Gout Worsens Heart Failure Outcomes

Find the history of gout worsening outlook for patients with heart failure, but the traditional treatment can improve results, and case-control study nested.

The failure patients heart who have a history of gout run an increased risk of endpoint in a boat to return to heart failure or death, with the ratio adjusted 1.63 (95% CI 1.48 to 1.80, P <0.001), according to George Thanassoulis, MD , and his colleagues at McGill University in Montreal.

The use of Allopurinol However, they are mentioned in No. 9 August Archives of Internal Medicine, useful for those with a history of gout, which led to:

* Heart failure or low acceptance of death, and the regular control of resources 0.69 (95% CI 0.60 to 0.79, 0.001)
* Reduce the mortality rate, adjusted RR 0.74 (95% CI 0.61 to 0.90)

High levels of uric acid in the blood and increased oxidative stress in patients who suffer from heart failure has been linked with increased mortality.

And small clinical studies have suggested potential benefits of Allopurinol oxidase inhibitor Ksidiz in cardiac function in patients who suffer from heart failure. Despite the recent trial did not show clinical benefits of drugs in the total population of heart failure, and was seen some positive effects in a subset with high levels of uric acid.

To clarify these conflicting results, and analysis Thanassoulis and colleagues analyzed data from the cohort, population-based retrospective of patients aged 66 and older with symptoms of heart failure, using administrative databases of all the Quebec health insurance program.

This was followed by study population consisted of 25090 patients from the hospital with a diagnosis of heart failure on the average 2.1 years.

Samples were taken randomly for each case, up to 10 and controls the appropriate time of the event.

Among patients included the 25090, there were 14 327 events for the results of a composite of readmission with heart failure or death, and the mortality rate 11 674 for all causes.

Not only was the remote history of gout associated with negative outcomes, so it was an acute episode within the past 60 days, with adjusted relative rates of 2.06 for cardiac readmission or death (95% CI 1.39 to 3.06, P <0.001) and 1.76 for mortality ( 95% CI 1.08 to 2.86, P = 0.02).

The population in the total heart failure there is no significant correlation between the considered use of Allopurinol and heart failure to return or death. However, Allopurinol was associated with a reduction in composite outcome for those who have a history of gout.

The Assembly continued to gout and the negative consequences of heart failure seen in this study after adjustment for many of the confusion that may be important, including myocardial infarction previous renal failure, and treatment of gout, such as anti-inflammatory drugs could precipitate heart failure.

Mechanisms that can be taken Allopurinol may be useful in patients with heart failure have a history of gout include improvements in the contraction of heart muscle and endothelial function, while reductions in uric acid may also reduce afterload, according to investigators.

The researchers noted that their study and control, and the results should be interpreted with caution.

"Given the events of the negative potential of serious associated Allopurinol, can not but that the trial of a large randomized between patients with hyperuricemia] and [heart failure, both with and without a history of gout, and assess the risks and benefits of such a strategy and provide the evidence required to use Allopurinol in clinical practice, "stated therein.

Other limitations of the study include reliance on administrative data with misclassification as possible, and the lack of information on factors such as obesity and alcohol abuse, and misunderstanding on the part of potential significance.

May, however, they concluded: "Given the limited novel treatment options for heart failure [] patients, Allopurinol can be considered as an important therapeutic groups specific subset of patients."