Xanthine oxidase inhibitors in elderly patients with heart failure. useful or useless?

Elevated serum uric acid levels have been progressively emerged as a powerful and independent risk factor for many cardiovascular diseases, including hypertension, coronary artery disease, stroke and congestive heart failure. It has been also reported strong, positive and independent correlations between high-serum levels of uric acid and metabolic abnormalities, including hypercholesterolemia, atherogenic dyslipidaemia, obesity, metabolic syndrome, and diabetes. Additionally, high serum uric acid levels are able to predict progression from end-stage renal and heart failure and they have been related to worsen prognosis and increased risk of cardiovascular death in many observational studies. On the other hand, several reports have demonstrated that reducing levels of serum uric acid levels with xanthine oxidase inhibitors was associated with better prognosis and improved event-free survival rate in different cardiovascular settings, including hypertension, coronary artery disease, and even congestive heart failure. On the basis of these consideration, high-serum levels of uric acid should never be neglected or ignored, independently by the clinical context or the clinical condi- tion in which they are observed