With the continuous improvement of people’s living standard in China, the prevalence of hyperuricemia (HUA) is increasing year by year, especially in economically developed cities and coastal areas, the prevalence of HUA reaches 5%-23.5%, and is higher in men than in women, which may be related to the excessive intake of high purine seafood, animal offal, meat food and large amounts of beer by residents in the area. The prevalence of HUA is 5% to 23%, and is higher in men than in women.
So, what is HUA?
Internationally, the diagnosis of HUA is defined as a fasting SUA level of >420μmol/L for men and >360μmol/L for women on two non-same days under normal purine diet.
What are the dangers of HUA?
Studies have found that HUA is closely related to metabolic syndrome, type 2 diabetes, hypertension, cardiovascular disease, chronic kidney disease and gout, and is an independent risk factor for the development of these diseases. HUA is an independent risk factor for the development of heart failure, ischemic stroke and death. Reducing SUA significantly improves coronary blood flow and left ventricular function in dilated cardiomyopathy, reducing the risk of cardiovascular and all-cause mortality in patients with hypertensive nephropathy. elevated SUA levels can lead to acute uric acid nephropathy, chronic uric acid nephropathy and kidney stones, increasing the risk of renal failure.
What is the relationship between HUA and gout?
HUA is the most important biochemical basis and the most direct cause of gout development. The prevalence of gout increases with the increase of SUA level, but most of HUA does not develop into gout, and gout only occurs when urate crystals are deposited in body tissues causing damage; in a small number of patients in acute stage, SUA level can also be in normal range, therefore, HUA cannot be equated with gout.
How to prevent HUA?
(A) Dietary factors: avoid high purine food such as meat, seafood, animal offal, thick broth, etc. Avoid drinking alcohol (especially beer) and smoking.
(ii) Disease factors: HUA is mostly accompanied with cardiovascular and metabolic diseases, interacting with each other and influencing each other. Therefore, pay attention to the SUA test for these patients to detect HUA early.
(iii) Avoid long-term use of drugs that may cause elevated uric acid: Try to remove drugs that may cause elevated uric acid, such as thiazide and tab diuretics, niacin, small dose aspirin, etc. For patients who need to take diuretics with HUA, avoid thiazide diuretics. In contrast, low-dose aspirin (<325mg/d) is not recommended to be discontinued as a means of cardiovascular disease prevention and treatment, despite the elevated SUA.
What does the treatment of HUA include?
(A) General treatment
1.Lifestyle change: healthy diet, restrict smoking and alcohol, adhere to exercise and weight control, etc.
(1) Healthy diet: low purine food is the mainstay.
(2) Drink more water, quit smoking and limit alcohol: daily water intake to ensure that the urine volume is above 1500ml per day, preferably above 2000ml per day. At the same time advocate to quit smoking, ban beer and liquor, red wine in moderation.
(3) adhere to the exercise, weight control: daily moderate intensity exercise more than 30min. Obese people should lose weight, so that the weight control in the normal range.
(2) Appropriate alkalinization of urine: commonly used drugs include sodium bicarbonate and sodium potassium hydrogen citrate.
(B) Active treatment of metabolic and cardiovascular risk factors associated with elevated SUA
Actively control obesity, MS, T2DM, hypertension, hyperlipidemia, CHD or stroke, chronic kidney disease, etc.
(c) Choice of uric acid-lowering drugs: At present, common clinical drugs include drugs that inhibit uric acid synthesis and drugs that increase uric acid excretion, whose representatives are allopurinol and benzbromarone respectively.
What is the appropriate level of SUA control?
In view of the large number of studies confirming that SUA levels above the normal range or the high limit of normal are associated with an increased risk of multiple co-morbidities, it is recommended that for HUA combined with cardiovascular risk factors and cardiovascular disease, life coaching and pharmacological uric acid lowering therapy should be provided to control SUA to <360μmol/L for a long period of time. L to prevent recurrent attacks. For HUA patients without cardiovascular risk factors or cardiovascular co-morbidities, it is still recommended to give appropriate intervention programs.