Genetic factors: Uric acid and gout both appear to have a genetic component, with uric acid levels estimated to be about 63% heritable.[1] A number of genes have been identified that influence gout risk and/or uric acid levels (SLC2A9, SLC22A12, and ABCG2, among others), most of which appear to primarily affect uric acid excretion by the kidneys.[2]
Body weight: Having overweight or obesity is associated with a much higher risk of gout,[3] with one meta-analysis reporting people with obesity were 2.24 times more likely to develop gout.[4]
Alcohol: Alcohol consumption can increase uric acid levels[5] and is associated with a higher risk of gout.[6] This effect may vary by the source of alcohol, as some research has observed an association between uric acid levels and intake of beer and liquor but not with wine.[7][8]
Diet: One meta-analysis of observational studies reported that risk of gout was associated with an increased consumption of red meat, seafood, alcohol, and fructose.[9] These foods were likewise associated with a higher risk of hyperuricemia. In general, this appears somewhat consistent with clinical research.
Medications: A number of drugs appear to increase uric acid and the risk of gout, including certain diuretics, immunosuppressant drugs, high doses of vitamin B3 (nicotinic acid), and low doses of aspirin.[10]
Kidney disease: Kidney disease is strongly associated with elevated uric acid and gout, although the nature of this relationship is debated. Specifically, reductions in kidney function might increase uric acid levels, or increased uric acid might cause reduced kidney function, or possibly a mix of both.[11]
Hypertension: Hypertension is associated with higher uric acid levels, possibly as a result of effects of high blood pressure on kidney function. However, as with kidney disease, this association could be backwards, with some research indicating uric acid may increase blood pressure.[12][13]