From the Guidelines
Allopurinol is the preferred urate-lowering therapy in a person with a recent myocardial infarction (MI).
Urate-Lowering Therapy Options
- Allopurinol: a xanthine oxidase inhibitor, is the first-line urate-lowering therapy 1
- Febuxostat: an alternative to allopurinol, is equally effective at decreasing serum urate levels, but has a different side effect profile 1
Considerations in Patients with Recent MI
- Patients with recent MI may have increased cardiovascular risk, and urate-lowering therapy should be initiated with caution 1
- Allopurinol is generally considered safe in patients with cardiovascular disease, but febuxostat may be associated with an increased risk of cardiovascular events 1
Dosing and Monitoring
- Allopurinol should be started at a low dose (50-100 mg daily) and titrated to achieve a target serum urate level (< 0.36 mmol/L or 6 mg/dL) [1, @7@]
- Febuxostat can be started at a dose of 40 mg daily, but may require dose adjustment based on serum urate levels and renal function 1
From the Research
Urate-Lowering Therapy in Patients with Recent Myocardial Infarction
The preferred urate-lowering therapy in a person with a recent myocardial infarction (MI) is a topic of interest due to the association between hyperuricemia, gout, and increased risk of cardiovascular disease.
- Allopurinol is considered a first-line treatment for gout in patients with cardiovascular disease, including those with a recent MI, due to its potential cardioprotective effects 2, 3.
- Febuxostat, another urate-lowering agent, has been associated with a higher risk of cardiovascular and all-cause mortality compared to allopurinol, particularly with long-term use 4, 5, 3, 6.
- A study found that rapid reduction in uric acid levels by a urate-lowering agent, such as febuxostat, is associated with an increased risk of recurrent cardiovascular events 6.
Considerations for Urate-Lowering Therapy
When selecting a urate-lowering therapy for a patient with a recent MI, the following factors should be considered:
- The potential cardioprotective effects of allopurinol 2, 3
- The increased risk of cardiovascular and all-cause mortality associated with febuxostat, particularly with long-term use 4, 5, 3, 6
- The need to avoid rapid reductions in uric acid levels, which may increase the risk of cardiovascular events 6
- The importance of individualizing treatment based on patient-specific factors, such as cardiovascular risk factors and comorbidities 5