Chrysant Steven G
Department of Cardiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
Hosp Pract (1995). 2023 Apr;51(2):54-63. doi: 10.1080/21548331.2023.2173413. Epub 2023 Feb 12.
The aim of the present study is to present a historical and unified perspective on the association of serum uric acid (SUA) in the cause of cardiovascular diseases (CVDs). The association of hyperuricemia (HUC) with CVD begun to be appreciated in the middle 1950s and early 1990s when clinical evidence was shown on the association of HUC with CVD. However, this association was disputed by several investigators including the Framingham group and by professional societies, like the American Heart Association and the American Society of Hypertension. This dispute was weakened or reversed by later studies, which showed a positive association of HUC with CVD, CHD, HF, CKD, and stroke, mediated by several risk factors, both molecular such as, oxidative stress, inflammatory stress, insulin resistance, and endothelial dysfunction, as well as clinical factors such as, atherosclerosis, hypertension, metabolic syndrome, and type 2 diabetes mellitus. The great majority of recent studies show a positive association of HUC with CVDs, and CKD. However, the cutoff of the damaging levels of SUA have not been established as yet. The European Society of Hypertension (ESH) Treatment Guidelines have proposed a cutoff level of SUA for CVD > 7 mg/dl for men and > 6 mg/dl for women. In contrast, the URRAH study has shown a SUA level of 4.7 mg/dl for all-cause mortality and 5.6 mg/dl for CV mortality. These levels are lower than the SUA levels proposed by the ESH, which are consistent with HUC. For a better understanding of this association, a Medline search of the English literature was conducted between 2015 and 2022 and 44 pertinent papers were selected. These papers together with collateral literature will be discussed in this review.
本研究的目的是就血清尿酸（SUA）与心血管疾病（CVD）病因之间的关联提供一个历史性的统一观点。高尿酸血症（HUC）与CVD之间的关联在20世纪50年代中期和90年代初开始受到关注，当时有临床证据表明HUC与CVD有关联。然而，包括弗雷明汉研究小组在内的一些研究人员以及美国心脏协会和美国高血压学会等专业协会对这种关联提出了质疑。后来的研究削弱或扭转了这一争议，这些研究表明HUC与CVD、冠心病（CHD）、心力衰竭（HF）、慢性肾脏病（CKD）和中风呈正相关，这是由多种危险因素介导的，包括分子因素如氧化应激、炎症应激、胰岛素抵抗和内皮功能障碍，以及临床因素如动脉粥样硬化、高血压、代谢综合征和2型糖尿病。最近的绝大多数研究表明HUC与CVD和CKD呈正相关。然而，SUA的损害水平临界值尚未确定。欧洲高血压学会（ESH）治疗指南提出，CVD患者的SUA临界值为男性>7mg/dl，女性>6mg/dl。相比之下，URRAH研究显示全因死亡率的SUA水平为4.7mg/dl，心血管死亡率的SUA水平为5.6mg/dl。这些水平低于ESH提出的SUA水平，这与HUC是一致的。为了更好地理解这种关联，我们在2015年至2022年期间对英文文献进行了Medline检索，并选择了44篇相关论文。本综述将讨论这些论文以及相关文献。
