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Мочевая кислота и сердечно-сосудистые заболевания: новый С-реактивный белок?
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Аннотация
В статье обсуждается роль увеличения уровня мочевой кислоты (МК) в крови как маркера повышенного риска развития осложнений сердечно-сосудистых заболеваний. Приведены данные о связи повышенной концентрации МК в крови с артериальной гипертонией, сердечной недостаточностью, ишемической болезнью сердца. Проведена аналогия повышенного уровня МК с другим стандартным маркером повышенного риска развития осложнений сосудистых заболеваний – С-реактивным белком. Рассмотрена роль лекарственных препаратов, влияющих на уровень МК, в частности лозартана, в лечении больных артериальной гипертонией.
Ключевые слова: сердечно-сосудистые заболевания, мочевая кислота, артериальная гипертония, лозартан.
Ключевые слова: сердечно-сосудистые заболевания, мочевая кислота, артериальная гипертония, лозартан.
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The paper discusses a role of elevated blood uric acid levels as a marker for an increased risk of developing cardiovascular events. It also gives data on the association of higher blood uric acid concentrations with arterial hypertension, heart failure, and coronary heart disease. An analogy is made between elevated uric acid levels and another standard marker (C-reactive protein) for an increased risk of vascular events. The role of drugs that affect uric acid levels, losartan in particular, in treating hypertensive patients is considered.
Key words: cardiovascular diseases, uric acid, arterial hypertension, losartan.
Полный текст
Список литературы
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2. Krishnan E. Inflammation, oxidative stress and lipids: the risk triad for atherosclerosis in gout. Rheumatology (Oxford) 2010; 49: 1229–38.
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13. Coutinho Tde A, Turner ST, Peyser PA et al. Associations of serum uric acid with markers of inflammation, metabolic syndrome, and subclinical coronary atherosclerosis. Am J Hypertens 2007; 20: 83–9.
14. Ruggiero C, Cherubini A, Ble A et al. Uric acid and inflammatory markers. Eur Heart J 2006; 27: 1174–81.
15. Leyva F, Anker SD, Godsland IF et al. Uric acid in chronic heart failure: a marker of chronic inflammation. Eur Heart J 1998; 19: 1814–22.
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17. Annemans L, Spaepen E, Gaskin M et al. Gout in the UK and Germany: prevalence, comorbidities and management in general practice 2000–2005. Ann Rheum Dis 2008; 67: 960–6.
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27. Shaninfar S, Simpson RL, Carides AD et al. Safety of losartan in hypertensive patients with thiazide induced hyperuricemia. Kidney Int 1999; 56: 1879–95.
28. Bardin T. Fenofibrate and losartan. Ann Rheum Dis 2003; 62: 497–8.
29. Liberopoulos E, Christed D, Elisaf M. Comparative effects of losartan and irbesartan on serum uric acid in hypertensive patients with hyperuricaemia and gout. J Hypertens 2002; 20 (2): 347.
30. Wallace SL, Robinson H, Masi AT et al. Preliminary criteria for the classification of the acute arthritis of gout. Arthritis Rheum 1977; 20: 895–900.
31. W. Zang et al. EULAR evidence based recommendation for gout. Ann Rheum Dis 2006; 65: 12312–24.
32. Alderman MH, Cohen H, Madhavan S. Distribution and determinants of cardiovascular events during 20 years of successful antihypertensive treatment. J Hypertens 1998; 16: 761–9.
2. Krishnan E. Inflammation, oxidative stress and lipids: the risk triad for atherosclerosis in gout. Rheumatology (Oxford) 2010; 49: 1229–38.
3. Mazzali M, Kanbay M, Segal MS et al. Uric acid and hypertension: cause or effect? Curr Rheumatol Rep 2010; 12: 108–17.
4. Kanbay M, Ozkara A, Selcoki Y et al. Effect of treatment of hyperuricemia with allopurinol on blood pressure, creatinine clearence, and proteinuria in patients with normal renal functions. Int Urol Nephrol 2007; 39: 1227–33.
5. Feig DI, Soletsky B, Johnson RJ. Effect of allopurinol on blood pressure of adolescents with newly diagnosed essential hypertension: a randomized trial. JAMA 2008; 300: 924–32.
6. Høieggen A, Alderman MH, Kjeldsen SE et al. LIFE Study Group. The impact of serum uric acid on cardiovascular outcomes in the LIFE study. Kidney Int 2004; 65: 1041–9.
7. Krishnan E. Hyperuricemia and Incident Heart Failure. Circ Heart Fail 2009; 2: 556–62.
8. Strasak A, Ruttmann E, Brant L et al. Ulmer H. Serum uric acid and risk of cardiovascular mortality: a prospective long-term study of 83,683 Austrian men. Clin Chem 2008; 54: 273–84.
9. Kang DH, Park SK, Lee IK, Johnson RJ. Uric acid-induced C-reactive protein expression: implication on cell proliferation and nitric oxide production of human vascular cells. J Am Soc Nephrol 2005; 16: 3553–62.
