Can Allopurinol Reduce Heart Attack Risk?
Can Allopurinol Reduce Heart Attack Risk?
One might have thought that in this study allopurinol use would be associated with increased risk for MI, largely because high uric acid levels and gout are associated with multiple cardiovascular risks such as hypertension, renal insufficiency, and obesity. However, as the authors pointed out, their findings suggest that allopurinol may have a more general cardioprotective effect. Unfortunately, it is not known if the association between allopurinol use and cardiovascular protection is from the effect of allopurinol on lowering uric acid levels or some other pharmacologic effect. Furthermore, the retrospective, uncontrolled design of this study, as well as the lack of statistical significance in the smaller sample, limits the impact of the findings. In particular, one wonders if patients who received allopurinol also had additional characteristics or protective factors that reduced their risk for cardiovascular disease. Given these limitations, it will be important to have these findings replicated in additional studies.
Of interest is a recent study by Goicoechea and colleagues that demonstrated in a small prospective trial that in patients with chronic kidney disease, the use of allopurinol was associated with decreased progression of kidney disease and decreased rates of cardiovascular events. Given that these findings are supportive of the study by Grimaldi-Bensouda and colleagues, as well as other studies discussed in an excellent editorial by Gianni Bellomo that accompanied the Goicoechea article, it will be of great interest to see how future research further elucidates the relationship between uric acid and uric acid-lowering therapy and health benefits beyond treating gout.
Abstract
Viewpoint
One might have thought that in this study allopurinol use would be associated with increased risk for MI, largely because high uric acid levels and gout are associated with multiple cardiovascular risks such as hypertension, renal insufficiency, and obesity. However, as the authors pointed out, their findings suggest that allopurinol may have a more general cardioprotective effect. Unfortunately, it is not known if the association between allopurinol use and cardiovascular protection is from the effect of allopurinol on lowering uric acid levels or some other pharmacologic effect. Furthermore, the retrospective, uncontrolled design of this study, as well as the lack of statistical significance in the smaller sample, limits the impact of the findings. In particular, one wonders if patients who received allopurinol also had additional characteristics or protective factors that reduced their risk for cardiovascular disease. Given these limitations, it will be important to have these findings replicated in additional studies.
Of interest is a recent study by Goicoechea and colleagues that demonstrated in a small prospective trial that in patients with chronic kidney disease, the use of allopurinol was associated with decreased progression of kidney disease and decreased rates of cardiovascular events. Given that these findings are supportive of the study by Grimaldi-Bensouda and colleagues, as well as other studies discussed in an excellent editorial by Gianni Bellomo that accompanied the Goicoechea article, it will be of great interest to see how future research further elucidates the relationship between uric acid and uric acid-lowering therapy and health benefits beyond treating gout.
Abstract
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