Febuxostat increases ventricular arrhythmogenesis through calcium handling dysregulation in human induced pluripotent stem cell-derived cardiomyocytes

Metabolic crosstalk and therapeutic interplay between diabetes and hyperuricemia

Hyperuricemia and diabetes mellitus (DM) are prevalent metabolic disorders with high comorbidity, imposing a substantial global public health burden. Their coexistence is not merely additive but synergistic, exacerbating metabolic dysregulation through mechanisms such as insulin resistance and β-cell apoptosis, ultimately establishing a vicious cycle. Both disorders induce acute and chronic damage to vital organs, particularly the cardiovascular, renal systems. Hyperuricemia aggravates diabetic complications, notably diabetic cardiomyopathy, nephropathy and retinopathy via oxidative stress, inflammation, and metabolic dysregulation.Current urate-lowering therapies (ULTs), such as xanthine oxidase inhibitors and urate transporter 1 (URAT1, also known as SLC22A12) antagonists, demonstrate potential benefits in ameliorating diabetic complications but face challenges including safety concerns and dose adjustments. Similarly, several glucose-lowering drugs also exhibit the benefits of improving hyperuricemia. This review summarizes the metabolic crosstalk and therapeutic interplay between hyperuricemia and DM, examines the pathogenic role of uric acid in diabetic complications, and discusses the benefits and challenges of existing ULTs and glucose-lowering drugs in disrupting this cycle of metabolic dysregulation and concurrent organ damage. We hope our findings deepen the comprehension of the intricate metabolic crosstalk between glucose and urate homeostasis, providing novel therapeutic insights for patients with comorbid DM and hyperuricemia.

Cardiovascular outcomes of urate-lowering therapies in patients with gout or hyperuricemia: a network meta-analysis

BACKGROUND

To evaluate the comparative cardiovascular safety of urate-lowering therapies (ULTs) in patients with gout or hyperuricemia.

RESEARCH DESIGN AND METHODS

Randomized controlled trials (RCTs) for ULTs with reported cardiovascular outcomes were included. Pairwise and network random-effect meta-analyses were performed to obtain the odds ratios (ORs) with 95% confidence intervals (CIs). The surface under the cumulative ranking curve (SUCRA) was employed to assess and rank the cardiovascular safety of ULTs.

RESULTS

A total of 3,663 literature were retrieved, of which 26 RCTs involving 25,329 patients were finally included. Pairwise and network meta-analyses showed that allopurinol demonstrated a significant reduction in arrhythmia compared with febuxostat (for pairwise meta-analysis, OR = 0.69, 95%CI 0.49 to 0.97; for network meta-analysis, OR = 0.71, 95%CI 0.51 to 0.99). Nevertheless, there was no statistically significant difference observed in other outcomes between different ULTs or between ULTs and placebo (p > 0.05). According to the SUCRA, febuxostat and pegloticase, had the highest probability of mitigating the occurrence of major adverse cardiovascular events (MACEs) and all-cause mortality respectively.

CONCLUSIONS

Overall, ULTs showed relatively good cardiovascular safety in patients with gout or hyperuricemia. However, febuxostat has a higher risk of arrhythmia compared with allopurinol. Further studies are needed to confirm our findings.

Advancements in understanding cardiotoxicity of EGFR- TKIs in non-small cell lung cancer treatment and beyond

Epidermal Growth Factor Receptor-Tyrosine Kinase Inhibitors (EGFR-TKIs) are a class of oral targeted anticancer drugs that have been demonstrated to significantly inhibit tumor progression and improve clinical prognosis in patients diagnosed with EGFR-mutated tumors, particularly in those with non-small cell lung cancer. However, the sustained usage of EGFR-TKIs may cause potential cardiotoxicity, thus limiting their applicability. The primary objective of this review is to systematically analyze the evolving landscape of research pertaining to EGFR-TKI-induced cardiotoxicity and elucidate its underlying mechanisms, such as PI3K signaling pathway inhibition, ion channel blockade, oxidative stress, inflammatory responses, and apoptosis. Additionally, the review includes an exploration of risk assessment for cardiotoxicity induced by EGFR-TKIs, along with management and response strategies. Prospective research directions are outlined, emphasizing the need for more accurate predictors of cardiotoxicity and the development of innovative intervention strategies. In summation, this review consolidates recent research advances, illuminates the risks associated with EGFR-TKI-induced cardiac toxicity and presents crucial insights for refining clinical dosage protocols, optimizing patient management strategies, and unraveling the intricate mechanisms governing EGFR-TKI-induced cardiotoxicity.

Progress of uric acid in cardiovascular disease

Due to the global prevalence of hyperuricemia (HUA), there is growing interest in research on uric acid (UA). HUA is a common condition that has various adverse consequences, including gout and kidney disease. However, recent studies have also implicated UA in the development of cardiovascular diseases (CVD) such as atrial fibrillation (AF) and coronary heart disease (CHD). Experimental and clinical research has extensively demonstrated the detrimental effects of elevated serum UA levels on cardiovascular health. Furthermore, serum UA levels have been identified as predictors of CVD outcomes following percutaneous coronary intervention (PCI) and catheter ablation. Additionally, the use of UA-lowering therapy holds important implications for the management of CVD. This review aims to consolidate the current evidence on the relationship between serum UA and CVD.