10. Johnson RJ, Rodriguez-Iturbe B, Kang DH et al. A unifying pathway for essential hypertension. Am J Hypertens 2005; 18: 431–40.
11. Kanellis J, Kang DH. Uric acid as a mediator of endothelial dysfunction, inflammation, and vascular disease. Semin Nephrol 2005; 25: 39–42.
12. Leyva F, Anker S, Swan JW et al. Serum uric acid as an index of impaired oxidative metabolism in chronic heart failure. Eur Heart J 1997; 18: 858–65.
13. Coutinho Tde A, Turner ST, Peyser PA et al. Associations of serum uric acid with markers of inflammation, metabolic syndrome, and subclinical coronary atherosclerosis. Am J Hypertens 2007; 20: 83–9.
14. Ruggiero C, Cherubini A, Ble A et al. Uric acid and inflammatory markers. Eur Heart J 2006; 27: 1174–81.
15. Leyva F, Anker SD, Godsland IF et al. Uric acid in chronic heart failure: a marker of chronic inflammation. Eur Heart J 1998; 19: 1814–22.
16. Olexa P, Olexova M, Gonsorcik J et al. Uric acid – a marker for systemic inflammatory response in patients with congestive heart failure? Wien Klin Wochenschr 2002; 114: 211–5.
17. Annemans L, Spaepen E, Gaskin M et al. Gout in the UK and Germany: prevalence, comorbidities and management in general practice 2000–2005. Ann Rheum Dis 2008; 67: 960–6.
18. Pascual E. Persistence of monosodium urate crystals and low-grade inflammation in the synovial fluid of patients with untreated gout. Arthritis Rheum 1991; 34: 141–5.
19. Hillis GS, Cuthbertson BH, Gibson PH et al. Uric acid levels and outcome from coronary artery bypass grafting. J Thorac Cardiovasc Surg 2009; 138: 200–5.
20. Culleton BF, Larson MG, Kannel WB, Levy D. Serum uric acid and risk for cardiovascular disease and death: the Framingham Heart Study. Ann Intern Med 1999; 131: 7–13.
21. Moriarity JT, Folsom AR, Iribarren C et al. Serum uric acid and risk of coronary heart disease: Atherosclerosis Risk in Communities (ARIC) Study. Ann Epidemiol 2000; 10: 136–43.
22. Ridker PM, Cushman M, Stampfer MJ et al. Inflammation, aspirin, and the risk of cardiovascular disease in apparently healthy men. N Engl J Med 1997; 336: 973–9. [Erratum N Engl J Med 1997; 337: 356.]
23. Ballantyne CM, Hoogeveen RC, Bang H et al. Lipoprotein-associated phospholipase A2, high-sensitivity C-reactive protein, and risk for incident coronary heart disease in middle-aged men and women in the Atherosclerosis Risk in Communities (ARIC) study. Circulation 2004; 109: 837–42.
24. Nakashima M, Uematsu T, Kosuge K. Pilot study of the uricosuric effect of DuP-753, a new angiotensin II receptor antagonist, in healthy subjects. Eur J Clin Pharmacol 1992; 42 (3): 333–5.
25. Ильиных Е.В. Факторы риска развития кардиоваскулярных заболеваний у больных подагрой. Автореф. дис. … канд. мед. наук. М., 2006.
26. Grossman E, Peleg E, Caroll J et al. Hemodynamic and humoral effect of the angiotensin II receptor antagonist losartan in essential hypertension. Am J Hypertens 1994; 7: 1041–4.
27. Shaninfar S, Simpson RL, Carides AD et al. Safety of losartan in hypertensive patients with thiazide induced hyperuricemia. Kidney Int 1999; 56: 1879–95.
28. Bardin T. Fenofibrate and losartan. Ann Rheum Dis 2003; 62: 497–8.
29. Liberopoulos E, Christed D, Elisaf M. Comparative effects of losartan and irbesartan on serum uric acid in hypertensive patients with hyperuricaemia and gout. J Hypertens 2002; 20 (2): 347.
30. Wallace SL, Robinson H, Masi AT et al. Preliminary criteria for the classification of the acute arthritis of gout. Arthritis Rheum 1977; 20: 895–900.
31. W. Zang et al. EULAR evidence based recommendation for gout. Ann Rheum Dis 2006; 65: 12312–24.
32. Alderman MH, Cohen H, Madhavan S. Distribution and determinants of cardiovascular events during 20 years of successful antihypertensive treatment. J Hypertens 1998; 16: 761–9.
Авторы
С.Р.Гиляревский, И.М.Кузьмина, Х.Р.Келехсаев
Научно-исследовательский институт скорой помощи им. Н.В.Склифосовского, Москва
Научно-исследовательский институт скорой помощи им. Н.В.Склифосовского, Москва
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S.R.Gilyarevsky, I.M.Kuzmina, Kh.R.Kelekhsayev
N.V.Sklifosovsky Research Institute of Emergency Care
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