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Effects of allopurinol on endothelial dysfunction: a meta-analysis.

AbstractOBJECTIVE:
Several studies have assessed the effect of allopurinol on endothelial function, but these studies were relatively small in size and used different methods of evaluating endothelial function. We conducted a meta-analysis to investigate the effect of allopurinol on both endothelial-dependent and -independent vasodilatation.
METHODS:
Electronic databases, Medline, PubMed, EMBASE, SCOPUS, EBSCO and the Cochrane Library Central Register of Clinical Trials were searched from January 1985 to July 2013 on clinical trials (randomized and non-randomized) which assessed the effect of allopurinol on endothelial function. We conducted a sensitivity analysis to assess the contribution of each study to the pooled treatment effect by excluding each study one at a time and recalculating the pooled treatment effect for the remaining studies. Treatment effect was significant if p < 0.05. We assessed for heterogeneity in treatment estimates using the Cochran Q test and the χ(2) statistic (with substantial heterogeneity defined as values >50%).
RESULTS:
The final analysis consisted of 11 studies (2 observational and 9 randomized). For the endothelial-dependent vasodilatation there were 6 studies, including 257 patients, that evaluated flow-mediated dilatation and 5 studies with 87 patients that reported data on forearm blood flow response to acetylcholine or flow-dependent vasodilatation. Overall, there was a significant increase in the endothelium-dependent vasodilatation with allopurinol treatment (MD 2.69%, 95% CI 2.49, 2.89%, p < 0.001; heterogeneity χ(2) = 319.1, I(2) = 96%, p < 0.001). There was only 1 study (100 patients) assessing nitrate-mediated dilatation and 4 studies (73 patients) evaluating forearm blood flow response to sodium nitroprusside as measures of endothelial-independent vasodilatation. The overall analysis (MD -0.08, 95% CI -0.50, 0.34, p = 0.70; heterogeneity χ(2) = 9.0, I(2) = 44%, p = 0.11) showed no effect of allopurinol treatment on endothelium-independent vasodilatation.
CONCLUSIONS:
We found that treatment of hyperuricemia with allopurinol is associated with an improvement in the endothelial-dependent, but not with the endothelial-independent vasodilatation.
AuthorsMehmet Kanbay, Dimitrie Siriopol, Ionut Nistor, Omer C Elcioglu, Ozge Telci, Mumtaz Takir, Richard J Johnson, Adrian Covic
JournalAmerican journal of nephrology (Am J Nephrol) Vol. 39 Issue 4 Pg. 348-56 ( 2014) ISSN: 1421-9670 [Electronic] Switzerland
PMID24751886 (Publication Type: Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't)
Chemical References
  • Gout Suppressants
  • Allopurinol
Topics
  • Allopurinol (pharmacology, therapeutic use)
  • Cardiovascular Diseases (prevention & control)
  • Endothelium, Vascular (drug effects)
  • Gout Suppressants (pharmacology, therapeutic use)
  • Humans
  • Hyperuricemia (drug therapy)
  • Vasodilation (drug effects)

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