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Mar 1, 2013

High dose Allopurinol reduces LVH and also decrease angina in IHD patients


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 to 307secs.

Allopurinol increased the time to chest pain from a baseline of 234secs to 304 secs, and placebo increased it to 272secs.