Reducing uric acid as a means to prevent cardiovascular and renal disease

Hyperuricaemia (uric acid levels > 6.5 mg/dl in men and > 6.0 mg/dl in women) affects ∼ 10% of the population but is not classically treated with uric acid-lowering drugs unless there is a history of gout or uric acid renal stones. However, there is strong epidemiological evidence that hyperuricaemia is associated with cardiovascular and renal disease. It has recently been shown that mild hyperuricaemia in rats causes hypertension, vascular disease and renal injury and that lowering uric acid levels can prevent these complications. Thus, there is renewed interest in current and future therapies that may be used to lower uric acid. This paper reviews current therapies, particularly the xanthine oxidase inhibitors and uricosuric agents, as well as novel approaches to uric acid reduction, such as replacement enzyme therapies.