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Efficacy of Allopurinol in Cardiovascular Diseases: A Systematic Review and Meta-Analysis

Waqas Ullah1, Shristi Khanal1, Rozi Khan2

  • 1Abington Jefferson Health, Abington, PA, USA.

Cardiology Research
|June 30, 2020
PubMed

Insights

Allopurinol use during coronary artery bypass graft (CABG) surgery may reduce the risk of acute cardiovascular syndrome (ACS) and cardiovascular mortality. However, allopurinol does not provide long-term benefits for secondary prevention in these patients.

Area of Science:

  • Cardiovascular Medicine
  • Pharmacology
  • Clinical Trials

Background:

  • The efficacy of allopurinol in preventing major cardiovascular events after coronary artery bypass graft (CABG), acute cardiovascular syndrome (ACS), or heart failure is not well-established.
  • Current evidence is insufficient to guide the use of allopurinol in patients undergoing CABG or with a history of ACS or heart failure.

Purpose of the Study:

  • To evaluate the effectiveness of allopurinol in reducing major cardiovascular events in patients undergoing CABG.
  • To assess the impact of allopurinol on periprocedural ACS and cardiovascular mortality in CABG patients.
  • To determine the long-term benefits of allopurinol for secondary prevention of ACS and mortality.

Main Methods:

  • A systematic review and meta-analysis of nine studies involving 850 patients.
  • Inclusion criteria focused on patients undergoing CABG, or with prior ACS or heart failure.
  • Random effect model used to calculate the unadjusted odds ratio (OR) for key outcomes.

Main Results:

  • Allopurinol use during CABG was associated with significantly lower odds of periprocedural ACS (OR: 0.25) and cardiovascular mortality (OR: 0.22).
  • The number needed to treat (NNT) to prevent one ACS event was 11, and to prevent one death was 24.
  • No significant reduction in cardiovascular mortality or recurrent ACS events was observed with long-term allopurinol use after ACS or heart failure.

Conclusions:

  • Periprocedural allopurinol administration may reduce the risk of ACS and cardiovascular mortality in patients undergoing CABG.
  • Allopurinol does not appear to offer long-term secondary prevention benefits for ACS or mortality.
  • Larger-scale studies are warranted to confirm these findings and validate the periprocedural use of allopurinol.
Abstract

Keywords:
ACSAllopurinolCABGHeart failure

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