Hyperuricemia is becoming more common and goes hand in hand with many diseases – metabolic syndrome, overweight and obesity, diabetes, chronic kidney disease, and hypertension. It directly increases the risk of cardiovascular disease, even when asymptomatic. That is why it is so important to check your uric acid levels regularly and to follow your doctor’s instructions when hyperuricemia is already diagnosed.
It is estimated that hyperuricemia occurs in 50% of people. people with hypertension and diabetes, and in the case of patients with metabolic syndrome, this problem affects as much as 70 percent. of them.
The inflammatory process is the main culprit
– We have known for some time that there is a correlation between high uric acid levels (hyperuricemia) and the risk of cardiovascular disease. High uric acid concentration is not only conducive to coronary disease, arterial hypertension, and cerebrovascular disease (increasing the risk of stroke or heart attack), but also to chronic kidney disease, obesity, metabolic syndrome, and diabetes. This relationship is two-way, because the diseases mentioned are also the most important risk factors for the development of hyperuricemia – says prof. dr hab. n. med. Artur Mamcarz, head of the XNUMXrd Department of Internal Diseases and Cardiology, Faculty of Medicine, Medical University of Warsaw. Why is hyperuricemia promoting cardiovascular disease? Because it intensifies the inflammatory process that affects the functions of the vascular endothelium and blood flow in important organs, including in the heart of.
– The systemic inflammatory response affects many processes, including on vascular damage processes. It is the inflammatory process that is key to understanding arterothrombosis, which is a consequence of atherosclerosis and thrombosis. – explains prof. Mamcarz.
The disease can be asymptomatic
Very often, hyperuricemia is asymptomatic, which is why it is so dangerous. When symptoms appear, we are already dealing with gout, which means that the level of uric acid in the blood serum has significantly exceeded the norm. Meanwhile, the asymptomatic hyperuricemia does not mean that it does not affect health, on the contrary – already slightly exceeded norms can damage blood vessels.
– Most often, hyperuricemia is diagnosed only when the patient is admitted to the hospital with complications, i.e. stroke heart attack, severe hypertension or advanced diabetes. Then it turns out that the patient has significantly exceeded the norms of uric acid concentration, which he did not know. Such situations most clearly show the importance of preventive screening tests – the assessment of uric acid concentration in people at cardiovascular risk. – explains the problem of prof. Mamcarz.
The group of increased risk of hyperuricemia includes people with arterial hypertension, atherosclerosis, coronary artery disease, obese people, patients with type 2 diabetes or with metabolic syndrome. It is these patients who should especially check the concentration of uric acid systematically. Everyone should do such a test at least once a year, because only through tests is it possible to diagnose the disease at an early stage, when it does not show symptoms yet.
What should be the correct concentration of uric acid
Until recently, blood uric acid testing was considered only optional. Today that approach has changed. Uric acid testing has been included in the basic test package that should be performed at least once a year. This is a chance for patients to react much faster and implement appropriate therapeutic steps, and thus recover faster.
According to the guidelines, we talk about hyperuricemia when the uric acid concentration exceeds 6,8 mg / dl in people not burdened with other comorbidities, but in patients at risk of cardiovascular diseases, this norm is much lower.
– If someone has a uric acid concentration of 6,7 mg / dl, it also requires intervention. We don’t wait for it to exceed the norm. Because according to the latest guidelines, as in the case of cholesterol, we are not talking about norms, but about target values depending on the patient’s cardiovascular risk. For a person without risk factors, a concentration below 6 mg / dl will be satisfactory. In patients with arterial hypertension, atherosclerosis, diabetes, obese patients, the target concentration should be below 5 mg / dl – explains prof. Mamcarz.
It is not worth giving up on research
Hyperuricemia is a chronic disease and should be controlled in the same way as high blood pressure, diabetes and dyslipidaemia. The COVID-19 pandemic is not conducive to this. Patients often miss check-ups, even those carried out online or by phone, do not undergo check-ups, and even discontinue therapy. This approach can be disastrous.
– In the case of hyperuricaemia, like hypercholesterolaemia, it is not the case that one day the patient finds out that he or she has abnormal test results, and that the next day he will have a heart attack. We operate with a specific probability of a cardiovascular event. For hyperuricemic patients, the probability is significantly higher, but complications do not arise overnight. In the long run, abnormal uric acid levels will be associated with a higher risk, in some cases this risk can be very quickly defined by a clinical syndrome. Therefore, it is worth checking the concentration of uric acid. And this regardless of the pandemic – says prof. Mamcarz.
Consequences of untreated or poorly controlled hyperuricaemia
The importance of the problem was noticed by the European Society of Cardiology, the European Society of Hypertension and the Polish Society of Hypertension, which included blood uric acid levels in routine tests performed cyclically in people with high cardiovascular risk.
– There are studies that show that every 1 mg / dl increase in uric acid concentration is associated with almost 50% increased risk of coronary artery disease in women, because they participated in this study. On the other hand, the study with the acronym MONIKA assessed the influence of many cardiovascular risk factors in long-term follow-up. It turned out that uric acid levels higher than 6,8 mg / dl after eight years mean twice the risk of heart attack and death from it. Some experts say that as uric acid concentration increases by 1 mg / dl above normal, mortality increases by 30-40%. – reminds prof. Mamcarz.
– We have the option of dietary treatment that allows only about 15 percent to achieve goals. On the other hand, pharmacological treatment significantly reduces the risk. Therefore, let’s make sure that the uric acid concentration is below 6 mg / dl in the population and below 5 mg / dl in risk groups. – summarizes prof. Mamcarz.
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