CardioExchange Archive

Allopurinol May Be Beneficial in Stable Angina: In addition to its well established role in treating gout, allopurinol may turn out to have beneficial effects in patients with chronic stable angina, according to a new study published online in the Lancet. In a double-blind, randomized, crossover trial, Awsan Noman and colleagues compared allopurinol with placebo in 65 stable angina patients. From a baseline of 232 s, the median time to ST depression was increased to 298 s with allopurinol and 249 s with placebo. The difference between the groups was highly significant. Compared to placebo, allopurinol also significantly increased median total exercise time and time to chest pain. Allopurinol was well tolerated throughout the trial.

In an accompanying comment, Renjith Antony and Henry Dargie write that the treatment effect of the study drug was similar to other established angina drugs, although it had no effect on hemodynamics. One possible mechanism of action, they say, is that allopurinol may prevent “deleterious effects of oxidative stress on endothelial dysfunction and energy supply.” They conclude: “Although further work is needed to confirm allopurinol’s putative anti-ischaemic effects and to better understand its mechanism of action, allopurinol joins a growing list of compounds that tests the conventional wisdom on what constitutes antianginal therapy. Although prevention of coronary artery disease remains important, protecting the myocyte from ischaemia is a logical and pragmatic approach to a disabling condition for which several mechanisms might be responsible.”