Allopurinol may improve prognosis of heart failure patients suffering from gout

A recent study has demonstrated that gout significantly increases the risk of death or rehospitalization in patients suffering from heart failure. The study also found that long-term use of the drug allopurinol can significantly ameliorate the risks of recurrent cardiac events in heart failure patients suffering from gout. The study was presented at the recent American Heart Association annual meeting by George Thanassoulis of Boston University, MA, USA, and the Framingham Heart Study. The ana lysis used administrative and health records from Quebec, incorporating data from more than 150,000 heart failure patients over the age of 65 years. During the 2-year follow-up, the incidence of death or readmission to hospital with heart failure was significantly higher in patients with gout and heart failure (6%) compared with patients being treated for heart failure alone. The ana lysis was controlled to account for several demographic and clinical variables that could have acted as confounding factors. These included age, sex, comorbidities and medication. The risk of death or heart failure hospitalization was even greater in patients who had acute gout – defined as hospitalization or the need of a home visit from a physician for gout within 60 days of the index heart failure event – with a twofold higher risk in adjusted ana lysis. The long-term use of allopurinol, defined as more than 30 days of treatment, by patients suffering from gout proved to significantly reduce the risk of gout by 1% compared with those patients with gout who were not on longterm allopurinol treatment. There was no link between allopruinol treatment and outcomes for the entire population, suggesting allopurinol is only beneficial for heart patients concurrently suffering with gout. Thanassoulis hypothesises that allopurinol exerts its beneficial effect on patients suffering from heart failure and gout by inhibiting xanthine oxidase, thereby preventing endothelial dysfunction caused by oxidative stress. He urges continued effort and research: “The next steps are to assess the relationship between heart failure, gout and allopurinol treatment in a prospective, controlled study.” In a commentary in Rheumatology News, Janet Maynard and Alan Baer, both of John Hopkins University in Baltimore, MD, USA, urge caution in extrapolation of results from this study, whilst supporting the need for further research into the area. They note that “patients who take allopurinol may differ from patients who do not take allopurinol. Thus, findings may reflect confounders, such as healthcare utilization patterns and medication adherence, rather than a direct effect of allopurinol on outcomes. This study does remind all rheumatologists of the importance of cardiovascular risk factor modification in patients with gout. In addition, it suggests that future work should evaluate whether treatment of hyperuricemia in patients with and without gout leads to improved cardiovascular outcomes.”