Dear all
Yesterday a 35 year old man came to see me following investigations for
renal calculus. The calculus was calcium oxalate, but he was found on
two occasions to have blood uric acid above the normal range. The
consultant urologist suggested that I prescribe allopurinol. The patient
has never had an attack of gout, is slightly overweight and drinks about
10 units per week.
I was doubtful that treating asymptomatic hyperuricaemia would benefit
him, and he was not happy about embarking on lifelong treatment for an
asymptomatic chance finding. Searching medline revealed no RCTs of
allopurinol for hyperuricaemia, but there were some case control and
cross sectional studies which suggested an association between
hyperuricaemia, high triglyceride levels, atherosclerotic disease
(cardiac and cerebrovascular - although this may be because of the link
to high triglyceride) and insulin resistance.
I've decided not to prescrible allopurinol, but to check lipids, measure
BMI and ask some more searching questions about diet and alcohol the
next time I see him. I don't want to medicalise his asymptomatic
condition but would hope to encourage him to modify his lifestyle. It is
likely that I will ask our dietician to see him, especially if his
lipids are abnormal.
Does anyone know of data which gives a more or less precise estimate of
how much his risk of CVD is affected by by hyperuricaemia and whether
lifestyle modification is effective? Are the effects simply because of
the association with other risk factors?
Cheers
Toby
--
Toby Lipman
General practitioner, Newcastle upon Tyne
Northern and Yorkshire research training fellow
Tel 0191-2811060 (home), 0191-2437000 (surgery)
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