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Query: UMLS:C0018099 (gout)
 5,192 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The ingestion of fructose, particularly in refined form, has significantly increased in the North American diet over the last two decades. The unique way in which fructose is metabolized has given rise to much research examining whether fructose is advantageous in appetite control, exercise endurance, and disease states such as diabetes. Overall, there is very little evidence that modest amounts of fructose have detrimental effects on carbohydrate and lipid metabolism in nondiabetic or NIDDM subjects or that its use is particularly advantageous compared to that of other sugars. However, fructose can cause insulin and triglyceride levels to rise dramatically, and hence be potentially harmful, in a subgroup of NIDDM subjects who have concomitant pronounced hypertriglyceridemia. Large doses of fructose should also be avoided by subjects with gout because of the hyperuricemia which may result. No evidence exists that fructose has any clear advantages over glucose in regard to exercise endurance. Similarly there is no conclusive evidence that physiologic amounts of dietary fructose exacerbate copper deficiency or aid in weight control.
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PMID:Current issues in fructose metabolism. 189 98

Determinants and risks associated with serum uric acid were investigated in 822 elderly hypertensive patients treated with hydrochlorothiazide and triamterene or placebo. Pretreatment serum uric acid levels were significantly higher in men than in women and had positive correlation with serum creatinine. After adjustment for serum creatinine, positive correlations of serum uric acid with body weight and fasting blood glucose in women and with serum cholesterol in men were significant. During follow-up, serum uric acid increased significantly in the treated patients, but remained unchanged in the placebo group. Total, cardiovascular, and noncardiovascular mortality were unrelated to initial serum uric acid levels. One placebo patient and seven treated patients developed gout. Of those seven, most were male patients and had significantly higher serum levels of uric acid and creatinine than the other patients. Gender and renal function were the major determinants of serum uric acid in elderly hypertensive patients.
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PMID:The determinants and prognostic significance of serum uric acid in elderly patients of the European Working Party on High Blood Pressure in the Elderly trial. 200 62

The authors present an up-to-date review on etiopathogenesis of atherosclerosis. Theories of etiology of atherosclerosis are described: response-to-injury hypothesis, lipid deposition hypothesis, lysosome hypothesis, encrustation hypothesis, mural thrombi hypothesis, monoclonal and clonal senescence hypothesis. The role of endothelial injury and platelet adhesion as well as smooth muscle cells proliferation due to these events, their growth control and the role of macrophages in atherogenesis are explained thoroughly. Special attention is focused on the interaction of arterial cells and lipoproteins at sites of vessel injury, lipid metabolism of the lesion and on synergy of arterial injury caused by various injury mechanisms and hypercholesterolemia in atherogenesis. Atherosclerotic risk factors and their impact on atherogenesis are discussed as well (e.g. hyperlipoproteinemia, hypertension, tobacco smoking, diabetes and abnormal glucose tolerance, gout, obesity, menopause and oral contraceptives, diminished physical activity, type A of personality behavior etc.). The possibilities of regression or reversal of ateromatous plaques are presented too.
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PMID:[Pathophysiology of atherosclerosis. II. Etiopathogenic mechanisms and risk factors]. 223 16

The influence of a once daily dose of 200 mg celiprolol alone and in combination with 12.5 mg chlorthalidone on uric acid and electrolyte metabolism was investigated in 22 hypertensive patients with gout in a randomized trial. All patients were treated with allopurinol and diet. A four weeks treatment with celiprolol (11 patients) showed no influence on uric acid metabolism, electrolytes, blood glucose, cholesterol and triglycerides. Under treatment with celiprolol plus chlorthalidone (11 patients) only a small rise in serum uric acid was observed after four weeks but at the same time uric acid clearance and excretion increased significantly. There was no obvious change in serum electrolytes but an increase in sodium, potassium and chloride urine excretion. Serum uric acid, uric acid clearance and excretion decreased during a 6 months treatment period. A small decrease in cholesterol and triglycerides was observed. Blood pressure decreased in both treatment groups but there was only a small change in heart rate.
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PMID:[Uricosuric action of a new beta receptor blocker-diuretic drug combination]. 287 73

