Allopurinol regresses left ventricular hypertrophy especially in those with highest left ventricular mass

Abstract

Aims: Left Ventricular Hypertrophy (LVH) is common in Type 2 Diabetes (T2DM) and contributes to their high Cardiovascular (CV) event rate. LVH can be related to Oxidative Stress (OS) and allopurinol reduces OS. We therefore investigated whether allopurinol regresses LVH in patients with T2DM. Methods: We conducted a randomised, double blind, placebo controlled study in 66 T2DM patients with echocardiographic evidence of LVH. Allopurinol 600mg/day or placebo was given for nine months over the study period. The primary outcome was reduction in Left Ventricular Mass (LVM) as calculated by cardiac Magnetic Resonance Imaging (MRI) at baseline and at nine months follow-up. The secondary end-points were change in Flow Mediated Dilatation (FMD) and Augmentation Index (AIx). Results: Allopurinol significantly reduced absolute LVM (-2.65±5.91g and placebo group +1.21±5.10g (p=0.012)) and LVMI (indexed) to body surface area (-1.32±2.84g/m2 and placebo group +0.65±3.07g/m2 (p=0.017)). No significant change was seen in either FMD or AIx. Allopurinol induced LVH regression was however concentrated in those with an above median LV mass at baseline, as might be expected, as shown in Figure 1. ![Figure][1] Figure 1 Conclusion: Allopurinol regresses LVM in patients with T2DM and LVH. Importantly the effects of allopurinol on regression of LVM was more marked in the cohort with above median baseline LVM. Regressing LVH has been shown previously to improve CV mortality and morbidity. Therefore allopurinol may become a useful therapy to reduce CV events in T2DM patients with LVH and patients with more marked LVH may have more to gain [1]: pending:yes