An evidence-based review on urate-lowering treatments: implications for optimal treatment of chronic hyperuricemia

Abstract

Several studies suggest that chronic hyperuricemia, the main precursor of gout, is involved in the pathogenesis of different systemic disorders that affect cardiovascular and renal systems, such as hypertension, obesity, hypercholesterolemia, atherosclerosis, metabolic syndrome, chronic heart failure, and chronic kidney disease. Recent epidemiological evidence has shown an increasing trend in the prevalence of hyperuricemia and gout in the Western world: a number of population-based studies estimate a prevalence of up to 21% for hyperuricemia and 1%–4% for gout. As such, early detection and careful management of this pathological condition is required, starting from lifestyle changes (mainly based on a diet low in red meat, sugars, and alcoholic beverages, with increased intake of vegetables, water, and vitamin C sources), adding specific drugs to lead serum uric acid (SUA) levels under the target value of 7 mg/dL. In particular, nonselective and selective XO inhibitors (allopurinol, oxypurinol, febuxostat) reduce SUA levels and the overproduction of reactive oxygen species, mainly related to XO overactivity that often causes inflammatory damage to the vascular endothelium. The effect of lowering SUA levels via XO inhibition includes an attenuation of oxidative stress and related endothelial dysfunction that largely contribute to the pathophysiology of metabolic syndrome and cardiovascular diseases. Therefore, the inhibition of XO overactivation seems to be an excellent therapeutic option to limit the harmful effects of excess UA and reactive oxygen species. In conclusion, rapid diagnosis and correct therapy for hyperuricemia may also improve the prevention and/or treatment of serious and multifactorial diseases. The available evidence supports the importance of promoting new experimental clinical trials to confirm the emerging antioxidant role of XO inhibitors, which could effectively contribute to cardiovascular and chronic kidney disease prevention.

Hyperuricemia is a Risk Factor for One-Year Overall Survival in Elderly Female Patients with Acute Coronary Syndrome

“…e present study showed a rate of 19.0% for 1-year all-cause mortality in elderly patients with ACS, which is consistent with a previous report [21]. A large body of evidence indicates that hyperuricemia is an emerging CVD risk factor [22,23], besides traditional risk factors for CVD. e results of the present study showed that hyperuricemia is associated with the female sex, arterial hypertension, AF, lower HDL-cholesterol, elevated serum creatinine, and in-hospital cardiac complications.…”

Part Ii. Other Optimized Upstream Therapy for Managing Patients With Postinfarction Cardiosclerosis Associated With Hyperuricemia

“…The same pertains to the efficiency of hypouricemic drugs [13]. The LIFE study showed that a decrease in SUA was associated with better long-term results in patients who were treated with losartan, as compared to those who took atenolol [14].…”

Aronia melanocarpa ameliorates gout and hyperuricemia in animal models

“…(Goldman et al, 2001;Hershfield et al, 2010). Along with the overproduction of UA, the occurrence of oxidative stress is always noted, which damages organ function (Bove, Cicero, Veronesi, & Borghi, 2017).…”