title: Uric acid and xanthine oxidase in heart failure - Emerging data and therapeutic implications.
abstract: The role of hyperuricaemia as cardiovascular risk factor has exhaustingly been debated for decades. While the association of elevated uric acid (UA) levels with increased mortality risk as convincingly been shown, the question whether UA is independently predictive of just a related effect within a more complex risk factor profile (including metabolic, inflammatory and haemodynamic risk factors) is still a matter of dispute. In heart failure the independent prognostic and functional impact of elevated UA has not only been shown but also the pathophysiologic mechanism(s) and the potential of targeted therapeutic interventions have been investigated in some detail. The emerging picture suggests the increased activity of the enzyme xanthine oxidase (XO) with corresponding increased production of free oxygen radical (ROS) as a main underlying principle with the resulting increase in UA levels being mostly a marker of this up-regulated pathway. While this concept will not diminish the value of UA as a prognostic marker, it provides the basis for a novel metabolic treatment option and the means to identify those patients most eligible for this tailored therapy. This review will summarize the recent evidence on XO as a novel and promising therapeutic target in heart failure.
authors: Centre for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Germany; Department of Cardiology, Campus Virchow, Charité-Universitätsmedizin Berlin, Germany; German Center for Cardiovascular Diseases (DZHK), Partner Site Berlin, Germany. Electronic address: wolfram.doehner@charite.de.
authors: Wolfram
authors: W
authors: Doehner
authors: Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland.
authors: Ewa A
authors: EA
authors: Jankowska
authors: Innovative Clinical Trials, Department of Cardiology & Pneumology, University Medical Center Göttingen (UMG), Göttingen, Germany.
authors: Jochen
authors: J
authors: Springer
authors: Division of Cardiology, University Clinic or Respiratory Diseases, Golnik, Slovenia.
authors: Mitja
authors: M
authors: Lainscak
authors: Innovative Clinical Trials, Department of Cardiology & Pneumology, University Medical Center Göttingen (UMG), Göttingen, Germany.
authors: Stefan D
authors: SD
authors: Anker
mesh_terms: D006333:Heart Failure / Q000201:enzymology* / Q000378:metabolism / Q000473:pathology; D006801:Humans; D011379:Prognosis; D017382:Reactive Oxygen Species / Q000378:metabolism; D012307:Risk Factors; D014527:Uric Acid / Q000378:metabolism*; D014969:Xanthine Oxidase / Q000378:metabolism*
chemical_list: D017382:Reactive Oxygen Species; D014527:Uric Acid; D014969:Xanthine Oxidase
keywords: Cachexia; Ischemic stroke; MCAO model; Muscle; Sarcopenia