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Hyperuricemia: clinical clusters at cardiovascular risk |
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| GROUPS |
Abbreviated Mechanisms |
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| Patients with CVD Accelerated atherosclerosis Congestive heart failure |
Increased apoptosis – necrosis of the arterial vessel wall and capillary resulting in increased purine metabolism and hyperuricemia. Increased oxidative – redox stress Antioxidant – Prooxidant Paradox: Urate Redox Shuttle |
| Patients with (T2DM) Accelerated atherosclerosis (Atheroscleropathy) |
Acting through obesity and insulin resistance. Accelerated atherosclerosis with increased vascular cell apoptosis and inflammatory necrosis with increased purine metabolism resulting in hyperuricemia and increased oxidative stress through ischemia-reperfusion and xanthine oxidase. Additional reductive stress associated with glucotoxicity and pseudohypoxia. Increased oxidative-redox stress Antioxidant – Prooxidant Paradox: Urate Redox Shuttle |
| Obesity – Insulin resistance Hyperinsulinemia – Insulin toxicity Metabolic Syndrome (figure 1): Hyperinsulinemia Hypertension Hyperlipidemia dyslipidemia, obesity Hyperglycemia |
Leptin may induce hyperuricemia. Insulin increases sodium reabsorption and is tightly linked to urate reabsorption. Increased oxidative – redox stress Antioxidant – Prooxidant Paradox: Urate Redox Shuttle |
| Men and Postmenopausal females |
Estrogen is uricosuric |
| Renal diseases |
Decreases in GFR increases uric acid levels |
| Hypertension |
Urate reabsorption increased in setting of increased renal vascular resistance, microvascular disease predisposes to tissue ischemia that leads to increased urate generation (excess purine metabolism) and reduced excretion (due to lactate competing with urate transporter in the proximal tubule). Increased oxidative – redox stress Antioxidant – Prooxidant Paradox: Urate Redox Shuttle |
| African American |
Unknown (assumed genetic causes as yet unidentified) |
| Diuretic use |
Volume contraction promotes urate reabsorption |
| Alcohol use (in excess) |
Increases urate generation and decreased urate excretion |
Hayden and Tyagi Nutrition & Metabolism 2004 1:10 doi:10.1186/1743-7075-1-10 |
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