无症状高尿酸血症:治疗还是不威胁?心血管疾病背景下高尿酸血症的临床循证管理方法。

IF 3.3 2区 医学 Q1 PERIPHERAL VASCULAR DISEASE
Journal of Hypertension Pub Date : 2024-10-01 Epub Date: 2024-07-10 DOI:10.1097/HJH.0000000000003807
Emiliano Fiori, Ludovica De Fazio, Chiara Pidone, Francesco Perone, Giuliano Tocci, Allegra Battistoni, Emanuele Barbato, Massimo Volpe, Giovanna Gallo
{"title":"无症状高尿酸血症:治疗还是不威胁?心血管疾病背景下高尿酸血症的临床循证管理方法。","authors":"Emiliano Fiori, Ludovica De Fazio, Chiara Pidone, Francesco Perone, Giuliano Tocci, Allegra Battistoni, Emanuele Barbato, Massimo Volpe, Giovanna Gallo","doi":"10.1097/HJH.0000000000003807","DOIUrl":null,"url":null,"abstract":"<p><p>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.</p>","PeriodicalId":16043,"journal":{"name":"Journal of Hypertension","volume":null,"pages":null},"PeriodicalIF":3.3000,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"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.\",\"authors\":\"Emiliano Fiori, Ludovica De Fazio, Chiara Pidone, Francesco Perone, Giuliano Tocci, Allegra Battistoni, Emanuele Barbato, Massimo Volpe, Giovanna Gallo\",\"doi\":\"10.1097/HJH.0000000000003807\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>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.</p>\",\"PeriodicalId\":16043,\"journal\":{\"name\":\"Journal of Hypertension\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":3.3000,\"publicationDate\":\"2024-10-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Hypertension\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/HJH.0000000000003807\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/7/10 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"PERIPHERAL VASCULAR DISEASE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Hypertension","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/HJH.0000000000003807","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/7/10 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"PERIPHERAL VASCULAR DISEASE","Score":null,"Total":0}
引用次数: 0

摘要

无症状高尿酸血症是指女性血清尿酸水平超过 6.2 毫克/分升,男性超过 7 毫克/分升。如果出现单钠尿酸盐结晶形成和关节炎症,高尿酸血症就会变成症状性高尿酸血症(即肾炎和痛风)。尿酸是嘌呤分解代谢的结果,是复杂的新陈代谢相互作用的核心,其中涉及氧化应激、炎症、肾素-血管紧张素-醛固酮系统(RAAS)激活和胰岛素抵抗。尿酸水平与高血压和慢性肾脏病(CKD)等疾病有持续的关系,据报道会对心血管事件的风险产生影响。然而,尿酸升高是否是致病因素,从而成为可能的治疗目标,目前仍不确定,有待进一步研究。治疗有症状的高尿酸血症包括服用降尿酸药物和控制炎症。降尿酸药物的耐受性良好,但对痛风患者心血管事件的影响很小。对于伴有心血管疾病的无症状高尿酸血症患者,使用直接作用的降尿酸药物并不能带来明显的益处,而使用指南推荐的疗法来解决心血管问题,可以降低尿酸并减少心血管事件的发生。建议在开始或重新开始降尿酸治疗前,定期评估尿酸和临床症状。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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.

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.

求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
Journal of Hypertension
Journal of Hypertension 医学-外周血管病
CiteScore
7.90
自引率
6.10%
发文量
1389
审稿时长
3 months
期刊介绍: The Journal of Hypertension publishes papers reporting original clinical and experimental research which are of a high standard and which contribute to the advancement of knowledge in the field of hypertension. The Journal publishes full papers, reviews or editorials (normally by invitation), and correspondence.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信