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*Only for medical professionals to read for reference.
Gout suffers from cardiovascular comorbidities.
Rheumatologists can do 3 things! At the annual meeting of the American Society of Rheumatology (ACR) in 2021, Professor Hyon Choi from Harvard Medical School gave a speech entitled "Gout with Cardiovascular Diseases, Challenges in Drug Management", Department of Rheumatology and Immunology, Huashan Hospital, Fudan University Deputy Chief Physician Zhu Xiaoxia interpreted this topic.
What is the specific content? Let's see it together! From the perspective of comorbidities, looking at gout and cardiovascular disease, the incidence of gout has been increasing in recent years
.
Dr.
Zhu Xiaoxia pointed out: The latest statistics from the China Centers for Disease Control and Prevention (CDC) show that the prevalence rate of hyperuricemia in China has exceeded 14%.
Among young and middle-aged men, the prevalence rate even exceeds 30%.
The prevalence of gout/high uric acid coincides with each other
.
Professor Hyon Choi also mentioned in the report of the ACR 2021 annual meeting: Among the inpatients in the Department of Rheumatology, the diagnosis of gout has significantly exceeded that of rheumatoid arthritis
.
Professor Hyon Choi believes that the high incidence of gout and hyperuricemia is closely related to the life>
.
Figure 1 Why is gout/hyperuricemia popular? Under the combined influence of multiple factors, the comorbidity of gout/hyperuricemia is becoming more common
.
The spectrum of comorbidities is quite extensive.
Among them, the comorbidity rate of gout and hypertension is as high as 74%, and the comorbidity rate with coronary artery disease is as high as 26% (Figure 2)
.
Figure 2 Disease spectrum of gout comorbidities.
In addition, Professor Hyon Choi and Dr.
Zhu Xiaoxia both believe that although the mechanism of comorbidity has not been fully elucidated (Figure 3), the relationship between gout/hyperuricemia and its comorbidities is not only a common relationship.
, Are more likely to be cause and effect and influence each other
.
Figure 3 The academic community has never stopped discussing the comorbidity of gout/hyperuricemia.
Professor Hyon Choi proposed that the comorbidity mechanism between gout/hyperuricemia and cardiovascular disease may be shared by the two inflammatory pathways (Figure 4) Related, and some of the treatment drugs for gout [interleukin-1 (IL-1) inhibitors and colchicine] may have cardiovascular protective effects
.
Figure 4 The inflammatory pathways of the two major diseases overlap in many places.
A series of studies, evidence, and opinions seem to prompt rheumatologists: In daily diagnosis and treatment, attention should be paid to the connection between gout/hyperuricemia and cardiovascular disease.
Medication issues related to comorbidities! What can rheumatologists do if gout suffers from cardiovascular disease? Although the causal relationship between gout/hyperuricemia and cardiovascular disease is not fully understood, rheumatologists are still promising
.
1.
When comorbid conditions exist, active treatment to reduce patient mortality is the first thing that clinicians should do.
Active treatment includes: Although the cardiovascular benefits of uric acid-lowering therapy are not clear, it should still be Active treatment of lowering uric acid; active treatment of cardiovascular and metabolic diseases may help achieve the standard of blood uric acid
.
2.
Carry out life>
.
On the basis of the individualized management proposed by Professor Hyon Choi, Dr.
Zhu Xiaoxia added a bit of information: The latest ACR guidelines for lipid-lowering treatment recommendations: If the patient has been treated with other lipid-lowering drugs to achieve good results, they can not switch to fenofib Special treatment
.
At the end of the speech, Professor Hyon Choi mentioned the topic of febuxostat use that rheumatologists are very concerned about
.
Febuxostat is a commonly used drug for the treatment of gout.
Its uric acid-lowering effect is equivalent to or slightly better than that of allopurinol.
It is mainly metabolized by the liver and has certain advantages in patients with renal insufficiency
.
However, in 2017, the U.
S.
Food and Drug Administration (FDA) issued a black box warning that the incidence of cardiovascular death, sudden cardiac death and all-cause mortality in patients with hyperuricemia treated with febuxostat were higher than allopurinol.
.
The FAST study, which has a lower rate of follow-up loss to follow-up, questioned the FDA's black box warning.
Therefore, the current effect of febuxostat on adverse cardiovascular events is still doubtful
.
When patients with high uric acid/gout have cardiovascular disease, rheumatologists should consider the medication according to the individualized situation of the patient
.
Expert profile Zhu Xiaoxia Deputy Chief Physician, Department of Rheumatology and Immunology, Huashan Hospital Affiliated to Fudan University
.
Member of the Rheumatology Branch of the Shanghai Medical Association, Member and Secretary of the Youth Committee of the Rheumatology Branch of the Chinese Medical Association, Member and Secretary of the Gout Group of the Rheumatology and Immunology Branch of the Chinese Medical Doctor Association, Vice Chairman of the Youth Committee of the Immunotherapeutic Engineering Branch of the Chinese Society of Biomedical Engineering, Straits Member and secretary of the Gout Group of the Rheumatology and Immunology Professional Committee of the Cross-Strait Medical and Health Exchange Association, and member and secretary of the High Uric Acid and Gout Expert Committee of the Chinese Geriatrics Committee
.
From October 2009 to April 2011, he studied abroad at Harvard Medical School
.
Main achievements: Presided over a number of international, provincial and ministerial projects such as the National Natural Science Foundation of China, the Special Scientific Research Fund for Doctoral Programs of Higher Education Institutions of the Ministry of Education, Shanghai Shenkang Development Center, and other international and provincial and ministerial topics, and published many SCI and core journal articles
.
