric acid and various chronic diseases.

Methods  Inverse variance weighting (IVW), MR-Egger regression, weighted median (WM), simple mode and weighted mode methods were utilized for Mendelian randomization (MR) analysis. The relevant data were obtained from the Genome-Wide Association Study (GWAS) pooled dataset with serum uric acid (SUA) levels as exposure and coronary artery disease (CAD), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), atrial fibrillation (AF), type 2 diabetes (T2D), chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), ischemic stroke (IS), osteoporosis (OP) and peripheral artery disease (PAD) as outcomes in the East Asian population. Sensitivity analyses were also performed for examining the data robustness of the results through heterogeneity test, horizontal multiple validity test and leave-one-out methods.

Results  SUA level had positive causal associations with CAD（OR=1.240, 95%CI: 1.152～1.335, P＜0.001）, DBP（OR=1.074, 95% CI: 1.030～1.120, P＜0.001）, MAP（OR =1.050, 95% CI: 1.016～1.086, P = 0.004）and CHF（OR = 1.146, 95% CI: 1.032～1.274, P = 0.011）and no causal associations with SBP, AF, T2D, COPD, IS, OP or PAD. However, the causal association of SUA with CAD was not robust due to the presence of horizontal pleiotropy.

Conclusions  A positive causal relationship exists between SUA level and DBP, MAP and CHF. And an elevation of SUA level boosts the levels of DBP and MAP and the risk of CHF.