Key result
Allopurinol was not associated with a significant reduction in cardiovascular death compared to placebo or usual care in patients with cardiovascular disease.
Why the study?
The effects of allopurinol in patients with cardiovascular disease are not well defined.
Does allopurinol reduce cardiovascular death and major adverse cardiovascular events compared to placebo/usual care or febuxostat in patients with established cardiovascular disease?
Meta-Analysis (n=22,806)
Does allopurinol reduce cardiovascular death and major adverse cardiovascular events compared to placebo/usual care or febuxostat in patients with established cardiovascular disease?
Allopurinol does not significantly reduce cardiovascular death or major adverse cardiovascular events in patients with established cardiovascular disease and is not recommended for secondary prevention in those without hyperuricemia or gout, though potential short-term benefits in CABG or ACS patients warrant further RCTs.
Answers are grounded in this paper and cite their sources.
Does not support allopurinol for cardiovascular death prevention in CVD; confirms lack of benefit in meta-analysis.
BACKGROUND: The effects of allopurinol in patients with cardiovascular disease are not well defined; therefore, the latest evidence is summarized in this study. METHODS: PubMed, Embase, Cochrane Library, and ClinicalTrials.gov databases were searched for randomized controlled trials (RCTs) of allopurinol in patients with cardiovascular disease published up to 11 February 2023. The primary outcome was cardiovascular death. RESULTS: We combined the results of 21 RCTs that included 22,806 patients. Compared to placebo/usual care, allopurinol treatment was not associated with a significant reduction in cardiovascular death (RR 0.60; 95% CI 0.33-1.11) or all-cause death (RR 0.90; 95% CI 0.72-1.12). However, evidence from earlier trials and studies with small sample sizes indicated that allopurinol might confer a protective effect in decreasing cardiovascular death (RR 0.34; 95% CI 0.15-0.76) across patients undergoing coronary artery bypass grafting (CABG) or having acute coronary syndrome (ACS). In comparisons between allopurinol and febuxostat, we observed no difference in cardiovascular death (RR 0.92; 95% CI 0.69-1.24) or all-cause death (RR 1.02; 95% CI 0.75-1.38). CONCLUSION: Allopurinol could not reduce cardiovascular (CV) death or major adverse CV outcomes significantly in patients with existing cardiovascular diseases. Given the limitations of the original studies, the potential advantages of allopurinol observed in patients undergoing CABG or presenting with ACS necessitate further confirmation through subsequent RCTs. In the comparisons between allopurinol and febuxostat, our analysis failed to uncover any marked superiority of allopurinol in reducing the risk of adverse cardiovascular incidents.
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Ye et al. (2023) conducted a meta-analysis in Cardiovascular disease (coronary artery disease, ischemic cardiomyopathy, hypertension, and heart failure) (n=22,806). Allopurinol vs. Placebo/usual care (main comparison, 15 trials, n=6,955) or febuxostat (active comparison, 6 trials, n=15,851) was evaluated on Cardiovascular death (RR 0.60, 95% CI 0.33-1.11). Allopurinol was not associated with a significant reduction in cardiovascular death compared to placebo or usual care in patients with cardiovascular disease.
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