Gout suffers from cardiovascular comorbidities.
Rheumatologists can do 3 things! At the annual meeting of the American Society of Rheumatology (ACR) in 2021, Professor Hyon Choi from Harvard Medical School gave a speech entitled "Gout with Cardiovascular Diseases, Challenges in Drug Management", Department of Rheumatology and Immunology, Huashan Hospital, Fudan University Deputy Chief Physician Zhu Xiaoxia interpreted this topic.
What is the specific content? Let's see it together! From the perspective of comorbidities, looking at gout and cardiovascular disease, the incidence of gout has been increasing in recent years
.
Dr.
Zhu Xiaoxia pointed out: The latest statistics from the China Centers for Disease Control and Prevention (CDC) show that the prevalence rate of hyperuricemia in China has exceeded 14%.
Among young and middle-aged men, the prevalence rate even exceeds 30%.
The prevalence of gout/high uric acid coincides with each other
.
Professor Hyon Choi also mentioned in the report of the ACR 2021 annual meeting: Among the inpatients in the Department of Rheumatology, the diagnosis of gout has significantly exceeded that of rheumatoid arthritis
.
Professor Hyon Choi believes that the high incidence of gout and hyperuricemia is closely related to the life>
.
Figure 1 Why is gout/hyperuricemia popular? Under the combined influence of multiple factors, the comorbidity of gout/hyperuricemia is becoming more common
.
The spectrum of comorbidities is quite extensive.
Among them, the comorbidity rate of gout and hypertension is as high as 74%, and the comorbidity rate with coronary artery disease is as high as 26% (Figure 2)
.
Figure 2 Disease spectrum of gout comorbidities.
In addition, Professor Hyon Choi and Dr.
Zhu Xiaoxia both believe that although the mechanism of comorbidity has not been fully elucidated (Figure 3), the relationship between gout/hyperuricemia and its comorbidities is not only a common relationship.
, Are more likely to be cause and effect and influence each other
.
Figure 3 The academic community has never stopped discussing the comorbidity of gout/hyperuricemia.
Professor Hyon Choi proposed that the comorbidity mechanism between gout/hyperuricemia and cardiovascular disease may be shared by the two inflammatory pathways (Figure 4) Related, and some of the treatment drugs for gout [interleukin-1 (IL-1) inhibitors and colchicine] may have cardiovascular protective effects
.
Figure 4 The inflammatory pathways of the two major diseases overlap in many places.
A series of studies, evidence, and opinions seem to prompt rheumatologists: In daily diagnosis and treatment, attention should be paid to the connection between gout/hyperuricemia and cardiovascular disease.
Medication issues related to comorbidities! What can rheumatologists do if gout suffers from cardiovascular disease? Although the causal relationship between gout/hyperuricemia and cardiovascular disease is not fully understood, rheumatologists are still promising
.
1.
When comorbid conditions exist, active treatment to reduce patient mortality is the first thing that clinicians should do.
Active treatment includes: Although the cardiovascular benefits of uric acid-lowering therapy are not clear, it should still be Active treatment of lowering uric acid; active treatment of cardiovascular and metabolic diseases may help achieve the standard of blood uric acid
.
2.
Carry out life>
.
On the basis of the individualized management proposed by Professor Hyon Choi, Dr.
Zhu Xiaoxia added a bit of information: The latest ACR guidelines for lipid-lowering treatment recommendations: If the patient has been treated with other lipid-lowering drugs to achieve good results, they can not switch to fenofib Special treatment
.
At the end of the speech, Professor Hyon Choi mentioned the topic of febuxostat use that rheumatologists are very concerned about
.
Febuxostat is a commonly used drug for the treatment of gout.
Its uric acid-lowering effect is equivalent to or slightly better than that of allopurinol.
It is mainly metabolized by the liver and has certain advantages in patients with renal insufficiency
.
However, in 2017, the U.
S.
Food and Drug Administration (FDA) issued a black box warning that the incidence of cardiovascular death, sudden cardiac death and all-cause mortality in patients with hyperuricemia treated with febuxostat were higher than allopurinol.
.
The FAST study, which has a lower rate of follow-up loss to follow-up, questioned the FDA's black box warning.
Therefore, the current effect of febuxostat on adverse cardiovascular events is still doubtful
.
When patients with high uric acid/gout have cardiovascular disease, rheumatologists should consider the medication according to the individualized situation of the patient
.
Expert profile Zhu Xiaoxia Deputy Chief Physician, Department of Rheumatology and Immunology, Huashan Hospital Affiliated to Fudan University
.
Member of the Rheumatology Branch of the Shanghai Medical Association, Member and Secretary of the Youth Committee of the Rheumatology Branch of the Chinese Medical Association, Member and Secretary of the Gout Group of the Rheumatology and Immunology Branch of the Chinese Medical Doctor Association, Vice Chairman of the Youth Committee of the Immunotherapeutic Engineering Branch of the Chinese Society of Biomedical Engineering, Straits Member and secretary of the Gout Group of the Rheumatology and Immunology Professional Committee of the Cross-Strait Medical and Health Exchange Association, and member and secretary of the High Uric Acid and Gout Expert Committee of the Chinese Geriatrics Committee
.
From October 2009 to April 2011, he studied abroad at Harvard Medical School
.
Main achievements: Presided over a number of international, provincial and ministerial projects such as the National Natural Science Foundation of China, the Special Scientific Research Fund for Doctoral Programs of Higher Education Institutions of the Ministry of Education, Shanghai Shenkang Development Center, and other international and provincial and ministerial topics, and published many SCI and core journal articles
.
