Vnitr Lek 2014, 60(10):893-901
Gout and cardiovascular risk
- Revmatologická ambulance II. interní kliniky LF MU a FN u sv. Anny, Brno, přednosta prof. MUDr. Miroslav Souček, CSc.
Gout represents a heterogeneous group of metabolic disorders characterized by production and deposition of sodium urate crystals in various tissues. The consequence of this deposition in musculoskeletal system causes gouty arthritis often presented by acute recurrent attack and development of chronic tophi. The most important risk factor is hyperuricemia which means higher level of acid uric in blood. Gout or hyperuricemia alone represents significant independent risk factor of all-cause and cardiovascular morbidity and mortality. Many patients with hyperuricemia and gout have risk factors typical for metabolic syndrome or suffer from other diseases. Maintaining the acid uric serum levels below 360 μmol/l, dissolution of sodium urate deposits and prevention of their formation are crucial for successful treatment. In addition to the non-pharmacological approaches, medications as xanthine oxidase inhibitors or uricosuric agents are used for lowering serum uric acid levels in treatment of chronic hyperuricemia. The successful treatment may contribute to reduce cardiovascular risk in patients with hyperuricemia and gout.
Keywords: gout; hyperuricemia; cardiovascular risk; uric acid; metabolic syndrome; treatment
Received: July 14, 2014; Accepted: August 19, 2014; Published: October 1, 2014 Show citation
References
- Zhang W, Doherty M, Pascual E et al. EULAR evidence based recommendations for gout. Part I: Diagnosis. Report of a task force of the Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis 2006; 65(10): 1301-1311.
Go to original source...
Go to PubMed...
- Mikuls TR, Farrar JT, Bilker WB et al. Gout epidemiology: results from the UK General Practice Research Database, 1990-1999. Ann Rheum Dis 2005; 64(2): 267-272.
Go to original source...
Go to PubMed...
- Annemans L, Spaepen E, Gaskin M et al. Gout in the UK and Germany: prevalence, comorbidities and management in general practice 2000-2005. Ann Rheum Dis 2008; 67(7): 960-966.
Go to original source...
Go to PubMed...
- Alamanos Y, Drosos AA. Epidemiology of adult rheumatoid arthritis. Autoimmun Rev 2005; 4(3): 130-136.
Go to original source...
Go to PubMed...
- Grassi D, Ferri L, Desideri G et al. Chronic hyperuricemia, uric acid deposit and cardiovascular risk. Curr Pharm Des 2013; 19(13): 2432-2438.
Go to original source...
Go to PubMed...
- Pavelka K. Dna (arthritis urica). In: Pavelka K, Rovenský J et al. Klinická revmatologie. Galén: Praha 2003: 347-358. ISBN 8072621742.
- Johnson RJ, Kang DH, Feig D et al. Is there a pathogenetic role for uric acid in hypertension and cardiovascular and renal disease? Hypertension 2003; 41(6): 1183-1190.
Go to original source...
Go to PubMed...
- Nakagawa T, Hu H, Zharikov S et al. A causal role for uric acid in fruktose-induced metabolit syndrome. Am J Physiol Renal Physiol 2006; 290(3): F625-F631.
Go to original source...
Go to PubMed...
- Campion EW, Glynn RJ, DeLabry LO. Asymptomatic hyperuricemia. Risks and consequences in the Normative Aging Study. Am J Med 1987; 82(3): 421-426.
Go to original source...
Go to PubMed...
- Puig JG, de Miguel E, Castillo MC et al. Asymptomatic hyperuricemia: impact of ultrasonography. Nucleosides Nucleotides Nucleic Acids 2008; 27(6): 592-595.
Go to original source...
Go to PubMed...
- Žurek M. Patogeneze, diagnostika a léčba dny. Vnitř Lék 2006; 52(7-8): 736-741.
Go to PubMed...
- Steele TH. Hyperuricemic nephropathies. Nephron 1999; 81(Suppl 1): 45-49.
Go to original source...
Go to PubMed...
- Souček. Metabolický syndrom. Vnitř Lék 2009; 55(6): 618-621.
- Choi HK, Ford ES, Li C et al. Prevalence of the metabolic syndrome in patients with gout: the Third National Health and Nutrition Examination Survey. Arthritis Rheum 2007; 57(1): 109-115.
Go to original source...
Go to PubMed...
- Perez-Ruiz F, Martínez-Indart L, Carmona L et al. Tophaceous gout and high level of hyperuricaemia are both associated with increased risk of mortality in patients with gout. Ann Rheum Dis 2014; 73(1): 177-182.
Go to original source...
Go to PubMed...
- Choi HK, Curhan G. Independent impact of gout on mortality and risk for coronary heart disease. Circulation 2007; 116(8): 894-900.
Go to original source...
Go to PubMed...
- Stack AG, Hanley A, Casserly LF et al. Independent and conjoint associations of gout and hyperuricaemia with total and cardiovascular mortality. QJM 2013; 106(7): 647-658.
Go to original source...
Go to PubMed...
- Niskanen LK, Laaksonen DE, Nyyssönen K et al. Uric acid level as a risk factor for cardiovascular and all-cause mortality in middle-aged men: a prospective cohort study. Arch Intern Med 2004; 164(14): 1546-1551.
Go to original source...
Go to PubMed...
- Facchini F, Chen YD, Hollenbeck CB et al. Relationship between resistance to insulin-mediated glucose uptake, urinary uric acid clearance, and plasma uric acid concentration. JAMA 1991; 266(21): 3008-3011.
Go to original source...
Go to PubMed...
- Takahashi S, Yamamoto T, Tsutsumi Z et al. Close correlation between visceral fat accumulation and uric acid metabolism in healthy men. Metabolism 1997; 46(10): 1162-1165.
