Hyperuricaemia, cardiovascular diseases and heart failure

Česká verzia

Authors: A. Dukát ¹; E. Goncalvesová ²
Authors place of work: II. Interná klinika LF UK a UN Bratislava, Slovensko ¹; Oddelenie zlyhávania a transplantácie srdca, Národný ústav srdcových a cievnych chorôb a. s., Bratislava, Slovensko ²
Published in the journal: Kardiol Rev Int Med 2016, 18(1): 43-46
Category: Cardiology Review

Summary

Hyperuricaemia is a common abnormal finding in patients with cardiovascular diseases and heart failure. The most common cause of hyperuricaemia is an increased activity of xanthine oxidase, the enzyme which degrades xanthine to hypoxanthine and uric acid, giving rise to the formation of a significant amount of free oxygen radicals. Associations of hyperuricaemia with systemic inflammation, decreased vasodilatory response of the vessels, pro-aggregation, endothelial dysfunction, hypertension and obesity have been demonstrated. In patients with heart failure, hyperuricaemia, particularly in concentrations exceeding 600 µmol/ l, is considered a signal of poor prognosis. Clinical studies have shown that uricostatics may be relevant for the prevention and control of hypertension in adolescents. In patients with heart failure, treatment of hyperuricaemia with allopurinol leads to decreased levels of uric acid and to the improvement of some parameters of endothelial or myocardial function. However, the effect of xanthine oxidase inhibition on mortality has not yet been demonstrated.

Keywords:
hyperuricaemia – hypertension – heart failure – allopurinol

Zdroje

1. 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: 1183– 1190.

2. Feig DI, Kang DH, Johnson RJ. Uric acid and cardiovascular risk. N Eng J Med 2008; 359: 1811– 1821. doi: 10.1056/ NEJMra0800885.

3. Culleton BF, Larson MG, Kannel WB et al. Serum uric acid and risk for cardiovascular disease and death: the Framingham Heart Study. Ann Intern Med 1999; 131: 7– 13.

4. Gavorník P, Dukát A, Gašpar L et al. Klinický význam a liečba hyperurikémie. Slov Klin Pr 2007; 1: 18– 20.

5. Zhu Y, Pandya BJ, Choi HK. Prevalence of gout and hyperuricemia in the US general population: the National Health and Nutrition Examination Survey 2007– 2008. Arthritis Rheum 2011; 63: 3136– 3141. doi: 10.1002/ art.30520.

6. Tangri N, Weiner DE. Uric acid, CKD, and cardiovascular disease: confounders, culprits, and circles. Am J Kidney Dis 2010; 56: 247– 250. doi: 10.1053/ j.ajkd.2010.06.004.

7. Khosla UM, Zharikov S, Finch JL et al. Hyperuricemia induces endothelial dysfunction. Kidney Int 2005; 67: 1739– 1742.

8. Doehner W, Jankowska EA, Springer J et al. Uric acid and xanthine oxidase in heart failure - Emerging data and therapeutic implications. Int J Cardiol 2015; pii: S0167-5273(15)30319-3. doi: 10.1016/ j.ijcard.2015.08.089.

9. Keenan T, Blaha MJ, Nasir K et al. Relation of uric acid to serum levels of high-sensitivity C-reactive protein, triglycerides, and high-density lipoprotein cholesterol and to hepatic steatosis. Am J Cardiol 2012; 110: 1787– 1792. doi: 10.1016/ j.amjcard.2012.08.012.

10. Kang DH, Nakagawa T, Feng L et al. A role for uric acid in the progression of renal disease. J Am Soc Nephrol 2002; 13: 2888– 2897.

11. Odden MC, Amadu AR, Smit E et al. Uric acid levels, kidney function, and cardiovascular mortality in US adults: National Health and Nutrition Examination Survey (NHANES) 1988–1994 and 1999–2002. Am J Kidney Dis 2014; 64: 550– 557. doi: 10.1053/ j.ajkd.2014.04.024.

12. Loeffler LF, Navas-Acien A, Brady TM et al. Uric acid level and elevated blood pressure in US adolescents: National Health and Nutrition Examination Survey, 1999-2006. Hypertension 2012; 59: 811– 817. doi: 10.1161/ HYPERTENSIONAHA.111.183244.

13. Feig DI, Soletsky B, Johnson RJ. Effect of allopurinol on blood pressure of adolescents with newly diagnosed essential hypertension: a randomized trial. JAMA 2008; 300: 924– 932. doi: 10.1001/ jama.300.8.924.

14. Soletsky B, Feig DI. Uric acid reduction rectifies prehypertension in obese adolescents. Hypertension 2012; 60: 1148– 1156. doi: 10.1161/ HYPERTENSIONAHA.112.196980.

15. Masuo K, Kawaguchi H, Mikami H et al. Serum uric acid and plasma norepinephrine concentrations predict subsequent weight gain and blood pressure elevation. Hypertension 2003; 42: 474– 480.

16. Gois PH, Souza ER. Pharmacotherapy for hyperuricemia in hypertensive patients. Cochrane Database Syst Rev 2013; 1: CD008652. doi: 10.1002/ 14651858.CD008652.pub2.

17. Sun HL, Pei D, Lue KH et al. Uric acid levels can predict metabolic syndrome and hypertension in adolescents: A 10-Year Longitudinal Study. PloS One 2015; 10: e0143786. doi: 10.1371/ journal.pone.0143786.

18. Krishnan E, Baker JF, Furst DE et al. Gout and the risk of acute myocardial infarction. Arthritis Rheum 2006; 54: 2688– 2696.

19. Harzand A, Tamariz L, Hare JM. Uric acid, heart failure survival, and the impact of xanthine oxidase inhibition. Congest Heart Fail 2012; 18: 179– 182. doi: 10.1111/ j.1751-7133.2011.00262.x.

20. Huang H, Huang B, Li Y et al. Uric acid and risk of heart failure: a systematic review and meta-analysis. Eur J Heart Fail 2014; 16: 15– 24. doi: 10.1093/ eurjhf/ hft132.

21. Shimizu T, Yoshihisa A, Kanno Y et al. Relationship of hyperuricemia with mortality in heart failure patients with preserved ejection fraction. Am J Physiol Heart Circ Physiol 2015; 309: H1123– H1129. doi: 10.1152/ ajpheart.00533.2015.

22. Tamariz L, Hare JM. Xanthine oxidase inhibitors in heart failure: where do we go from here? Circulation 2015; 131: 1741– 1744. doi: 10.1161/ CIRCULATIONAHA.115.016379.

23. Hare JM, Mangal B, Brown J et al. Impact of oxypurinol in patients with symptomatic heart failure. Results of the OPT-CHF study. J Am Coll Cardiol 2008; 51: 2301– 2309. doi: 10.1016/ j.jacc.2008.01.068.

24. Givertz MM, Anstrom KJ, Redfield MM et al. Effects of xanthine oxidase inhibition in hyperuricemic heart failure patients: the xanthine oxidase inhibition for hyperuricemic heart failure patients (EXACT-HF) Study. Circulation 2015; 131: 1763– 1771. doi: 10.1161/ CIRCULATIONAHA.114.014536.

25. Tayar JH, Lopez-Olivo MA, Suarez-Almazor ME. Febuxostat for treating chronic gout. Cochrane Database Syst Rev 2012; 11: CD008653. doi: 10.1002/ 14651858.CD008653.pub2.