Effect of Long-Term Allopurinol Therapy on Left Ventricular Mass Index in Patients with Ischemic Heart Disease; A Cross-Sectional Study

Influence of Left Ventricular Mass Index on Clinical Outcomes in Patients with Acute Myocardial Infarction

The aim of this study was to analyze the correlation between left ventricular mass index (LVMI) and the prognosis of patients with acute myocardial infarction (AMI).The study retrospectively analyzed the Registry of New-onset Atrial Fibrillation Complicating Acute Myocardial Infarction-Shanghai database and included 1957 patients with AMI who were hospitalized from February 2014 to March 2018, with a median follow-up of 2.7 ± 1.3 years; it calculated the number of all-cause mortalities after AMI. Through receiver operating characteristic curve analysis of LVMI, the optimal LVMI cutoff value was obtained, and the enrolled patients were grouped accordingly. The effects of different LVMI levels on the occurrence of cardiovascular and cerebrovascular adverse events were evaluated in patients with AMI. In addition, the risk assessment and prognostic value of the combined application of LVMI and the GRACE score was explored in patients with AMI.The incidences of all-cause mortality, cardiovascular death, heart failure readmission rate, and reinfarction in patients with AMI in LVMI ≥ 98.90 group were significantly higher than those in LVMI < 98.90 group (P< 0.05). The value of LVMI combined with the GRACE score in predicting the risk of post-AMI all-cause mortality as well as cardiovascular death seemed to be better than that of using the GRACE score alone. LVMI, old age, male sex, renal insufficiency, previous heart failure, stroke history, and decreased left ventricular ejection fraction were independent risk factors for all-cause mortality after AMI.High LVMI may be closely associated with all-cause mortality and adverse cardiovascular events after AMI, especially in patients with AMI with LVMI > 98.9. The risk of all-cause mortality after AMI can also be assessed in combination with LVMI and GRACE scores.

Effect of low dose allopurinol on glycemic control and glycemic variability in patients with type 2 diabetes mellitus: A cross-sectional study

Background

Type 2 diabetes mellitus (DM), gout, and asymptomatic hyperuricemia are inter-connected pathologies. Glycemic control (GC), involving a range of treatments is central to the management of DM, whereas allopurinol continues to be the most widely recommended urate lowering agent. Allopurinol has been shown to possess anti-oxidant properties: this study explores the potential effect of allopurinol on glucose homeostasis.

Methods

This is an observational study with a cross-sectional design performed on patients with type 2 diabetes mellitus (DM), recruited from centers in Saudi Arabia. Patients were divided into two groups; allopurinol users; (for gout or asymptomatic hyperuricemia) and a matching disease control group. Patient demographics, co-morbid conditions, biochemical tests, and pharmacological treatments were extracted from electronic records to investigate the effect of allopurinol therapy on Glycemic control (GC), as assessed by glycated haemoglobin (HbA1c as primary endpoint), and on parameters of glycaemic variability (GV) (secondary endpoints).

Results

A total of 194 patients with type 2 DM were recruited (97 in both groups). The two groups were matched for age, sex, and duration of DM: mean age: 59.4 years, 73% males, and 122 months in the allopurinol group vs 59.6 years, 73% males, and 113 months in the control group. Antidiabetic medications were matched between the two groups. In the allopurinol group, it was prescribed with a daily dose of 100 mg, for 77% of the patients, with median duration of 39.5 months. HbA1c values were; 6.90% (6.20, 7.80) in the allopurinol group vs 7.30% (6.60, 8.40) in the control group (P = 0.010). Parameters of GV were calculated from 3 consecutive fasting blood sugar (FBS) readings: variability independent of the mean (VIM) was 0.140 in the allopurinol group vs 0.987 in the control group (P < 0.001).

Conclusion

Concomitant low-dose allopurinol therapy in patients with type 2 DM was associated with modest but significant improvements in GC and GV.

Clinical, Echocardiographic, and Therapeutic Characteristics of Heart Failure in Patients with Preserved, Mid-Range, and Reduced Ejection Fraction: Future Directions

Background

Heart failure (HF) is recognized as a worldwide epidemic. Definitions and risk stratification are usually based upon measurements of left ventricular ejection fraction (LVEF) but such classifications reflect an underlying spectrum of different pathologic, phenotypic, and therapeutic patterns.

Methods

This was a retrospective cohort study of HF patients in Saudi Arabia. Patients were divided into three categories based on LVEF: those with preserved ejection fraction (EF) (EF≥50%, HFpEF); those with mid-range EF (EF 40–49%, HFmrEF); and those with reduced EF (EF <40%, HFrEF). Their demographics, co-morbid conditions, echocardiographic findings, pharmacological treatments and all-cause mortality (ACS) after a follow-up period of 24 months were compared.

Results

A total of 293 HF patients were identified (mean age: 63 years). In total, 65% were males, 79% were Saudi nationals, and 70% had type 2 diabetes mellitus (DM). Classification based on EF was established in 288 patients: HFpEF (105 patients, 36.5%), HFmrEF (49, 17.0%), and HFrEF (134, 46.5%). The 3 groups differed in sex distribution: 51% females in the HFpEF group and 78% males in the HFrEF group (P<0.001). Body mass index (BMI) was highest in the HFpEF group and lowest in the HFrEF group (31.5 vs 26.6; P<0.001). Although systolic blood pressure (SBP in mmHg) was highest in patients with HFpEF, left ventricular mass index (LVMI in g/cm²) was highest in patients with HFrEF 121.00 (94.50, 151.50), and eccentric hypertrophy was the dominant LV geometrical characteristic (54.6%). HFrEF patients had the highest use of ACE inhibitors (60.5%), loop diuretics (79.9%), and aldosterone receptor antagonists (56.7%) (P values; 0.009, 0.007, and <0.001, respectively). A total of 42 deaths occurred during follow-up: HFpEF (17 events), HFmrEF (3 events) and HFrEF (22 events) (Logrank test P=0.189).

Conclusion

This Saudi HF population shows similarities to other populations: EF category distribution, sex distribution, therapeutic trends, and survival outcomes. However, findings related to the underlying risk factors, namely type 2 DM and obesity, have identified HFpEF as an emerging threat in this (relatively) young population.