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Serum uric acid and the risk of cardiovascular and renal disease

Borghi, Claudioa; Rosei, Enrico Agabitib; Bardin, Thomasc , d , e; Dawson, Jessef; Dominiczak, Annaf; Kielstein, Jan T.g; Manolis, Athanasios J.h; Perez-Ruiz, Fernandoi; Mancia, Giuseppej

doi: 10.1097/HJH.0000000000000701

Substantial evidence suggests that chronic hyperuricemia is an independent risk factor for hypertension, metabolic syndrome, chronic kidney disease (CKD) and cardiovascular diseases. This highlights the need for greater attention to serum uric acid levels when profiling patients, and suggests that the threshold above which uricemia is considered abnormal is 6 mg/dl, in light of the available evidence. Another important question is whether lowering serum uric acid can improve cardiovascular and renal outcomes, and what therapeutic mechanism of action could provide more clinical benefits to patients; the available literature shows a trend toward improvement associated with administration of urate-lowering drugs, in particular for the xanthine oxidase inhibitors. The demonstrated efficacy of urate-lowering therapy on outcomes other than gout flares leads to the consideration that treatment may be beneficial even in the absence of overt gout when hyperuricemia accompanies other clinical conditions, such as urate deposition, advanced CKD or cardiovascular risk factors.

aDepartment of Medical and Surgical Sciences, University of Bologna, Bologna, Italy

bDepartment of Clinical and Experimental Sciences, University of Brescia, Department of Medicine, Spedali Civili, Brescia, Italy

cAssistance Publique Hôpitaux de Paris, Hôpital Lariboisière

dUniversité Paris Diderot, Sorbonne Paris Cité

eINSERM, UMR 1132, Paris, France

fInstitute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK

gDepartment of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany

hCardiology Department, Asklepeion Hospital, Athens, Greece

iRheumatology Division, Hospital Universitario Cruces and Biocruces Health Research Institute, Vizcaya, Spain

jUniversità Milano-Bicocca, IRCCS Istituto Auxologico Italiano, Milan, Italy

Correspondence to Giuseppe Mancia, Università Milano-Bicocca, IRCCS Istituto Auxologico Italiano, Milan, Italy, dei Daini, 4, 20126 Milan, Italy. Tel: +39 039 233 3357; fax: +39 039 322274; e-mail:

Abbreviations: CAD, coronary artery disease; CKD, chronic kidney disease; GFR, glomerular filtration rate; sUA, serum uric acid; XO, xanthine oxidase

Received 10 February, 2015

Revised 11 June, 2015

Accepted 11 June, 2015

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