Promise for Potential Heart Failure Treatment

By Paula Rasich
Reviewed by Elizabeth Klodas, MD, FACC

(CardioSmart) When it comes to treating heart failure with new drugs, one size may not fit all. A study published in the June 17th issue of the Journal of the American College of Cardiology suggests that patients with heart failure do not respond to drug treatment in the same way.

Joshua M. Hare, MD, of the University of Miami Miller School of Medicine in Florida, led a multi-center trial investigating whether the drug oxypurinol would help improve the condition of patients with advanced heart failure already receiving the best available drug treatments. Oxypurinol, a medication commonly used to treat gout, lowers blood levels of uric acid. Previous studies have shown that heart failure patients with high levels of uric acid die sooner, and its buildup in the bloodstream is associated with an increased risk of cardiovascular disease.

In this study, 405 patients, ages 18 to 85, were randomized to receive sugar pills or 600 mg of oxypurinol a day for 6 months. The results showed no differences in death rates or quality of life between the groups, overall. However, when patients were grouped according to blood levels of uric acid, a benefit was seen in those with high levels at study outset.

In patients with high uric acid levels (equal to or above 9.5 mg/dL), researchers noted a trend toward a lower risk of death and an overall improvement in quality of life with oxypurinol treatment. That same benefit was not seen in oxypurinol-treated patients whose uric acid levels were lower to begin with. In addition, those patients whose condition worsened during the trial had substantially lower reductions in uric acid levels over the course of the study.

“Not all heart failure patients are alike,” says W.H. Wilson Tang, MD, assistant professor of medicine at the Cleveland Clinic Lerner College of Medicine in Cleveland, Ohio. “Different people have disease that develops in a different manner.  What is unique about this study is that it has provided some important insight into utilizing uric acid to distinguish who may benefit additionally from oxypurinol [treatment].” 

Future studies are needed to confirm these findings.

Sources:

Hare et al.  Impact of Oxypurinol in Patients with Symptomatic Heart Failure. Results of the OPT-CHF Study.  Journal of the American College of Cardiology 2008.

Tang. The Ongoing Search for a Stratified Medicine Approach in Heart Failure.  Journal of the American College of Cardiology 2008.

W.H. Wilson Tang, MD, Assistant Professor of Medicine at Cleveland Clinic Lerner College of Medicine in Ohio, and Director of Heart Failure Research, Section of Heart Failure and Cardiac Transplantation Medicine, Heart and Vascular Institute, Cleveland Clinic, Ohio.