Thiazide diuretics have been in use for over 30 years in the treatment of hypertension. Their action results in a reduction in peripheral resistance without a significant decrease in cardiac output or a major shift in plasma volume. They are as or more effective than any of the other antihypertensive agents when used as monotherapy and can serve as baseline therapy in combination with any of the available adrenergic, converting enzyme-inhibiting agents, or calcium-entry blockers. There is a high degree of patient acceptance; titration to an effective dosage is relatively easy; and cost, relatively low. Although certain undesirable metabolic changes may occur following the use of these agents, most of them are controllable, and there is no evidence to date that they offset the benefits achieved by blood pressure lowering. Asymptomatic elevated uric acids have not been shown to be of great significance. If gout occurs, it can be managed. Alterations in glucose metabolism may occur, and in some patients, it appears that blood glucose levels are elevated over time. This is not a desirable metabolic change, but is one of doubtful prognostic significance. Changes in lipids are generally short-term, and in the major clinical trials, lipid levels have not remained elevated with a continuation of diuretic therapy. Although diuretics produce hypokalemia in a fairly high percentage of patients, this is not generally severe (less than 3.3 mEq per liter) and usually does not produce symptoms. There is no firm evidence that the hypokalemia produced by diuretics predisposes the patient to severe arrhythmias or sudden death, although this point has been emphasized repeatedly in recent publications. Diuretics can usually be given without potassium-maintenance therapy. However, hypokalemia should be prevented in the elderly, in patients with ischemic heart disease, left ventricular hypertrophy and those on digitalis, or with diabetes. We prefer potassium-sparing agents along with a diuretic over supplements to prevent hypokalemia; the number of pills is kept at a reasonable level, and cost is minimized. Physicians should continue to prescribe diuretics as first-step therapy in the majority of patients to maximize therapeutic outcome.
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PMID:Diuretics in the management of hypertension. 330 12

The relationship between gout and coronary disease is controversial. We studied the distribution of cholesterol among lipoprotein fractions separated by ultracentrifugation in a group of 29 gouty men and 34 healthy controls, matched by age, weight and serum glucose. Our results showed that patients had significantly higher serum triglycerides and cholesterol-VLDL and lower total cholesterol and cholesterol in LDL and HDL fractions. The comparison of both groups separated by weight and alcohol intake showed similar results. The cholesterol-LDL/cholesterol-HDL ratio was not significantly different between the groups. Based on these results, we conclude that our group of gouty patients may not be at greater risk of coronary disease than a similar control population.
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PMID:Cholesterol distribution among lipoprotein fractions in patients with gout and normal controls. 346 58

Blood pressure (BP) and metabolic variables were determined initially and after 1, 2, 4, 6 and 10 years' treatment in two groups of hypertensive men (n = 53 each) randomized to bendroflumethiazide 2.5-5 mg/day or propranolol 160-320 mg daily. There was no significant differences in BP or metabolic variables between the two groups at entry. BP was reduced to the same degree by both treatments. Five men in the propranolol group and one man in the thiazide group developed clinically overt diabetes during follow-up. Fasting blood sugar increased slightly but significantly though equally in both groups. Oral glucose tolerance was initially impaired to the same degree in both groups but improved significantly during treatment with both drugs. Fasting insulin increased slightly but to the same degree. While serum potassium decreased significantly in the thiazide group, the total body potassium was unchanged in this group. In the propranolol group, serum potassium rose, while total body potassium decreased significantly. Serum urate increased in both groups, though slightly more during thiazide treatment. One case of gout was found in each group. There was no difference in serum lipids between the two groups. The finding in this long-term trial indicate that in middle-aged men with mild to moderate hypertension a low-dose thiazide diuretic like bendroflumethiazide is as effective and safe an antihypertensive agent as the beta-blocker propranolol is and that it does not induce diabetes. The total clinical picture favors the retention of thiazide diuretics as a first choice drug in hypertension.
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PMID:Low-dose antihypertensive treatment with a thiazide diuretic is not diabetogenic. A 10-year controlled trial with bendroflumethiazide. 354 90

