Optimal uric acid reduction to improve vascular endothelial function in patients with chronic heart failure complicated by hyperuricemia

Gout and rheumatoid arthritis are associated with subclinical vascular damage, reduced brachial vasoreactivity and coronary microvascular dysfunction: a case-control study

Gout and rheumatoid arthritis (RA) are distinct disorders, but both of these inflammatory arthropaties are associated with a relatively similar risk of atherosclerotic cardiovascular disease. We aimed to assess carotid intima-media thickness (CIMT), flow-mediated vasodilatation (FMD) and coronary flow reserve (CFR) in both disorders to understand and compare the extent of vascular damage. Patients with recently diagnosed gout (n = 30) and RA (n = 40) without previous cardiovascular disease were included to the present study, and 45 healthy volunteers served as controls. All participants underwent ultrasonographic examinations to measure CIMT, FMD and CFR. In unadjusted analysis, both gout and RA were associated with a significantly higher CIMT and significantly lower CFR as compared to controls, while FMD was only lower in the gout group. After adjustment, there was a significantly higher odds ratio (OR) for CIMT (OR:7.02, 95%CI:2.45-20.58 for gout and OR:2.86, 95%CI:1.27-6.57 for RA) and a lower OR for CFR (OR:0.21, 95%CI:0.08-0.55 for gout and OR:0.17, 95%CI:0.07-0.45 for RA) in both groups, while only gout patients had a lower OR for FMD (OR:0.21, 95%CI:0.08-0.55). There were no significant differences or evidence of a difference between gout and RA patients for CIMT, FMD or CFR. Gout and RA are associated with a similar degree of vascular damage, which may explain the similar incidence of atherosclerotic cardiovascular disease in both diseases.

Current updates and future perspectives in uric acid research, 2024

Uric acid, the final product of purine metabolism, plays a significant role in hypertension Research on uric acid has advanced significantly, particularly regarding its links to hypertension and cardiovascular disease (CVD). Our 2023 review covered the relationship between uric acid, hypertension; and CVD, however, numerous new studies have emerged since then. This paper provides an update, summarizing recent findings over the past two years on hyperuricemia and its association with hypertension, preeclampsia, arteriosclerosis, kidney disease, sleep-disordered breathing, CVD, and so on. Hyperuricemia, often driven by reduced uric acid excretion or increased production, is influenced by genetic factors and lifestyle habits, including high-purine foods, alcohol, and fructose intake. While hyperuricemia has been proposed to contribute to hypertension and CVD through mechanisms like inflammasome activation and oxidative stress, its causal role remains debated. Further clinical and basic science studies on hyperuricemia and purine metabolism are necessary to clarify its impact on CVD and guide therapeutic approaches.

The Role of Hyperuricemia in Cardiac Diseases: Evidence, Controversies, and Therapeutic Strategies

Hyperuricemia (HUA) may lead to myocardial cell damage, thereby promoting the occurrence and adverse outcomes of heart diseases. In this review, we discuss the latest clinical research progress, and explore the impact of HUA on myocardial damage-related diseases such as myocardial infarction, arrhythmias, and heart failure. We also combined recent findings from basic research to analyze potential mechanisms linking HUA with myocardial injury. In different pathological models (such as direct action of high uric acid on myocardial cells or combined with myocardial ischemia-reperfusion model), HUA may cause damage by activating the NOD-like receptor protein 3 inflammasome-induced inflammatory response, interfering with cardiac cell energy metabolism, affecting antioxidant defense systems, and stimulating reactive oxygen species production to enhance the oxidative stress response, ultimately resulting in decreased cardiac function. Additionally, we discuss the impact of lowering uric acid intervention therapy and potential safety issues that may arise. However, as the mechanism underlying HUA-induced myocardial injury is poorly defined, further research is warranted to aid in the development novel therapeutic strategies for HUA-related cardiovascular diseases.

2023 update and perspectives

Total 276 manuscripts were published in Hypertension Research in 2022. Here our editorial members picked up the excellent papers, summarized the current topics from the published papers and discussed future perspectives in the sixteen fields. We hope you enjoy our special feature, 2023 update and perspectives in Hypertension Research.