Puig Juan García, Martínez María Angeles
Vascular Risk Unit, Division of Internal Medicine, La Paz University Hospital, Paseo de la Castellana 261, Madrid, Spain.
Curr Opin Rheumatol. 2008 Mar;20(2):187-91. doi: 10.1097/BOR.0b013e3282f4b1ed.
The metabolic syndrome is defined by the clustering of a number of cardiovascular risk factors and entails an increased risk for cardiovascular disease and mortality from both cardiovascular disease and all causes. In the present paper, we review the most recent evidence on the association between hyperuricemia, metabolic syndrome, and cardiovascular disease.
Serum urate is frequently elevated in patients with the metabolic syndrome and increases with the number of components of this condition. Hyperuricemia has been related to decreased renal uric acid excretion, which may be mediated by enhanced proximal tubular sodium reabsorption and hyperinsulinemia. Recent epidemiologic studies have shed some light on the prognosis of hyperuricemia. While hyperuricemia appears to show a benign significance in low cardiovascular risk individuals, it clearly increases cardiovascular mortality in patients at high cardiovascular disease risk.
Clinicians should be aware of the presence of metabolic syndrome in patients with hyperuricemia or gout in order to control its components (high blood pressure, obesity, etc.) and hence reduce the risk for cardiovascular disease. Long-term, randomized interventional clinical trials are needed to test the hypothesis that urate-lowering therapy can reduce cardiovascular risk in these patients.
代谢综合征由多种心血管危险因素聚集定义，会增加心血管疾病风险以及心血管疾病和全因死亡率。在本文中，我们综述了关于高尿酸血症、代谢综合征和心血管疾病之间关联的最新证据。
代谢综合征患者的血清尿酸经常升高，且随着该病症组成成分数量的增加而升高。高尿酸血症与肾脏尿酸排泄减少有关，这可能由近端肾小管钠重吸收增强和高胰岛素血症介导。近期的流行病学研究对高尿酸血症的预后有了一些了解。虽然高尿酸血症在心血管风险较低的个体中似乎显示出良性意义，但在心血管疾病风险较高的患者中，它明显增加心血管死亡率。
临床医生应注意高尿酸血症或痛风患者中代谢综合征的存在，以便控制其组成成分（高血压、肥胖等），从而降低心血管疾病风险。需要长期、随机的干预性临床试验来检验降低尿酸治疗能否降低这些患者心血管风险的假设。
