GOUT, HEART FAILURE, and ALLOPURINOL

[trev]

This allopurinol for heart failure discussion is quite old. Please see Have A Heart! Allopurinol Helps More Than Gout. If you still have questions, start a new discussion here.

There have been many suppositions relating uric acid to heart disease. It is an important topic for those of us with gout.

Here's some hopeful information on the topic.

theheart.org/article/1108863.do

I have always scorned low-dose allopurinol becasue anecdotally it seemed to cause more flares than high dose (300mg. or more)

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THere may be more to it:

ncbi.nlm.nih.gov/pmc/articles/PMC1767024/

The study is long and subtle but the conclusion is particularly incisive:

Conclusion

We have found that long term low dose allopurinol is associated with increased mortality while long term high dose allopurinol was associated with the same mortality as in those who received no allopurinol. One possible interpretation of these results is that low dose allopurinol inadequately reduces the adverse effects associated with a longstanding high urate concentration but that high dose allopurinol does reduce the risks associated with a high urate concentration in CHF. It also raises the hypothesis that patients with CHF who have gout ought to receive ≥ 300 mg allopurinol/day even if a lower dose keeps the gout under clinical control. Further work is required to see whether the hypothesis raised by these results is true.  

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Here's a study using a large cohort of veterans with a uric acid of 7.0 mg/dL or greater. Some had gout some not. Some took allopurinol, some not.  There was a 23% difference in all cause mortality in favor of the allopurinol even though those taking the drug were in worse physical shape than those not taling it (fatter with more co-morbidities.)

rheumatology.oxfordjournals.org/cgi/content/full/48/7/804

Deaths were not broken down by cause.

[vegetarianGuy]

Is high cholesterol prerequisite for most heart problems or can one have low cholesterol ands till develop heart problems?

[zip2play]

Heart FAILURE is a slow deterioration of the heart, usually the left ventricle which pumps blkood to the body. Coronary artery disease causing heart attacks has a great deal to do with cholesterol and deposited blood fats and causes heart attacks killing part of the heart muscle and this is the MAJOR casue of heart failure which, if you are not killed instantly, begins the process of heart weakening, aka failure.

But your hear can go into failure for other reasons, like infections (endocarditis, pericarditis,) defective  valves from disease or heredity, rheumatic fever, rampant hypertension causing unending pressure on the left ventricle, pulmonary hypertension (distension and weakening ofn the RIGHT ventricle becasue of lung problems) and even just inheriting a “weak heart” and now it seems untreated hyperuricemia. There are so many more, even cancer, emphysema, kidney disease, auto-immmune diseases like Lupus, and on and on.

There are many things that can transform a tight, hard little POWERFUL muscle into a flabby bag beating irregularlynot able to do the one job it must…pump blood well.

[azasadny]

I have dyslipidemia due to liver disease (NASH) and so I'm hoping that Allopurinol may have some positive effect on my lipids as well as my uric acid. I'm hoping for a lot, I know!

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