【Gout】What diseases can it cause? It’s too serious!

The pathological basis of many chronic disease complications is directly or indirectly related to gout or hyperuricemia. A number of epidemiological data show that hyperuricemia often coexists with cardiovascular disease, hypertension, obesity, dyslipidemia, and diabetes. They are mutually causal and promote each other, creating a vicious cycle.

1. Gout and hypertension:

The correlation between hyperuricemia or gout and hypertension has attracted much attention. Gout is not only a risk factor for hypertension but also a predictor. About 50% of untreated hypertensive patients have concurrent hyperuricemia, which occurs before hypertension. A large number of studies have shown that blood uric acid is closely related to the occurrence, development and prognosis of hypertension. Long-term hypertension in patients can cause tissue hypoxia and lead to increased lactate levels. Lactic acid has a competitive inhibitory effect on the excretion of urate. In addition, the use of certain diuretics and antihypertensive drugs can also lead to reduced uric acid excretion, causing uric acid retention and thus leading to hyperuricemia.

Increased blood uric acid levels stimulate renin secretion and activate the RAAS system; increased blood pressure causes urate to deposit in the blood vessel walls, directly damaging the vascular endothelium, leading to arteriosclerosis, aggravating hypertension, coronary heart disease, etc., forming a vicious cycle.

2. Gout and hyperinsulinemia:

Hyperuricemia can also cause insulin resistance, accelerate the occurrence and development of vascular lesions and impaired glucose tolerance. In the state of insulin resistance, the intermediates in the glycolysis process are transferred to ribose phosphate and ribose phosphate pyrophosphate, leading to increased production of uric acid in the blood, thus causing hyperuricemia.

For patients with diabetes and hyperuricemia, in addition to the influence of genetic and dietary factors, in the early stages of diabetes, the competition between high blood sugar and high urine sugar in the proximal tubules of the kidneys inhibits the reabsorption of uric acid, increasing uric acid excretion. Excessive blood uric acid can damage pancreatic β cells and induce the occurrence of diabetes.

3. Gout, obesity and dyslipidemia:

Epidemiological surveys have found that more than 50% to 70% of gout and hyperuricemia patients are overweight or obese, and more than 2/3 have hyperlipidemia. Therefore, the relationship between gout or hyperuricemia and obesity and hyperlipidemia is inseparable.

The mechanism of dyslipidemia combined with hyperuricemia is that elevated lipoprotein lipase in serum may lead to impaired clearance of lipoprotein uric acid, while increased uric acid levels in the body can lead to decreased lipoprotein lipase activity and reduced decomposition of triglycerides, resulting in increased triglyceride levels in the blood. Obesity can also affect blood uric acid metabolism, and its mechanism may be related to endocrine disorders (decreased androgen and ACTH) or increased ketone body production inhibiting uric acid excretion.

4. Gout and cardiovascular disease:

Metabolic syndrome is a risk factor for cardiovascular disease. When multiple risk factors occur simultaneously, the risk of cardiovascular disease is self-evident. Since urate can be directly deposited in the arterial wall, damaging the arterial intima, stimulating the proliferation of endothelial cells, and inducing the deposition of blood lipids in the arterial wall, hyperuricemia can cause or aggravate atherosclerosis. In addition, increased blood uric acid levels will increase platelet adhesion, leading to endothelial cell dysfunction and promoting thrombosis. At the same time, atherosclerosis can cause renal artery sclerosis, increased renal vascular resistance, reduced effective renal blood flow, etc., which can hinder uric acid excretion and cause hyperuricemia.