Występowanie hiperurykemii u pacjentów obciążonych bardzo wysokim ryzykiem sercowo-naczyniowym — jednoośrodkowe retrospektywne badanie kohortowe

Introduction. Asymptomatic hyperuricemia is an established independent risk factor for cardiovascular (CV) disease. However, the awareness of this fact among physicians is still insufficient. Data are also lacking on the prevalence of asymptomatic hyperuricemia in a population of patients potentially requiring drug therapy. The aim of the study was to assess the prevalence of asymptomatic hyperuricemia in the population of patients hospi- talized in an internal medicine unit and the frequency of use of uricosuric drugs in this group of patients. Material and methods. Single centre retrospective cohort study — evaluation of medical records of patients hospitalized in an internal medicine unit in the first half of 2018. The analysis included biochemical testing results, data on patients’ medical conditions and drug therapy used. Based on the collected data, a group of patients with a very high CV risk was identified in whom serum uric acid level ≥ 5 mg/dL is considered abnormal. Typical statistical methods were used including descriptive statistics, appropriate parametric and non-parametric tests to evaluate significance of differences in the values of selected parameters between the study groups, and generalized regression models. Statistically signi- ficant differences were conventionally defined as p < 0.05. Results. The analysis included data from 354 patients, of whom 194 (55%) met the criteria of a very high CV risk. These patients were older (75 vs. 62 years, p < 0.001) and had lower glomerular filtration rate values (85 vs. 118 mL/ /min/1.73 m2, p = 0.04) and higher mean serum uric acid level (6.6 vs. 5.5 mg/dL, p < 0.001) compared to the control group (non-very high CV risk patients). No significant differences in lipid levels were found between the two groups. Se- rum uric acid level was measured in 55% of patients in the very high CV risk group. Abnormal renal function parameters were an independent predictor of serum uric acid level above 5 mg/dL in this group (R2 = 0.18, p < 0.001). Serum uric acid level was above 5 mg/dL in 70% of very high CV risk patients in whom it was measured. Allopurinol was used in only 25% of these patients, and the mean serum uric acid level in those receiving uricosuric treatment was 8.1 mg/dL. The most commonly used allopurinol dose was 100 mg/day. The mean serum uric acid level in patients not receiving uricosuric treatment was 6.2 mg/dL. Conclusions. Serum uric acid level measurement is too rarely considered in the biochemical profile of patients at a very high CV risk. Serum uric acid level may be an indication for the use of uricosuric drugs in most patients at a very high CV risk. In the light of the current expert consensus, allopurinol is underused and underdosed in the very high CV risk group.