Allopurinol has anti-ischaemic effect for patients with angina

January 01, 0001

Allopurinol has anti-ischaemic effect for patients with angina

Experimental evidence suggests that xanthine oxidase inhibitors can reduce myocardial oxygen consumption for a particular stroke volume. If such an effect also occurs in man, this class of inhibitors could become a new treatment for ischaemia in patients with angina pectoris. The researchers from the UK ascertained whether high-dose allopurinol prolongs exercise capability in patients with chronic stable angina. 65 patients (aged 18—85 years) with angiographically documented coronary artery disease, a positive exercise tolerance test, and stable chronic angina pectoris (for at least 2 months) were recruited into a double- blind, randomised, placebo-controlled, crossover study in a hospital and two infirmaries in the UK. They used computer-generated randomisation to assign patients to allopurinol (600 mg per day) or placebo for 6 weeks before crossover.

Allopurinol increased the median time to ST depression to 298 s from a baseline of 232 s, and placebo increased it to 249 s (significant). The point estimate (absolute difference between allopurinol and placebo) was 43 s. Allopurinol increased median total exercise time to 393 s from a baseline of 301 s, and placebo increased it to 307 s (significant); the point estimate was 58 s. Allopurinol increased the time to chest pain from a baseline of 234 s to 304 s, and placebo increased it to 272 s (significant); the point estimate was 38 s. No adverse effects of treatment were reported.

The researchers concluded: "Allopurinol seems to be a useful, inexpensive, well tolerated, and safe anti-ischaemic drug for patients with angina."

6 weeks is a very short time to assess safety.

For the full abstract, click here.

The Lancet published online 8 June 2010 © Elsevier Ltd 2010
Effect of high-dose allopurinol on exercise in patients with chronic stable angina: a randomised, placebo controlled crossover trial. Awsan Noman, Donald SC Ang, Simon Ogston, Chim C Lang and Allan D Struthers. Correspondence to Prof Allan D Struthers: [email protected]

Category: K. Circulatory. Keywords: allopurinol, exercise, chronic stable angina, randomised placebo controlled crossover trial, journal watch.
Synopsis edited by Dr Stephen Wilkinson, Melbourne, Australia. Posted on Global Family Doctor 25 June 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.