Efficacy of allopurinol in improving endothelial eysfunction: A systematic review and meta-analysis

Authors

Shurjeel Uddin Qazi, Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan. qazishurjeel62@gmail.com.
Usama Qamar, Department of Medicine, King Edward Medical University, Lahore, Punjab, Pakistan.
Muhammad Talha Maqsood, Department of Medicine, King Edward Medical University, Lahore, Punjab, Pakistan.
Rabbia Gul, Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan.
Saad Ali Ansari, Department of Medicine, Riverside School of Medicine, University of California, Riverside, CA, USA.
Zeeshan Imtiaz, Department of Medicine, King Edward Medical University, Lahore, Punjab, Pakistan.
Amatul Noor, Department of Medicine, King Edward Medical University, Lahore, Punjab, Pakistan.
Mohammed Zia Suheb, Advocate Aurora HealthFollow
Zaofashan Zaheer, Department of Medicine, King Edward Medical University, Lahore, Punjab, Pakistan.
Adeela Andleeb, Department of Medicine, Allama Iqbal Medical College, Allama Shabbir Ahmed Usmani Road, Lahore, Punjab, Pakistan.
Masooma Naseem, Department of Medicine, Ziauddin Medical University, Karachi, Pakistan.
Muhammad Shariq Akram, Department of Medicine, King Edward Medical University, Lahore, Punjab, Pakistan.
Mubarak Ali, Department of Medicine, King Edward Medical University, Lahore, Punjab, Pakistan.
Alina Barmanwalla, Department of Medicine, Brigham and Women's Hospital and Cape Cod Hospital, Boston, MA, USA.
Rutab Tareen, Department of Medicine, CMH Multan Institute of Medical Sciences, Naseem Hayath Road, Cantt Area, Multan, Punjab, Pakistan.
Irfa Zaheer, Department of Medicine, King Edward Medical University, Lahore, Punjab, Pakistan.

Affiliations

Saint Luke's Aurora Hospital

Abstract

Introduction:Endothelial dysfunction has been implicated in various cardiovascular disorders as the initial pathology. Allopurinol has been shown to improve endothelial dysfunction in patients with gout, but its effect on cardiovascular patients is unclear.

Aims:We aim to assess allopurinol efficacy in improving endothelial dysfunction overall and in different disease states including but not limited to heart failure, chronic kidney disease, ischemic heart disease METHODS: We conducted a literature search of PubMed, Cochrane's Central Library, and Scopus until December 2022, including randomized controlled trials and double-arm observational studies. The primary outcome measure was endothelial function assessed by change in flow mediated dilation (FMD) RESULTS: Our meta-analysis included 22 studies with a total of 1472 patients. Our pooled analysis shows that allopurinol significantly improved FMD (WMD = 1.46%, 95% CI [0.70, 2.22], p < 0.01) compared to control. However, there was no significant difference between allopurinol and control for endothelial-independent vasodilation measured by forearm blood flow (WMD = 0.10%, 95% CI [- 0.89, 0.69], p = 0.80). Subgroup analysis indicated that the effect of allopurinol on FMD was more significant in diabetic and congestive heart failure patients.

Conclusion:While allopurinol may improve endothelial function in various patient populations, further high-quality randomized controlled trials are needed to determine its efficacy in preventing cardiovascular disease exacerbation.

Document Type

Article

PubMed ID

38070035


 

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