Abstract 10324: The Effect of Allopurinol on B-Type Natriuretic Peptide Levels in Patients with Chronic Stable Angina
Background: An increasing body of evidence points towards myocardial ischaemia as an important trigger for B-type natriuretic peptide (BNP) release. In a recent study, we found high dose allopurinol to have anti-ischaemic effects in patients with chronic stable angina. In this sub-study, we report the effect of allopurinol on resting and post exercise BNP and study the correlation between BNP and the severity of coronary artery disease (CAD).
Method: In a recently reported double-blind, placebo-controlled, crossover trial, 60 patients with chronic stable angina were randomised to a 6-week treatment of allopurinol (600mg/day) or placebo to assess the potential anti-ischaemic effects of allopurinol. In these patients, BNP was measured at rest and after exercise at baseline visit (Baseline) and after each treatment period (Allopurinol and Placebo).
Results: The Median [IQR] of baseline-resting BNP was 84.3pg/ml [44.8–186]. This was significantly higher in patients with triple-vessel CAD compared to those with non-triple vessel CAD (122.1pg/ml [74.2–223.3] vs. 55.9pg/ml [33.5–136.5], p=0.007). BNP increased significantly with ischaemia-limited exercise in patients with non-triple vessel CAD but not in those with triple-vessel CAD. Allopurinol significantly reduced resting BNP from 84.3pg/ml [44.8–186.0] to 65.6pg/ml [37.0–122.7] compared to 80.4pg/ml [40.1–132.8] for placebo (p=0.045). In addition, allopurinol reduced immediate-post-exercise BNP from 131.2pg/ml [51.9–191.1] to 84.1pg/ml [48.6–168.8] compared to 100.5pg/ml [49.1–194.9] for placebo (p=0.028). The effect of allopurinol on BNP levels was independent of baseline uric acid level.
Conclusions: In patients with chronic stable angina and preserved LVSF, BNP is higher in the presence of triple-vessel CAD. In this group of patients, high dose allopurinol reduces resting and immediate post-exercise BNP. This result could be explained by (and further confirms) the previously reported anti-ischaemic effect of allopurinol.
- © 2010 by American Heart Association, Inc.