Diagnosis and treatment of hyperuricemia in cardiovascular prevention based on the pathophysiological mechanism of its occurrence: expert consensus of Czech and Slovak experts 2024

Czech version

Authors: Michal Vrablík ¹; Claudio Borghi ²; Hana Rosolová ³; Blanka Stibůrková ⁴; Ivana Šoo Šová ⁵; Martin Čaprnda ⁶; Ján Števlík ⁷; Adriana Ilavská ⁸; Peter Jackuliak ⁹; Zuzana Zafarová
Authors‘ workplace: Centrum preventivní kardiologie, III. interní klinika – endokrinologie a metabolismu 1. LF UK a VFN v Praze ¹; Settore scientifico disciplinare, Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Italia ²; Centrum preventivní kardiologie, II. interní klinika LF UK a FN Plzeň Bory ³; Revmatologický ústav, Praha ⁴; Národný ústav srdcových a cievnych chorôb, a. s., Bratislava ⁵; I. interná klinika LF UK a UNB, Nemocnica Staré Mesto, Bratislava ⁶; Kardiologická a interná ambulancia II., V. interná klinika LF UK a UNB, Nemocnica Ružinov, Bratislava ⁷; Diabetologické a metabolické centrum, Medispektrum s. r. o., Bratislava ⁸; V. interná klinika LF UK a UNB, Nemocnica Ružinov, Bratislava ⁹
Published in: AtheroRev 2024; 9(2): 61-71
Category: Guidelines

Overview

A panel of experts from the Czech and Slovak Republics, with the contribution of Professor C. Borghi from the University of Bologna, discussed the clinical approach for the investigation and treatment of hyperuricemia (HU) in patients with increased cardiovascular (CV) risk. Since elevated uric acid (UA) modifies CV risk, it should be considered as an important modifier of CV risk and patients in whom its therapeutic reduction may improve CV parameters should be identified. The lack of selection of suitable patients is probably the reason for the inconsistent results of studies evaluating the clinical outcomes of antihyperuricemic therapy to date. The expert panel suggests treating HU due to an increase in xanthine oxidase (XO) activity, which is associated with an increase in CV risk, rather than HU due to decreased renal excretion of UA, which is not as risky from a CV perspective. To differentiate, he proposes to use a new index of the ratio of serum UA to creatinine (sUA/sCr), which has been shown to correlate with the incidence of CV events. For the purpose of CV prevention, it is recommended to investigate UA levels in patients with increased CV risk (hypertension, diabetes, dyslipidemia, chronic kidney disease, accumulation of CV risk factors or CVD) and to initiate intervention to target serum UA levels < 360 µmol/l in men and < 300 µmol/l in women with sUA/sCr index > 3.6. Intervention consists of patient education and lifestyle modification, optimization of treatment of other CV risk factors and administration of an XO inhibitor, allopurinol in the first line. The dose of allopurinol should be gradually titrated, usually in the range of 100–300 mg/day, according to the achievement of the target level of UA, with regular checks every 4–6 weeks. After stabilization of the condition, continued treatment with regular monitoring every 6 months is recommended.

Keywords:

allopurinol – Uric acid – cardiovascular risk – hyperuricemia – xanthine oxidase inhibitors – sUA/sCr – xanthine oxidase

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