ГИПЕРУРИКЕМИЯ: КЛИНИЧЕСКИЕ ПОСЛЕДСТВИЯ, СЕРДЕЧНО-СОСУДИСТЫЙ РИСК, СОВРЕМЕННЫЙ ПОДХОД К ТЕРАПИИ

Abstract

Introduction. In recent decades, increased attention has been paid to hyperuricemia due to the widespread prevalence of this pathology in the population (16.8%), the presence of a connection with the risk of developing cardiovascular diseases, as well as the variety of its clinical consequences. Aim. A review of current data on the causes of hyperuricemia, clinical aspects, the effect of hyperuricemia on cardiovascular risk, and the current view of therapy, including asymptomatic hyperuricemia. Material and methods. The review carried out topical medical publications in foreign and domestic literature on this issue, accumulated at the present time. Results and discussion. An increase in uric acid level can occur as a result of inaccuracies in the diet, taking certain medications, impaired excretion of uric acid due to impaired renal function and other reasons. Hyperuricemia is the main cause of gout, which can manifest itself as acute gouty arthritis, chronic topical arthritis, urate nephropathy, and other diseases. Modern research shows that an increase in serum uric acid concentration is associated with an increased cardiovascular risk. Acting as an independent predictor of arterial hypertension, coronary heart disease, chronic heart failure, chronic kidney disease. Treatment with xanthine oxidase inhibitors (allopurinol, febuxostat) can affect hyperuricemia, gout, and various forms of ischemic and vascular damage. As evidence of the efficacy of urate-lowering therapy remains controversial, these drugs are not currently indicated for routine prophylactic treatment in patients without gout symptoms. In 2018, specialists in the field of hyperuricemia proposed an algorithm for the management of patients with asymptomatic hyperuricemia. However, the algorithm is not recommended for everyday practice due to further research's need to verify it. Conclusion. Classic manifestations of hyperuricemia such as gout and kidney damage remain the main indications for urate-lowering therapy. At the same time, the increased cardiovascular risk in hyperuricemia, proven by numerous studies, requires special attention in treating patients with comorbid pathology. Diet and lifestyle changes remain an integral part of therapy. The final decision on the need for pharmacological treatment of patients with asymptomatic hyperuricemia with xanthine oxidase inhibitors is made individually. The development of algorithms and indications for the appointment of urate-lowering therapy continues. Recommendations for drug therapy for hyperuricemia are only possible after large, double-blind, placebo-controlled, randomized trials.