Prof. Krystyna Widecka from the Department of Hypertension and Internal Diseases of the Pomeranian Medical University in Szczecin explained that elevated uric acid levels are associated primarily with gout, a form of inflammatory arthritis caused by deposition of uric acid crystals in joint fluid.
According to data presented by the expert, in Europe gout affects 7.5 million people. "Much more common, affecting 27 million Europeans, is an increased level of uric acid, which also requires treatment" - argued Prof. Widecka.
There are no Polish data but experts believe that elevated uric acid levels may occur in almost 50% persons with hypertension. According to the NATPOL 2011 study, more than 10 million in Poland have hypertension.
Prof. Widecka stressed that excessive concentration of this acid is conducive to not only the development of gout, but also increases the risk of cardiovascular disease, and is associated with its more severe course and worse prognosis. Hyperuricemia, as the excessive level of uric acid is called, is a separate ailment requiring appropriate treatment.
The Polish Society of Hypertension published new guidelines for the treatment of hyperuricemia. These are the first such recommendations in Europe, but we are confident that they will soon be presented by experts in other countries and international scientific societies" - said Prof. Widecka. She added that it is a common position of doctors of various specializations: cardiologists, diabetologists and rheumatologists.
Prof. Andrzej Tykarski from the Chair and Department of Hypertension, Angiology and Internal Diseases of the Clinical Hospital of the Medical University of Poznań emphasised that the serum uric acid level of 6.8 mg/dl is considered hyperuricemia requiring treatment. It should be applied primarily in people with high cardiovascular risk, i.e. hypertension, coronary heart disease, metabolic syndrome or diabetes.
"I am convinced that the treatment of elevated uric acid levels will soon be recognized as just as important in the prevention of heart attacks as statins, blood cholesterol lowering drugs" - stressed Prof. Tykarski. Treatment should therefore start much earlier, before gout attacks occur.
The expert presented the study, according to which in patients with high cardiovascular risk hyperuricemia is associated with an increased overall risk of death, and each 1 mg/dL increase in blood uric acid leads to a 39% increase in total mortality risk.
Prof. Widecka told PAP that the uric acid concentration of 6.8 mg/dl is the maximum level at which high-risk patients with cardiovascular disease should start treatment. "This applies in particular to women, in whom high uric acid concentration is more dangerous than in men" - she added.
Experts believe that for cardiovascular prevention, it is more beneficial to maintain serum uric acid levels below 5 mg/dl. The latest recommendation, which is 6.8 mg/dl, is therefore quite mild when it comes to the recommended level of this acid that requires therapy.
Treatment should begin with a change of diet. It should be a low-purine diet with lower consumption of meat, offal and seafood, as well as alcohol and products containing fructose. "This, however, only allows to lower the level of uric acid by 10-15%, so if this proves insufficient, it is necessary to start pharmacological treatment" - said Prof. Widecka.
Pharmacotherapy mainly involves the use of a drug that blocks the activity of xanthine oxidase, lowering the level of uric acid. "Treatment begins with a low dose of 100-200 mg/day and increases to a maximum dose of 700-900 mg/day if necessary. In general, so-called maintenance dose of 300-600 mg/day is usually sufficient"- explained Prof. Widecka.
Experts drew particular attention to this, as many physicians use too small a dose of this drug and are satisfied with the uric acid lovel of 7 mg/dl, which is still too high for cardiovascular prevention.
PAP - Science and Scholarship in Poland, Zbigniew Wojtasiński
zbw/ agt/ kap/