title: Effect of allopurinol on mortality and hospitalisations in chronic heart failure: a retrospective cohort study.
abstract: OBJECTIVE
  To examine whether allopurinol is associated with any alteration in mortality and hospitalisations in patients with chronic heart failure (CHF). This hypothesis is based on previous data that a high urate concentration is independently associated with mortality with a risk ratio of 4.23 in CHF.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Medicines Monitoring Unit, Ninewells Hospital, Dundee, UK.
  
  
  METHODS
  1760 CHF patients divided into four groups: those on no allopurinol, those on long term low dose allopurinol, those on short term low dose allopurinol, and those on long term high dose allopurinol.
  
  
  METHODS
  Total mortality, cardiovascular mortality, cardiovascular hospitalisations, cardiovascular mortality or hospitalisations.
  
  
  RESULTS
  Long term low dose allopurinol was associated with a significant worsening in mortality over those who never received allopurinol (relative risk 2.04, 95% confidence interval (CI) 1.48 to 2.81). This may be because low dose allopurinol is insufficient to negate the adverse effect of a high urate concentration. However, long term high dose (> or = 300 mg/day) allopurinol was associated with a significantly better mortality than longstanding low dose allopurinol (relative risk 0.59, 95% CI 0.37 to 0.95). This may mean that high dose allopurinol can fully negate the adverse effect of urate and return the mortality to normal.
  
  
  CONCLUSIONS
  Long term high dose allopurinol may be associated with a better mortality than long term low dose allopurinol in patients with CHF because of a dose related beneficial effect of allopurinol against the well described adverse effect of urate. Further work is required to substantiate or refute this finding.
authors.affiliation: Department of Clinical Pharmacology & Therapeutics, and the Medicines Monitoring Unit, Ninewells Hospital, Dundee DD1 9SY, UK. a.d.struthers@dundee.ac.uk
authors.forename: A D
authors.initials: AD
authors.lastname: Struthers
authors.forename: P T
authors.initials: PT
authors.lastname: Donnan
authors.forename: P
authors.initials: P
authors.lastname: Lindsay
authors.forename: D
authors.initials: D
authors.lastname: McNaughton
authors.forename: J
authors.initials: J
authors.lastname: Broomhall
authors.forename: T M
authors.initials: TM
authors.lastname: MacDonald
mesh_terms: D000368:Aged; D000493:Allopurinol / Q000008:administration & dosage*; D002303:Cardiac Output, Low / Q000517:prevention & control*; D002908:Chronic Disease; D015331:Cohort Studies; D005260:Female; D016166:Free Radical Scavengers / Q000008:administration & dosage*; D006074:Gout Suppressants / Q000008:administration & dosage*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D009026:Mortality; D016016:Proportional Hazards Models; D012044:Regression Analysis; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D016166:Free Radical Scavengers; D006074:Gout Suppressants; D000493:Allopurinol