The prevalence of heart failure (HF) is increasing worldwide and in particular in
the industrialized countries [
[1]
,
[2]
. This is associated with a parallel increase in the rate of hyperuricemia and gout
[
- Ponikowski P
- et al.
ESC guidelines for the diagnosis and treatment of acute and chronic heart failure:
the task force for the diagnosis and treatment of acute and chronic heart failure
of the european society of cardiology (ESC)Developed with the special contribution
of the heart failure association (HFA) of the esc.
[3]
,
[4]
that occurs with a high rate of hypertension, chronic kidney disease, atrial fibrillation,
metabolic syndrome, diabetes, dyslipidemia, and obesity [
- Yamanaka H.
Japanese society of, G. & nucleic acid, M. japanese guideline for the management of
hyperuricemia and gout: second edition.
Nucleosides Nucleotides Nucleic Acids. 2011; 30: 1018-1029https://doi.org/10.1080/15257770.2011.596496
[5]
], leading to an overall increase in urate mediated cardiovascular risk. The close
correlation between uric acid and HF is based on a complex pathophysiological mechanism
that, probably, does not reflect a direct effect of elevated uric acid on left ventricular
function, but rather involves the extensive activation of the enzyme xanthine-oxidase
(XO) that is responsible for urate production and increased levels of oxidative stress
[
[6]
]. In HF patients, serum uric acid is probably representative of XO levels or activity
that can play an important role in the pathophysiologic process leading to heart failure
through inflammatory damage and loss of vascular endothelial function. In practical
terms, the overexpression of XO and related oxidative stress could be a potential
mechanism for the identification of those HF patients where hyperuricemia can be associated
with a poor clinical prognosis. The main problem is how to identify these patients
across the heterogeneous population of patients with HF where the clinical diagnosis
and the severity of the disease can be a major confounder due to the extensive interaction
between HF severity, renal function and diuretic use.Keywords
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References
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Article info
Publication history
Published online: January 21, 2020
Accepted:
January 13,
2020
Received:
December 30,
2019
Identification
Copyright
© 2020 Published by Elsevier B.V. on behalf of European Federation of Internal Medicine.
