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Effect of Long-Term Allopurinol Therapy on Left Ventricular Mass Index in Patients with Ischemic Heart Disease; A
Manal M Alem1, Sarah R Aldosari2, Alhassna A Alkahmous2
1Department of Pharmacology, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
Insights
Allopurinol, an antioxidant, may reduce left ventricular mass (LVM) in ischemic heart disease patients with normal kidney function. This treatment also improved glycemic control, suggesting potential cardiovascular benefits.
Area of Science:
- Cardiology
- Pharmacology
- Nephrology
Background:
- Left ventricular hypertrophy (LVH) is a significant cardiovascular risk factor, often present in ischemic heart disease (IHD).
- Oxidative stress is implicated in the development of LVH.
- The potential of antioxidant therapy, specifically allopurinol, to mitigate LVH is under investigation.
Purpose of the Study:
- To investigate the association between long-term allopurinol therapy and left ventricular mass index (LVMI) in IHD patients.
- To evaluate the effect of allopurinol on LV geometry, function, blood pressure, glycemic control, and lipid profile.
Main Methods:
- Observational, cross-sectional study comparing 96 IHD patients on standard treatment with 96 patients additionally receiving allopurinol (>12 months).
- Primary endpoint: LVMI measured by 2D-echocardiography.
- Secondary endpoints: LV ejection fraction, blood pressure, HbA1c, and lipid profile.
Main Results:
- Allopurinol was associated with the lowest LVMI (70.5 g/m²) in patients with normal serum creatinine.
- Patients with elevated serum creatinine showed higher LVMI in both allopurinol and control groups.
- Allopurinol treatment correlated with improved glycemic control (HbA1c difference of 0.8%, P=0.004).
Conclusions:
- Allopurinol treatment showed a tendency towards reduced LVM in IHD patients with normal serum creatinine, likely due to its antioxidant properties.
- Allopurinol was associated with better glycemic control in this patient population.
- Further research may explore allopurinol's role in managing cardiovascular risk in IHD.
Background:
Left ventricular hypertrophy (LVH), as assessed by measurement of left ventricular mass (LVM), is one of the most important cardiovascular risk factors. It is commonly present in patients with ischemic heart disease (IHD), irrespective of the level of blood pressure; recently, oxidative stress has been shown to be an important factor in its development. The question then arises: can this risk factor be modified by antioxidant treatment (e.g., with allopurinol, a xanthine oxidase inhibitor)?
Methods:
This is an observational study with a cross-sectional design which explored the association between long-term (>12 months) allopurinol therapy and LV mass index (LVMI) as well as geometry in patients generally receiving standard treatments for IHD. The primary endpoint was LVMI measurement (by 2D-echocardiography) and secondary endpoints included the association of allopurinol use with LV function (ejection fraction), blood pressure, glycemic control, and lipid profile.
Results:
Ninety-six patients on standard anti-ischemic drug treatment (control group) and 96 patients who were additionally taking allopurinol (minimum dose 100 mg/day) were enrolled. Both groups were matched for age, sex, height, and co-morbidities, but poorer kidney function in the allopurinol group required further sub-group analysis based on renal function. Allopurinol treatment was associated with the lowest LVMI in the patients with normal serum creatinine (median LVMI; 70.5 g/m2): corresponding values were 76.0 and 87.0 in the control group with, respectively, normal and elevated serum creatinine, and 89.5 in the allopurinol group with elevated serum creatinine (P=0.027). In addition, allopurinol was associated with better glycemic control (HbA1c) with a difference of 0.8% (95% CI; 1.3, 0.2) (P=0.004) as compared with control patients.
Conclusion:
In our population, treatment with allopurinol (presumably because of its anti-oxidant properties) has shown a tendency to be associated with smaller LVM in IHD patients with normal serum creatinine, along with better glycemic control.
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