Allopurinol is xanthine oxidase inhibitors
used commonly for treating gout has been found to reduce LVH in IHD patients
and also angina in chronic stable angina patients,.
As per article published JACC Volume 61,
Issue 9, and March 2013. Allopurinol was given in high dose i.e. 600mg/day. In this
study 66 patients of IHD with LVH were included they were randomized to Allopurinol
and placebo for 9 months.
Allopurinol significantly reduced left
ventricular mass −5.2 ± 5.8 g vs. placebo −1.3 ± 4.48 g; p = 0.007
Allopurinol reduced Left ventricular
mass index −2.2 ± 2.78 g/m2 vs. placebo −0.53 ± 2.5 g/m2; p = 0.023
Allopurinol reduced LV end-systolic
volume −2.81 ± 7.8 ml vs. placebo +1.3 ± 7.22 ml; p = 0.047
The quoted mechanism of reduction of
left ventricular mass with Allopurinol were, reduction in augmentation index i.e.
Allopurinol −2.8 ± 5.1% vs. placebo +0.9 ± 7%; p = 0.02.
| Augmentation pressure is the additional pressure added to the forward wave by the reflected wave. Augmentation index is defined as the augmentation pressure as a percentage of pulse pressure. |
Allopurinol improved endothelial
dysfunction i.e. flow mediated dilation improved with Allopurinol −2.8 ± 5.1% vs.
placebo +0.9 ± 7%; p = 0.02.
LIFE study showed reduction of LVH, and was
associated with reduction of all cause mortality by 28%, cardiovascular
mortality by 38%, myocardial infarction by 15%, new onset AF by 12%, stroke by
24%, CCF by 36% and sudden cardiac death by 19%.
However it remains to be seen whether
Allopurinol’s LVH regression will show benfit as seen in LIFE study. Major limitations
this study was, LVH regression was modest and also this was single center study
with small group of subjects.
Allopurinol reduces angina by decreasing
oxygen consumption, in chronic stable angina patients. click
here in this study Allopurinol increased the median time to ST depression
to 298 secs from a baseline of 232 secs, where as placebo increased it to 249secs p=0·0002.
Allopurinol increased median total
exercise time to 393secs from a baseline of 301secs , and placebo increased it
Allopurinol increased the time to chest
pain from a baseline of 234secs to 304 secs, and placebo increased it to 272secs.
Labels: Drugs, For Doctors, Intermediate Level, Ischemic Heart Disease