Allopurinol and Cardiovascular Outcomes in Patients With Ischemic Heart Disease - ALL-HEART
Contribution To Literature:
Highlighted text has been updated as of October 19, 2022.
The ALL-HEART trial failed to show that allopurinol improves cardiovascular outcomes among patients with ischemic heart disease.
The goal of the trial was to evaluate allopurinol compared with usual care among patients with ischemic heart disease.
Patients with ischemic heart disease were randomized to allopurinol (n = 2,853) versus usual care (n = 2,868). Allopurinol was given at a dose of 100 mg daily for 2 weeks, then 300 mg daily for 2 weeks, then 600 mg daily. Among patients with estimated glomerular filtration rate (GFR) 30-59 cc/min/1.73 m2, allopurinol was given at a dose of 100 mg daily for 2 weeks, then 300 mg daily.
- Total number randomized: 5,721
- Duration of follow-up: 4.8 years
- Mean patient age: 72 years
- Percentage female: 24%
- Percentage with diabetes: 22%
- Patients ≥60 years of age with ischemic heart disease
- Severe renal impairment (eGFR <30 cc/min/1.73 m2)
- Significant hepatic impairment
- Participation in another clinical trial
- Allergy to allopurinol
- Serious adverse cutaneous reaction to any drug
- Patients already on urate lowering therapy
- Taking azathioprine, mercaptopurine, cyclosporine, or theophylline
- Malignancy within the last 5 years
The primary outcome, cardiovascular death, myocardial infarction, or stroke, occurred in 11.0% of the allopurinol group vs. 11.3% of the usual care group (p = 0.65). Outcomes were the same among tested subgroups.
- All-cause death: 10.1% of the allopurinol group vs. 10.6% of the usual care group (p = 0.77)
- Hospitalization for heart failure: 2.6% of the allopurinol group vs. 3.4% of the usual care group (p = 0.18)
Among patients with ischemic heart disease and without gout, allopurinol did not improve outcomes compared with usual care. Safety issues were similar between treatment groups. Allopurinol cannot be recommended for cardiovascular event reduction among patients with ischemic heart disease.
Mackenzie IS, Hawkey CJ, Ford I, et al. Allopurinol versus usual care in UK patients with ischemic heart disease (ALL-HEART): a multicenter, prospective, randomized, open-label, blinded-endpoint trial. Lancet 2022;400:1195-205.
Presented by Dr. Isla Shelagh Mackenzie at the European Society of Cardiology Congress (ESC 2022), Barcelona, Spain, August 27, 2022.
Keywords: ESC22, ESC Congress, Allopurinol, Angina Pectoris, Geriatrics, Heart Failure, Glomerular Filtration Rate, Myocardial Infarction, Myocardial Ischemia, Stroke
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