evrazkarЕвразийский Кардиологический ЖурналEurasian heart journal2225-16852305-0748Евразийская ассоциация кардиологов10.38109/2225-1685-2022-2-72-78evrazkar-6323Research ArticleОБЗОРREVIEWГиперурикемия: современные особенности терапии у пациентов с сердечно-сосудистыми заболеваниямиHyperuricemia: contemporary treatment in patients with cardiovascular diseasehttps://orcid.org/0000-0002-5820-1759МироноваО. Ю.MironovaO. Yu.

Миронова Ольга Юрьевна, д.м.н., профессор кафедры факультетской терапии №1 Института клинической медицины им. Н.В. Склифосовского

ул. Бол. Пироговская, д. 6, стр. 1, г. Москва 119435

Olga Iu. Mironova, Dr. of Sci. (Med.), Associate Professor of the Department of Faculty Therapy No. 1, N.V. Sklifosovsky Institute of Clinical Medicine

st. Bol. Pirogovskaya, 6/1, Moscow 119435

mironova_o_yu@staff.sechenov.ruФГАОУ Первый МГМУ им. И. М. Сеченова (Сеченовский Университет) МЗ РФРоссияI.M. Sechenov First Moscow State Medical University (Sechenov University)Russian Federation202228052022027278Copyright © Миронова О.Ю., 20222022Миронова О.Ю.Mironova O.Y.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.heartj.asia/jour/article/view/6323

Распространенность гиперурикемии обусловлена эпидемией ожирения, изменениями пищевого поведения в популяции с преобладанием продуктов, богатых пуринами, алкоголя и фруктозы, а также увеличением частоты назначения диуретиков. Также важно отметить, что за последние 20 лет отмечается увеличение распространенности таких сопутствующих ГУ заболеваний и состояний, как артериальная гипертензия (+15%), сахарный диабет (+19%), снижение функции почек (+17%), гиперлипидемия (+40%) и ожирение (+19%). ГУ (и/или подагра) может являться как причиной, так и следствием различных коморбидных состояний. Именно поэтому их лечение тесно связано с лечением, особенно бессимптомной ГУ, даже в том случае, когда очевидную связь становится трудно достоверно установить.Важно определять не только верхнюю границу значений уровня мочевой кислоты (МК), когда необходимо начинать проведение терапии, но и оптимального целевого уровня МК, которого необходимо достичь на фоне проводимого лечения.В обзорной статье обсуждаются основные особенности проведения немедикаментозной и медикаментозной терапии у пациентов с сердечно-сосудистыми заболеваниями. Рассматривается необходимость проведения терапии, целевые значения уровня мочевой кислоты у пациентов с факторами риска развития сердечно-сосудистых заболеваний, а также дальнейшие научные перспективы в вопросе изучения гиперурикемии в сочетании с сердечно-сосудистыми заболеваниями.Аллопуринол в настоящее время является ключевым препаратом, назначаемым пациентам с ГУ и сердечно-сосудистыми факторами риска. Важнейшим достоинством является профиль безопасности аллопуринола. Ведь как известно, препарат могут получать даже пациенты, получающие заместительную почечную терапию. Необходимость снижения уровня МК у пациентов с ССЗ в настоящее время сомнений не вызывает. В группе пациентов с дополнительными факторами риска, такими как сахарный диабет, метаболический синдром и ХБП, модификация образа жизни в сочетании с уратснижающей терапией улучшают как качество жизни, так и прогноз. В настоящее время аллопуринол является препаратом выбора для лечения ГУ в сочетании с АГ, принимая во внимание как эффективность, так и безопасность его назначения этой группе пациентов. Однако очевидно, что необходимо проведение дальнейших исследований с более четкими критериями включения для проведения анализа влияния терапии на отдельные сердечно-сосудистые события, а также комбинированные конечные точки.

The prevalence of hyperuricemia is due to the epidemic of obesity, changes in eating behavior in the population with the rise of purines, alcohol and fructose consumption, as well as the increased use of diuretics. It’s important to mention that over the past 20 years there has been an increase in the prevalence of such concomitant diseases and conditions as arterial hypertension (+15%), diabetes mellitus (+19%), decreased kidney function (+17%), hyperlipidemia (+40%) and obesity (+19%). Hyperuricemia (and/or gout) can be both a cause and a consequence of various comorbid conditions. That is why their treatment is closely connected with the treatments of hyperuricemia, especially of asymptomatic one.It’s important to determine not only the upper limit of the uric acid in patients, when the therapy is being initiated, but to assess the target levels of uric acid, that must be achieved in patients receiving optimal treatment.In this review article the main principles of both non-pharmacological and pharmacological treatment in patients with cardiovascular diseases are described. The need for medical treatment, target serum urate levels in patients with cardiovascular risk factors are discussed, as well as further perspectives in the field of research in patients with hyperuricemia and cardiovascular diseases.Allopurinol is currently the key drug prescribed to patients with hyperuricemia and cardiovascular risk factors. The most important advantage is its safety profile. Patients receiving renal replacement therapy can also safely receive the drug.The need to reduce the level of uric acid in patients with cardiovascular disease is currently beyond doubt. In the group of patients with additional risk factors, such as diabetes mellitus, metabolic syndrome and CKD, lifestyle modification in combination with urate-lowering therapy improves both the quality of life and prognosis. Currently, allopurinol is the drug of choice for the treatment of AH in combination with AH, taking into account both the efficacy and safety of its administration to this group of patients. However, it is obvious that further studies with clearer inclusion criteria are needed to analyze the effect of therapy on cardiovascular events, as well as combined endpoints.

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The authors declare that there are no conflicts of interest present.