Гиперурикемия: современные особенности терапии у пациентов с сердечно-сосудистыми заболеваниями

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.

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