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The main force in lowering uric acid can actually reduce the risk of myocardial infarction in patients with gout by as much as 50%!

 Last Update: 2022-01-08
 Source: Internet
 Author: User

Data synthesis-observational research

Table 1 summarizes the results of retrospective cohort studies and case-control studies of cardiovascular mortality, myocardial infarction, and stroke, as well as the combined outcomes of cardiovascular mortality, myocardial infarction, and stroke
.

Cardiovascular disease mortality

Three cohort studies of sufficiently high quality were searched, comparing current users with untreated or previously treated cohorts
.

All three cohort studies have a retrospective design

Myocardial infarction

Four cohort studies of adequate quality were retrieved , which compared the current user cohort with untreated or previously treated cohorts
.

All four studies adopted a retrospective study design

A study design of sufficient quality .

De Abajo et al.

Six (Table 1)

A case-control study was retrieved that studied the relationship between allopurinol treatment and ischemic stroke
.
They studied 14,937 first-time ischemic stroke cases and compared them with a control group matched to age and sex
.
They included the cumulative use time of allopurinol in their analysis
.
They adjusted for age (despite a match, but slightly different between the control group and the case) , and found that the exposure-dependent reduction of the adjusted odds ratio for ischemic stroke: exposure <1 year is 1.
12 (1.
04-1.
21), It is 0.
97 (0.
81-1.
16) for 1-3 years, and 0.
74 (0.
57-0.
96) for exposure more than 3 years
.
They were compared with a control group matched to age and gender
.
They included the cumulative use time of allopurinol in their analysis
.
They adjusted for age (despite a match, there is a slight difference between the control group and the case)

Comprehensive results

Only two retrospective cohort studies of sufficient quality reported this comprehensive outcome
.
Larsen et al.
observed a significant association between allopurinol use and reduced cardiovascular death and event rates
.
Unfortunately, they did not study the effect of allopurinol dosage on this relationship
.
Wei et al.
showed similar trends in a small group of patients
.
Interestingly, in the allopurinol user group, there was a significant association between allopurinol dose and cardiovascular events (see Table 1)
.

Shows a significant relationship between allopurinol dose and cardiovascular events (see Table 1)
.

In summary, this study found that compared with the control group, the combined endpoint of the allopurinol group (hazard ratio 0.
65 [95% CI] [0.
46, 0.
91]; p = 0.
012) and myocardial infarction (RR 0.
47 [0.
27, 0.
80] ;p = 0.
01) The risk is significantly reduced
.
Allopurinol has no significant effect on mortality from stroke or cardiovascular disease
.
Among the 15 observational studies of sufficient quality, 1/3 of the studies reported that allopurinol was associated with reducing cardiovascular mortality, 6/8 of the studies reported myocardial infarction, and 4/7 of the studies reported stroke.
Two out of two studies reported a combined endpoint
.
Only when allopurinol treatment is extended for more than 6 months, and an appropriate dose of allopurinol (300 mg or more/day) or a sufficient reduction in serum urate concentration (<0.
36 mmol/l) is achieved, can it be observed To cardiovascular benefits
.

Research significance and future research directions

The current meta-analysis shows that the use of allopurinol treatment significantly reduces the incidence of cardiovascular events in patients with hyperuricemia with preserved renal function (eGFR>30ml/min/.
73 m2)
.
However, the quality of the data has significant limitations, mainly due to its reliance on (possibly insufficient) adverse event reports and imprecise results
.
Because of these limitations, the results of this meta-analysis that does not support the conventional cardiovascular risk management implementation in
.
On the other hand, this analysis provides important signals for the potential efficacy of allopurinol in preventing cardiovascular events
.
Therefore, there is still an urgent need to provide high-level experimental evidence for the application of allopurinol in cardiovascular protection
.
Observational research data provides important information on how to design such experiments
.
Based on this systematic review, we emphasize the need for a well-designed randomized double-blind placebo-controlled trial to study the benefits of allopurinol on cardiovascular outcomes
.
In this test, allopurinol should be administered in a dose of 200-400 mg, preferably for at least 3 years
.
In addition, the statistical power should be sufficient to detect at least a 25% reduction in cardiovascular events
.

Allopurinol treatment, (the eGFR> 30ml / min /.
73 is M2) significant limitations, the management on the other hand, this analysis provides an important signal for the allopurinol therapeutic potential prevention of cardiovascular events
.
It is best to use it for at least 3 years
.
statistics

Original source:

Karel H.
van der Pol,et al.
Allopurinol to reduce cardiovascular morbidity and mortality: A systematic review and meta-analysis.

PLOS ONE | https://doi.
org/10.
1371/journal.
pone.
0260844 December 2, 2021

PLOS ONE | https://doi.
org/10.
1371/journal.
pone.
0260844 December 2, 2021 Leave a message here

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