Authors: Claudio Borghi, Enrico Agabiti-Rosei, Richard J. Johnson, Jan T. Kielstein,Empar Lurbe, Giuseppe Mancia, Josep Redon, Austin G. Stack, Konstantinos P. Tsioufis.
Increasing prevalence of hyperuricaemia has been noted in many populations.
Uric acid is a potentially treatable predictive risk factor for cardiometabolic diseases.
Uric acid-lowering therapies improve outcomes in hypertension and kidney disease.
There may be benefit to lowering serum uric acid in other cardiometabolic diseases.
During the last century, there has been an increasing prevalence of hyperuricaemia noted in many populations. While uric acid is usually discussed in the context of gout, hyperuricaemia is also associated with hypertension, chronic kidney disease, hypertriglyceridaemia, obesity, atherosclerotic heart disease, metabolic syndrome, and type 2 diabetes. Here we review the connection between hyperuricaemia and cardiovascular, kidney and metabolic diseases. Contrary to the popular view that uric acid is an inert metabolite of purine metabolism, recent studies suggest serum uric acid may have a variety of pro-inflammatory, pro-oxidative and vasoconstrictive actions that may contribute to cardiometabolic diseases. Hyperuricaemia is a predictive factor for the development of hypertension, metabolic syndrome, type 2 diabetes, coronary artery disease, left ventricular hypertrophy, atrial fibrillation, myocardial infarction, stroke, heart failure and chronic kidney disease. Treatment with uric acid-lowering therapies has also been found to improve outcomes in patients with hypertension and kidney disease, in some but not all studies. In conclusion, uric acid is emerging as a potentially treatable risk factor for cardiometabolic diseases, and more clinical trials investigating the potential benefit of lowering serum uric acid are recommended in individuals with hyperuricaemia with and without deposition and concomitant hypertension, metabolic syndrome or chronic kidney disease.
Citation: Borghi C, Agabiti-Rosei E, Johnson RJ, et al. Hyperuricaemia and gout in cardiovascular, metabolic and kidney disease [published online ahead of print, 2020 Jul 29]. Eur J Intern Med. 2020;S0953-6205(20)30290-9. doi:10.1016/j.ejim.2020.07.006