Risk factors for cardiovascular disease include atherogenic personal attributes, living habits that promote them, signs of preclinical disease and host susceptibility. Atherogenic traits include the blood lipids, blood pressure and glucose tolerance. An increased low density lipoprotein cholesterol level is positively related, and an increased high density lipoprotein cholesterol level is inversely related, to cardiovascular disease incidence. Hypertension, whether systolic or diastolic, labile or fixed, casual or basal, at any age in either sex contributes greatly. The impact of diabetes is greater for women than men and varies depending on the level of the foregoing risk factors. An atherogenic lifestyle is typified by a diet excessive in calories, fat and salt, sedentary habits, unrestrained weight gain and smoking. Alcohol used in moderation may be beneficial. Oral contraceptives worsen atherogenic traits and, when used for long periods beyond age 35 and in conjunction with cigarettes, predispose to thromboembolism. Type A persons with an overdeveloped sense of time urgency, drive and competitiveness develop an excess of angina pectoris. Men married to more highly educated women are at increased risk as are men married to women in white collar jobs. Preclinical signs of compromised coronary circulation include silent myocardial infarction, left ventricular hypertrophy on the electrocardiogram, blocked intraventricular conduction and repolarization abnormalities. An electrocardiogram obtained during exercise may elicit still earlier evidence. Measures of innate susceptibility include a family history, history of premature cardiovascular disease, diabetes, hypertension and gout. Optimal prediction of risk requires a quantitative combination of risk factors in multiple logistic risk formulations to identify high risk persons with multiple marginal abnormalities.
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PMID:Status of risk factors and their consideration in antihypertensive therapy. 354 87

The relationships between serum uric acid, serum glucose and diabetes have been examined in a survey of 7735 middle-aged men drawn at random from general practices in 24 British towns. There was a positive relationship between serum glucose and serum uric acid concentrations up to about 8.0 mmol/l; at higher levels of glucose, serum uric acid decreased. Uric acid levels were significantly reduced in insulin-dependent diabetics and in those on oral hypoglycaemics and also in 'non-diabetics' with casual glucose levels greater than 10 mmol/l. Both uric acid and glucose concentrations were positively related to body mass index; only uric acid was positively related to alcohol intake. Men on antihypertensive treatment had raised levels of uric acid (significant) and glucose (non-significant). The positive relationship between serum uric acid and serum glucose could not be explained by associations with body mass index, alcohol intake, age, social class, gout or treatment for hypertension. It probably reflects the biochemical interaction between serum glucose and purine metabolism, with increased excretion of uric acid during hyperglycaemia and glycosuria.
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PMID:Serum uric acid, serum glucose and diabetes: relationships in a population study. 362 42

Contributors to CHD include atherogenic personal attributes, living habits which promote these, signs of preclinical disease, and host susceptibility to these influences. Atherogenic traits include the blood lipids, blood pressure, and glucose tolerance. High LDL cholesterol is positively and high HDL cholesterol inversely related to CHD incidence. Hypertension, whether systolic or diastolic, labile or fixed, casual or basal, at any age in either sex contributes powerfully to coronary heart disease. The impact of diabetes on CHD is greater for women than for men and varies according to the level of the foregoing risk factors. The faulty life-style is typified by a diet excessive in calories, fat, and salt, a sedentary habit, unrestrained weight gain, and cigarettes. Alcohol used in moderation may be beneficial. Oral contraceptives worsen atherogenic traits and, when used for long periods beyond age 35 in conjunction with cigarettes, predispose to thromboembolism. Type A persons with an overdeveloped sense of time urgency, drive, and competitiveness develop an excess of angina pectoris. Men married to more highly educated women are at increased risk, as are men married to women in white-collar jobs. Preclinical signs of a compromised coronary circulation include silent MI, ECG-LVH, blocked intraventricular conduction, and repolarization abnormalities. Exercise ECG may elicit still earlier evidence. Measures of innate susceptibility include a family history of premature cardiovascular disease, diabetes, hypertension, and gout. Optimal prediction of CHD requires a quantitative combination of risk factors in multiple logistic risk formulations that identify high-risk persons with multiple marginal abnormalities. Preventive management should also be multifactorial.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Psychosocial and other features of coronary heart disease: insights from the Framingham Study. 377 1


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