Effect of uric acid-lowering treatment on vascular health and influence of different drug regimens

The heightened prevalence of hyperuricemia among coastal populations is closely linked to dietary habits, particularly those high in seafood consumption. This metabolic disorder causes extensive vascular damage, including endothelial dysfunction, which can be measured by the reactive hyperemia index (RHI), and arterial stiffness, which is assessed through brachial-ankle pulse wave velocity (baPWV). Uric acid-lowering therapy may improve vascular health, and our study primarily examined the relationship between serum uric acid (SUA) levels and RHI, as well as baPWV. We also compared the effects of various drug regimens after receiving uric acid-lowering therapy for 1 year. Our retrospective analysis of 589 subjects revealed that SUA levels were significantly correlated with RHI (p for trend < 0.001) and baPWV (p for trend < 0.001). Moreover, after adjustments were made, it was found that increased SUA levels were associated with a dose-dependent deterioration of endothelial function (OR 2.45, 95% CI 1.83–3.27, p < 0.001) and vascular stiffness (OR 2.41, 95% CI 1.86–3.11, p < 0.001). Our 1-year longitudinal data support the use of drug therapy to lower uric acid to a specific range, providing effective vascular protection. We also found that improvements in RHI and baPWV were significantly correlated with the extent of SUA reduction, suggesting the dynamic monitoring of both SUA and vascular biomarkers to optimize therapeutic outcomes. Subjects treated with febuxostat demonstrated superior vascular protective effects compared to those taking allopurinol and benzbromarone, likely due to its more potent uric acid-lowering effect. Febuxostat appears to be a favorable option; however, clinicians should exercise caution regarding potential cardiovascular risks associated with its long-term use. This study demonstrated the significant impact of uric acid-lowering drugs on vascular health, providing compelling evidence to support initiating uric acid-lowering treatment in hyperuricemia patients to preserve vascular health, when clinically appropriate.