Expert consensus for the diagnosis and treatment of patients with hyperuricemia and high cardiovascular…

GuidelineEuropean journal of internal medicine· Apr 2026

Expert consensus for the diagnosis and treatment of patients with hyperuricemia and high cardiovascular risk: 2025 update.

Richard Johnson, Ivan Gruev, Yoto Yotov … Mieczyslaw Litwin

Internal MedicineGuidelineClinical practiceQ1IF 3.6

Hyperuricemia should be recognized as a relevant cardiovascular and renal risk factor rather than a benign biochemical finding.

Expert consensus for the diagnosis and treatment of patients with hyperuricemia and high cardiovascular risk: 2025 update.

Richard Johnson … Mieczyslaw Litwin

European journal of internal medicine · Apr 2026 · Q1 in Internal Medicine

Background

Hyperuricemia has traditionally been viewed primarily as a cause of gout; however, accumulating evidence indicates that elevated serum uric acid (sUA) is also associated with increased cardiovascular and renal risk.

Methods

The recommendations are based on a critical narrative review of the literature published, including large cohort studies, meta-analyses, randomized controlled trials, and contemporary European guidelines (ESC, ESH, KDIGO, EULAR).

More results

Elevated sUA is independently associated with cardiovascular mortality, heart failure, stroke, and faster progression of chronic kidney disease.

More results

Based on current evidence, this consensus proposes a risk-based, individualized approach to hyperuricemia management and presents a pragmatic six-rung therapeutic ladder integrating lifestyle measures, optimization of comorbidities, and pharmacological urate-lowering therapy when clinically indicated.

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Conclusion · 1 of 2

Hyperuricemia should be recognized as a relevant cardiovascular and renal risk factor rather than a benign biochemical finding. Serum urate measurement can improve risk stratification in selected high-risk populations.

Conclusion · 2 of 2

While routine treatment of asymptomatic hyperuricemia cannot be universally recommended, targeted urate-lowering strategies may be appropriate in patients with high cardiovascular risk, symptomatic disease, or very high sUA levels.

Expert consensus for the diagnosis and treatment of patients with hyperuricemia and high cardiovascular risk: 2025 update.

Expert consensus for the diagnosis and treatment of patients with hyperuricemia and high cardiovascular risk: 2025 update.

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