Медицинский совет (Dec 2020)
Modern paradigm of treatment of hyperuricemia and gout in comorbid patients with the development of cardio-vascular pathology
Abstract
The article presents the actuality of the problem of hyperuricemia (HU) and gout in modern medicine, caused by the high prevalence and socio-economic consequences associated with the development in patients with these pathologies of earlier and more severe course of atherosclerosis, coronary heart disease, chronic kidney disease (CKD) and increased mortality. Illustrated pathogenetic mechanisms of HU influence on the cardiovascular system, which are characterized by the formation of endothelial dysfunction, increased adhesion and aggregation of thrombocytes, blood rheology disorders, increased levels of inflammatory markers, renal function disorders. It is highlighted that in arterial hypertension (AH) a possible mechanism for increasing the concentration of uric acid (UA) is a violation of renal excretion due to reduced tubal secretion. The data of the studies are presented, showing that in patients with type 2 diabetes mellitus and higher UA concentration is associated with increased risk of fatal and non-fatal stroke. Modern recommendations of HU correction, approved in the Russian Federation, are highlighted, where the expediency ofcomorbid condition therapy, correction of diet and lifestyle are noted. The consensus of the European Society of Cardiology and the Russian Society of Cardiology (RSC) on the management of patients with HU with high cardiovascular risk (CVR) and the RSC Clinical Practice Guidelines for AH are presented. Based on these documents, all patients with AH are recommended to evaluate the level of UA in serum and consider it high - more than 360 pmol/l, it is recommended to perform urate-lowering therapy for patients with high CVR, with the target level below 300 pmol/l. Modern possibilities of pathogenetic therapy of gout are presented. It is noted that the use of febuxostat demonstrates not only higher efficiency in reducing and maintaining the level of UA, but also better tolerance, in comparison with allopurinol. It is emphasized that elderly people do not need to correct the dose of febuxostat, it can be used by patients with CKD.
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