Statin and uric acid level

Q: Which of the statins has a unique urate-lowering effect?

A) Atorvastatin 

B) Fluvastin 

C) Pravastatin

D) Rosuvastatin 

E) Simvastatin 

Answer: A

For patients who have gout and cardiovascular risk factors such as hypertension (HTN) and hypercholesterolemia (HCL), three drugs can be used as adjuvant treatment due to their unique uricosuric properties.

• Losartan
• Atorvastatin
• Fenofibrate

Losartan is the only angiotensin II receptor antagonist with a modest uricosuric effect when used up to a dose of 50 mg/day. Atorvastatin, in comparison to losartan, has a mild uricosuric effect but should be used in such patients. Fenofibrate works via increased uric acid renal clearance and can be considered.

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References:

1. Würzner G, Gerster JC, Chiolero A, et al. Comparative effects of losartan and irbesartan on serum uric acid in hypertensive patients with hyperuricaemia and gout. J Hypertens 2001; 19:1855.

2. Milionis HJ, Kakafika AI, Tsouli SG, et al. Effects of statin treatment on uric acid homeostasis in patients with primary hyperlipidemia. Am Heart J 2004; 148:635.

3. Feher MD, Hepburn AL, Hogarth MB, et al. Fenofibrate enhances urate reduction in men treated with allopurinol for hyperuricaemia and gout. Rheumatology (Oxford) 2003; 42:321.