Asymptomatic hyperuricemia is defined by serum uric acid levels above 6.2 mg/dl in women and 7 mg/dl in men. In the presence of monosodium urate crystal formation and articular inflammation, hyperuricemia may become symptomatic (namely nephrolithiasis and gout). Uric acid results from purine catabolism and is at the centre of a complex metabolic interplay that involves oxidative stress, inflammation, renin-angiotensin-aldosterone system (RAAS) activation and insulin resistance. Uric acid levels present a continuous relation with conditions like hypertension and chronic kidney disease (CKD) and are reported to have an impact on risk of cardiovascular events. However, whether elevated uric acid is a causal agent and thus a possible therapeutic target is still uncertain and matter of further investigation. Treating symptomatic hyperuricemia involves lowering uric acid drugs and controlling inflammation. Urate-lowering agents are well tolerated but show minimal impact on cardiovascular events in patients with gout. Use of direct-acting urate-lowering agents in asymptomatic hyperuricemia associated with cardiovascular diseases does not warrant a clear benefit, whereas addressing cardiovascular issues with guideline-recommended therapies lowers uric acid and reduces the occurrence of cardiovascular events. Regular assessment of uric acid and clinical symptoms is advised before starting and renewing a urate-lowering treatment.

Asymptomatic hyperuricemia: to treat or not a threat? A clinical and evidence-based approach to the management of hyperuricemia in the context of cardiovascular diseases / Fiori, Emiliano; De Fazio, Ludovica; Pidone, Chiara; Perone, Francesco; Tocci, Giuliano; Battistoni, Allegra; Barbato, Emanuele; Volpe, Massimo; Gallo, Giovanna. - In: JOURNAL OF HYPERTENSION. - ISSN 1473-5598. - 42:10(2024), pp. 1665-1680. [10.1097/HJH.0000000000003807]

Asymptomatic hyperuricemia: to treat or not a threat? A clinical and evidence-based approach to the management of hyperuricemia in the context of cardiovascular diseases

Fiori, Emiliano
;
De Fazio, Ludovica;Pidone, Chiara;Tocci, Giuliano;Battistoni, Allegra;Barbato, Emanuele;Volpe, Massimo;Gallo, Giovanna
2024

Abstract

Asymptomatic hyperuricemia is defined by serum uric acid levels above 6.2 mg/dl in women and 7 mg/dl in men. In the presence of monosodium urate crystal formation and articular inflammation, hyperuricemia may become symptomatic (namely nephrolithiasis and gout). Uric acid results from purine catabolism and is at the centre of a complex metabolic interplay that involves oxidative stress, inflammation, renin-angiotensin-aldosterone system (RAAS) activation and insulin resistance. Uric acid levels present a continuous relation with conditions like hypertension and chronic kidney disease (CKD) and are reported to have an impact on risk of cardiovascular events. However, whether elevated uric acid is a causal agent and thus a possible therapeutic target is still uncertain and matter of further investigation. Treating symptomatic hyperuricemia involves lowering uric acid drugs and controlling inflammation. Urate-lowering agents are well tolerated but show minimal impact on cardiovascular events in patients with gout. Use of direct-acting urate-lowering agents in asymptomatic hyperuricemia associated with cardiovascular diseases does not warrant a clear benefit, whereas addressing cardiovascular issues with guideline-recommended therapies lowers uric acid and reduces the occurrence of cardiovascular events. Regular assessment of uric acid and clinical symptoms is advised before starting and renewing a urate-lowering treatment.
2024
chronic kidney disease, functional rehabilitation, heart failure, hypertension, hyperuricemia, ischemic heart disease, stroke
01 Pubblicazione su rivista::01g Articolo di rassegna (Review)
Asymptomatic hyperuricemia: to treat or not a threat? A clinical and evidence-based approach to the management of hyperuricemia in the context of cardiovascular diseases / Fiori, Emiliano; De Fazio, Ludovica; Pidone, Chiara; Perone, Francesco; Tocci, Giuliano; Battistoni, Allegra; Barbato, Emanuele; Volpe, Massimo; Gallo, Giovanna. - In: JOURNAL OF HYPERTENSION. - ISSN 1473-5598. - 42:10(2024), pp. 1665-1680. [10.1097/HJH.0000000000003807]
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