High levels of uric acid, or hyperuricemia, promote heart attacks and strokes. Hence, in recent years, the concentration of uric acid has been included in the cardiovascular risk factors. The appropriate lifestyle can reduce this risk, but very often drugs are needed for this.
How is hyperuricemia, or elevated uric acid levels, related to cardiovascular disease?
First of all, I would like to decipher this difficult phrase “cardiovascular disease”. Cardiovascular diseases are primarily myocardial infarction, stroke and heart failure. We have several major risk factors for developing these diseases. These include: blood pressure, LDL cholesterol, i.e. bad cholesterol, and glucose levels. We have influence on them, i.e. we can modify them. There are also non-modifiable risk factors such as age, gender, and family history of cardiovascular disease. There are also many other factors that further modify cardiovascular risk. One of them is the concentration of uric acid. It has been found that if this concentration is too high, heart attacks and strokes are more likely to occur. Hence, in recent years, the concentration of uric acid has been included in the aforementioned cardiovascular risk factors.
The assessment of uric acid concentration was included in the panel of preventive examinations that should be performed by every 40-year-old in Poland. You can do this test without a referral, and free of charge until the end of this year. Why is this study so important in this group of people?
The golden maxim is: prevention is better than cure. Therefore, this panel includes many markers of heart attack or stroke risk that need to be assessed in order to intervene early, before diseases such as heart attack, stroke and heart failure develop. We are all afraid of these diseases, because they are the main cause of death in Poland – almost half of them result from cardiovascular diseases.
In addition to checking the main risk factors, the panel also includes others, such as uric acid levels. The “other” ones allow to refine the cardiovascular risk and to assess more precisely whether the patient, in whom, despite moderate concentration of eg LDL cholesterol or a slight increase in blood pressure, the risk is not additionally increased, eg by high concentration of uric acid. So it’s important to have a holistic view.
It’s good that this prophylactic panel includes the determination of uric acid concentration. A few years ago, the Polish Society of Hypertension included uric acid concentration among the obligatory tests to be performed in patients with newly diagnosed arterial hypertension.
Should we wait until the age of 40 to assess the uric acid concentration? What is the indication for such a test in younger people?
I think these 40 years have become such an arbitrarily adopted turning point. Perhaps it was influenced by the cult series “Czter 40olatek”. And these 40 years became the age limit beyond which we cease to be young. The problem is that for many risk factors, this limit is below 55 years. Therefore, it is necessary to identify in time people who require prior assessment of cardiovascular risk factors. One of such elements is a family history. If someone in the immediate family has had a heart attack or stroke early – that is, before the age of 65 for a man and before the age of 40 for a woman – risk factors, including uric acid levels, should be assessed much earlier than before the age of XNUMX.
Are there any symptoms of hyperuricemia?
First, we have gout, which is a symptom of uric acid build-up in certain parts of our body, which causes painful, reddened areas around our joints. Gout is most often caused by high levels of uric acid. But often high levels of uric acid do not give any symptoms, but it contributes to the faster development of atherosclerotic diseases or to the progression of kidney failure. It is similar with high blood pressure or LDL cholesterol – they are also asymptomatic. The first effect of these risk factors that I have listed could simply be a heart attack.
At what uric acid values does hyperuricemia begin?
Of course, it can be defined, but for all risk factors, including hyperuricemia, there is a linear relationship between them and myocardial infarction and stroke. It is not the case that uric acid or any other risk factor can be up to some value, and it does not affect cardiovascular risk. The more blood pressure, cholesterol, uric acid, and glucose increase, the more the risk of heart attack and stroke increases. We know that uric acid levels higher than 5-6 mg / dl are associated with a higher risk of death, heart attack and stroke. We must do this to keep our cardiovascular risk factors as low as possible. We must take care of cardiovascular risk factors ourselves and live in such a way that the concentration of cholesterol, blood pressure, glucose and uric acid levels are as low as possible. The following applies: the lower the better.
Lifestyle comes first. Of course, the set of genes we inherited from our ancestors determines the amount of cardiovascular risk factors, such as blood pressure, cholesterol and uric acid levels. With our lifestyle, we modify this genetically determined level, i.e. we either increase it or decrease it.
When it comes to uric acid, the most common association is that its high concentration is caused by a large amount of meat in the diet. Of course yes, but there are two more aspects. Foods containing fructose also contribute to an increase in uric acid levels, but beer the most. Beer is the type of alcohol that has the greatest effect on increasing uric acid levels. And in Poland, unfortunately, beer is drunk a lot.
Should treatment of hyperuricemia be lifelong, such as for hypertension, hypercholesterolaemia, even if parameters improve?
As I said, remember that we have genetically determined levels of cardiovascular risk factors. We are able to reduce them with our lifestyle, but in most cases it is not enough. Therefore, we must take medication and treat ourselves chronically. This applies to uric acid as well as LDL cholesterol, glucose, blood pressure. During treatment, we also need to systematically monitor risk factors to see if their value has decreased. Most often it happens as a result of the drugs used and it is a sign that we should continue taking them, because thanks to them we have a low level of risk factors. If it turns out that the risk factors are not fully controlled, the dose of the drug is probably insufficient. Then we not only have to continue the therapy, but also increase its intensity. For these reasons, follow-up during treatment is so important.