Detailed Explanation of the Dangers of Heart Disease Combined with Hyperuricemia and Guidelines for Scientific Medication Adjustment

What to do when heart disease meets high uric acid: Many people frequently discover elevated blood uric acid levels during physical examinations. Since there may not be clinical symptoms, most people may dismiss it. Many believe that high uric acid only leads to gout, and that eating less seafood and drinking less beer will naturally resolve the issue. But is this really the case?

The dangers of high uric acid: Currently, regardless of gender, two separate blood uric acid tests exceeding 420 μmol/L are considered hyperuricemia. It's common knowledge that excessive uric acid deposits in the joints, inducing inflammation and leading to gout. However, long-term high uric acid can actually cause many more problems.

1. Kidney disease and kidney stones: Long-term high uric acid can cause uric acid kidney stones, leading to kidney tissue damage, proteinuria, and edema.

2. Cardiovascular diseases: High uric acid damages vascular endothelial cells, causing vascular damage and potentially inducing hypertension, heart failure, and myocardial infarction.

3. Diabetes: High uric acid can increase insulin resistance, inducing diabetes and its complications. Factors that can trigger elevated uric acid levels:

1. Genetic factors (a minority);

2. Dietary factors, such as long-term consumption of high-purine foods like animal organs and drinking beer.

Many people may ask, why does uric acid still rise even without seafood or alcohol? A significant but easily overlooked factor is excessive fructose intake, which is also a reason why many children have high uric acid.

Researchers in Boston, USA, found that drinking a glass of orange juice daily increases the risk of gout by 41%; a can of sugary drink can increase the risk of gout in women by 70%.

Fructose is commonly found in fruits and honey. After being ingested, fructose is directly broken down into uric acid, and it also reduces the kidneys' excretion of uric acid.

3. Some medications can affect uric acid metabolism, such as aspirin, beta-blockers, and diuretics.

How to lower uric acid:

1. Develop healthy lifestyle habits: eat a balanced diet, drink less alcohol, drink more water, exercise more, and control your weight.

2. If serum uric acid is ≥540 μmol/L or ≥480 μmol/L and accompanied by one of the following symptoms: hypertension, stroke, coronary heart disease, heart failure, uric acid kidney stones, or kidney damage, medication should be initiated. However, lower uric acid levels are not always better; uric acid <180 μmol/L can lead to Parkinson's disease.

What to do if you have hyperuricemia and need long-term medication for heart disease:

1. Should aspirin be stopped if you have hyperuricemia? Currently, many doctors weigh the pros and cons, prioritizing heart disease treatment. Patients who need to take aspirin can continue taking it, only requiring uric acid monitoring.

However, Dr. Zhou does not recommend this approach. First, even small doses of aspirin can increase uric acid levels by more than 15%, and long-term high uric acid is very detrimental to the cardiovascular system. Second, aspirin is not irreplaceable. For example, patients with implanted stents can use cilostazol and clopidogrel dual antiplatelet therapy. If it is simply coronary heart disease, clopidogrel can completely replace aspirin.

2. The following heart medications can lower uric acid: Losartan, fenofibrate, atorvastatin, and other medications promote uric acid excretion, so patients taking these medications do not need to adjust their uric acid levels even if they are already high.

(Note: Medication adjustments should be made under the guidance of a doctor.)