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, 13, 23-28

An Evidence-Based Review on Urate-Lowering Treatments: Implications for Optimal Treatment of Chronic Hyperuricemia


An Evidence-Based Review on Urate-Lowering Treatments: Implications for Optimal Treatment of Chronic Hyperuricemia

Marilisa Bove et al. Vasc Health Risk Manag.


Several studies suggest that chronic hyperuricemia, the main precursor of gout, is involved in the pathogenesis of different systemic disorders that affect cardiovascular and renal systems, such as hypertension, obesity, hypercholesterolemia, atherosclerosis, metabolic syndrome, chronic heart failure, and chronic kidney disease. Recent epidemiological evidence has shown an increasing trend in the prevalence of hyperuricemia and gout in the Western world: a number of population-based studies estimate a prevalence of up to 21% for hyperuricemia and 1%-4% for gout. As such, early detection and careful management of this pathological condition is required, starting from lifestyle changes (mainly based on a diet low in red meat, sugars, and alcoholic beverages, with increased intake of vegetables, water, and vitamin C sources), adding specific drugs to lead serum uric acid (SUA) levels under the target value of 7 mg/dL. In particular, nonselective and selective XO inhibitors (allopurinol, oxypurinol, febuxostat) reduce SUA levels and the overproduction of reactive oxygen species, mainly related to XO overactivity that often causes inflammatory damage to the vascular endothelium. The effect of lowering SUA levels via XO inhibition includes an attenuation of oxidative stress and related endothelial dysfunction that largely contribute to the pathophysiology of metabolic syndrome and cardiovascular diseases. Therefore, the inhibition of XO overactivation seems to be an excellent therapeutic option to limit the harmful effects of excess UA and reactive oxygen species. In conclusion, rapid diagnosis and correct therapy for hyperuricemia may also improve the prevention and/or treatment of serious and multifactorial diseases. The available evidence supports the importance of promoting new experimental clinical trials to confirm the emerging antioxidant role of XO inhibitors, which could effectively contribute to cardiovascular and chronic kidney disease prevention.

Keywords: cardiorenal diseases; hyperuricemia; therapy; xanthine oxidoreductase inhibitors.

Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.


Figure 1
Figure 1
Results from pairwise meta-analysis on the size effect of urate-lowering therapy with major drugs. Note: Adapted from Clin Ther, 2013;35, Ye P, Yang S, Zhang W, et al, Efficacy and tolerability of febuxostat in hyperuricemic patients with or without gout: a systematic review and meta-analysis, Copyright (2013), with permission from Elsevier. Abbreviations: A, allopurinol (100–300 mg/day); F80, febuxostat 80 mg/day; B, benzbromarone (100–200 mg/day); F120, Febuxostat 120 mg/day; F240, Febuxostat 240 mg/day.

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