Vnitr Lek 2024, 70(8):491-500

Diagnosis and treatment of hyperuricemia in cardiovascular prevention based on its pathophysiological mechanism: An Expert Consensus of Czech and Slovak Specialists, 2024

Michal Vrablîk¹, Claudio Borghi², Hana Rosolová³, Blanka Stibůrková⁴, Ivana Šoóšová⁵, Martin Čaprnda⁶, Ján Števlîk⁷, Adriana Ilavská⁸, Peter Jackuliak⁹, Zuzana Zafarová¹⁰

¹ 0medical writer, Praha

² Oddělení lékařských a chirurgických věd, Boloňská univerzita, Itálie

³ II. interní klinika LF UK a FN Plzeň

⁴ Revmatologický ústav, Praha

⁵ Národní ústav srdečních a cévních chorob, a. s., Bratislava

⁶ Interní klinika LF UK a FN Bratislava

⁷ Kardiologická a interní klinika FN Bratislava

⁸ Diabetologické a metabolické centrum, Medispektrum, Bratislava

⁹ UNB Bratislava a LF UK Bratislava

A panel of experts from the Czech and Slovak Republics, with the contribution of Professor C. Borghi from the University of Bologna, discussed the clinical approach for the investigation and treatment of hyperuricemia (HU) in patients with increased cardiovascular (CV) risk. Since elevated uric acid (UA) modifies CV risk, it should be considered as an important modifier of CV risk and patients in whom its therapeutic reduction may improve CV parameters should be identified. The lack of selection of suitable patients is probably the reason for the inconsistent results of studies evaluating the clinical outcomes of antihyperuricemic therapy to date. The expert panel suggests treating HU due to an increase in xanthine oxidase (XO) activity, which is associated with an increase in CV risk, rather than HU due to decreased renal excretion of UA, which is not as risky from a CV perspective. To differentiate, he proposes to use a new index of the ratio of serum UA to creatinine (sUA/sCr), which has been shown to correlate with the incidence of CV events. For the purpose of CV prevention, it is recommended to investigate UA levels in patients with increased CV risk (hypertension, diabetes, dyslipidemia, chronic kidney disease, accumulation of CV risk factors or CVD) and to initiate intervention to target serum UA levels < 360 μmol/l in men and < 300 μmol/l in women with sUA/sCr index > 3.6. Intervention consists of patient education and lifestyle modification, optimization of treatment of other CV risk factors and administration of an XO inhibitor, allopurinol in the first line. The dose of allopurinol should be gradually titrated, usually in the range of 100-300 mg/day, according to the achievement of the target level of UA, with regular checks every 4-6 weeks. Aer stabilization of the condition, continued treatment with regular monitoring every 6 months is recommended.

Keywords: uric acid, hyperuricemia, xanthine oxidase, cardiovascular risk, sUA/sCr index, xanthine oxidase inhibitors, allopurinol.

Published: December 18, 2024  Show citation