6/28/23, 12:06 AM ALL-HEART Pathway Feedback Search Clinical Topics Home Studies ALL HEART ALL HEART Disease Coronary artery disease Trial question What is the role of allopurinol in patients with ischemic heart disease? Study design Multi-center Open label RCT Population Characteristics of study participants 24.0% female N = 5721 76.0% male 5721 patients (1398 female, 4321 male) Inclusion criteria: patients aged 60 years with ischemic heart disease but no history of gout Key exclusion criteria: history of gout; moderate-severe renal impairment; moderate-to-severe HF; significant hepatic disease; severe adverse skin reaction to any drug or significant malignancy within the past 5 years Interventions N=2853 allopurinol (up-titration to an oral dose of 600 mg/day, 300 mg/day in moderate renal impairment) N=2868 standard care (continuation of usual care) Primary outcome https://web.pathway.md/studies/recCPMAJBPI24ahGJ 1/2 6/28/23, 12:06 AM ALL-HEART Pathway Nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death 11.3 % 11.3 11 8.5 % 5.7 % 2.8 % No significant difference 0.0 % Allopurinol Standard care No significant difference in nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death (11% vs. 11.3%; HR 0.96, 96% CI 0.82 to 1.12) Secondary outcomes No significant difference in death from any cause (10.1% vs. 10.6%; HR 0.98, 95% CI 0.83 to 1.15) No significant difference in nonfatal myocardial infarction (5.5% vs. 6%; HR 0.97, 95% CI 0.78 to 1.21) No significant difference in cardiovascular death (3.9% vs. 3.8%; HR 1.1, 95% CI 0.85 to 1.43) Safety outcomes No significant difference in serious adverse events. Significant difference in new rash during the previous 12 months (13.1% vs. 9.1%). Conclusion In patients aged 60 years with ischemic heart disease but no history of gout, allopurinol was not superior to standard care with respect to nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death. Reference Isla S Mackenzie, Christopher J Hawkey, Ian Ford et al. Allopurinol versus usual care in UK patients with ischaemic heart disease (ALL-HEART): a multicentre, prospective, randomised, open-label, blinded-endpoint trial. Lancet. 2022 Oct 8;400(10359):1195-1205. Open reference URL https://web.pathway.md/studies/recCPMAJBPI24ahGJ 2/2