Go to original source...
Go to PubMed...
- Dessein PH, Shipton EA, Stanwix AE et al. Beneficial effects of weight loss associated with moderate calorie/carbohydrate restriction, and increased proportional intake of protein and unsaturated fat on serum urate and lipoprotein levels in gout: a pilot study. Ann Rheum Dis 2000; 59(7): 539-543.
Go to original source...
Go to PubMed...
- Lee JAE, Kim YG, Choi YH et al. Serum uric acid is associated with microalbuminuria in prehypertension. Hypertension 2006; 47(5): 962-967.
Go to original source...
Go to PubMed...
- Perlstein TS, Gumieniak O, Williams GH et al. Uric acid and the development of hypertension: the normative aging study. Hypertension 2006; 48(6): 1031-1036.
Go to original source...
Go to PubMed...
- Zhang W, Doherty M, Bardin T et al. EULAR evidence based recommendations for gout. Part II: Management. Report of a task force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis 2006; 65(10): 1312-1324.
Go to original source...
Go to PubMed...
- Khanna D, Fitzgerald JD, Khanna PP et al. 2012 American College of Rheumatology guidelines for management of gout. Part 1: systematic nonpharmacologic and pharmacologic therapeutic approaches to hyperuricemia. Arthritis Care Res (Hoboken) 2012; 64(10): 1431-1446.
Go to original source...
Go to PubMed...
- Khanna D, Khanna PP, Fitzgerald JD et al. 2012 American College of Rheumatology guidelines for management of gout. Part 2: therapy and antiinflammatory prophylaxis of acute gouty arthritis. Arthritis Care Res (Hoboken) 2012; 64(10): 1447-1461.
Go to original source...
Go to PubMed...
- Pavelka K. Doporučení České revmatologické společnosti pro léčbu dnavé artritidy. Čes Revmatol 2012; 20(2): 82-92.
- Pavelka K. Terapie dny. In: Pavelka K et al. Farmakoterapie revmatických onemocnění. Grada Publishing: Praha 2005: 345-351. ISBN 80-247-0459-5.
- Okamoto K, Nishino T. Crystal structures of mammalian xanthine oxidoreductase bound with various inhibitors: allopurinol, febuxostat, and FYX-051. J Nippon Med Sch 2008; 75(1): 2-3.
Go to original source...
Go to PubMed...
- Khosravan R, Kukulka MJ, Wu JT et al. The effect of age and gender on pharmacokinetics, pharmacodynamics, and safety of febuxostat, a novel nonpurine selective inhibitor of xanthine oxidase. J Clin Pharmacol 2008; 48(9): 1014-1024.
Go to original source...
Go to PubMed...
- Schumacher HR Jr, Becker MA, Wortmann RL et al. Effects of febuxostat versus allopurinol and placebo in reducing serum urate in subjects with hyperuricemia and gout: a 28-week, phase III, randomized, double-blind, parallel-group trial. Arthritis Rheum 2008; 59(11): 1540-1548.
Go to original source...
Go to PubMed...
- Becker MA, Schumacher HR Jr, Wortmann RL et al. Febuxostat compared with allopurinol in patients with hyperuricemia and gout. N Engl J Med 2005; 353(23): 2450-2461.
Go to original source...
Go to PubMed...
- Becker MA, Schumacher HR, MacDonald PA et al. Clinical efficacy and safety of successful long term urate lowering with febuxostat or allopurinol in subjects with gout. J Rheumatol 2009; 36(6): 1273-1282.
Go to original source...
Go to PubMed...
- Schumacher HR Jr, Becker MA, Lloyd E et al. Febuxostat in the treatment of gout: 5-year findings of the FOCUS efficacy and safety study. Rheumatology (Oxford) 2009; 48(2): 188-194.
Go to original source...
Go to PubMed...
- Becker MA, Schumacher HR Jr, Wortmann RL et al. Febuxostat, a novel nonpurine selective inhibitor of xanthine oxidase: a twenty-eight-day, multicenter, phase II, randomized, double-blind, placebo-controlled, dose-response clinical trial examining safety and efficacy in patients with gout. Arthritis Rheum 2005; 52(3): 916-923.
Go to original source...
Go to PubMed...
- George J, Carr E, Davies J et al. High-dose allopurinol improves endothelial function by profoundly reducing vascular oxidative stress and not by lowering uric acid. Circulation 2006; 114(23): 2508-2516.
Go to original source...
Go to PubMed...
- Kanbay M, Siriopol D, Nistor I et al. Effects of allopurinol on endothelial dysfunction: a meta-analysis. Am J Nephrol 2014; 39(4): 348-356.
Go to original source...
Go to PubMed...
- Whelton A, MacDonald PA, Chefo S et al. Preservation of renal function during gout treatment with febuxostat: a quantitative study. Postgrad Med 2013; 125(1): 106-114.
Go to original source...
Go to PubMed...
- Kok VC, Horng JT, Chang WS et al. Allopurinol therapy in gout patients does not associate with beneficial cardiovascular outcomes: a population-based matched-cohort study. PLoS One 2014; 9(6): e99102. Dostupné z DOI: <http://doi:10.1371/journal.pone.0099102>.
Go to original source...
Go to PubMed...
- Tausche AK, Christoph M, Forkmann M et al. As compared to allopurinol, urate-lowering therapy with febuxostat has superior effects on oxidative stress and pulse wave velocity in patients with severe chronic tophaceous gout. Rheumatol Int 2014; 34(1): 101-109.
Go to original source...
Go to PubMed...
- Malik UZ, Hundley NJ, Romero G et al. Febuxostat inhibition of endothelial-bound XO: implications for targeting vascular ROS production. Free Radic Biol Med 2011; 51(1): 179-184.
Go to original source...
Go to PubMed...