Hyperuricemia as a risk factor for cardiovascular disease

Response to: Borghi C, Verardi FM, Pareo I, Bentivenga C, Cicero AF. Hyperuricemia and cardiovascular disease risk. Expert Rev Cardiovasc Ther 2014;12(10):1219-25.

We read the review by Borghi et al. [1] with interest. The authors discuss possible causes and treatments of hyperuricemia as well as the links between elevated serum uric acid (SUA) levels and cardiovascular (CV) risk factors.

Borghi et al. [1] mention that loop diuretics, thiazides and aspirin may increase SUA levels, whereas losartan may decrease them. However, there are also other drugs that have been reported to reduce SUA levels including calcium channel blockers (i.e., amlodipine), angiotensin-converting enzyme inhibitors (i.e., captopril, enalapril and ramipril), lipid lowering (i.e., atorvastatin, simvastatin, ezetimibe and fenofibrate), weight reducing (e.g., orlistat) and hypoglycemic agents (i.e., metformin) [2], although data are limited. Dapagliflozin, a new antidiabetic drug that inhibits sodium glucose transporter-2 in the kidneys, was also shown to lower SUA levels [3]. Furthermore, we have previously found that multifactorial treatment, including a statin, significantly improved renal function and decreased SUA concentrations, even in patients with stage 3 chronic kidney disease [4,5]. Such drug-induced SUA lowering effects have been reported to contribute to CV risk reduction in the Losartan Intervention For Endpoint reduction in hypertension [6], as Borghi et al. [1] state. We have shown similar results in the Greek atorvastatin and coronary-heart disease Evaluation study [7].

Borghi et al. [1] mention the associations between hyperuricemia and hypertension, diabetes, obesity, dyslipidemia and the metabolic syndrome. Elevated SUA levels have also been linked to both micro- and macrovascular diabetic complications [8]. Furthermore, hyperuricemia was related to other CV risk predictors such as non-alcoholic fatty liver disease [9] and stage 3 chronic kidney disease [10]. Finally, Borghi et al. [1] discuss the association between elevated SUA levels and stroke. In this context, we have previously found that hyperuricemia was related to an increased in-hospital mortality after acute stroke [11].

Financial & competing interests disclosure

N Katsiki has given talks and attended conferences sponsored by Novartis, Pfizer, MSD and AstraZeneca. A Karagiannis has given talks and attended conferences sponsored by Menarini, AstraZeneca, Novartis and Pfizer. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.