Doctors have been urged to avoid allopurinol for secondary prevention of major cardiac events in over-60s with ischaemic heart disease following results from a landmark trial.

UK researchers report that off-label use of the xanthine oxidase inhibitor in this setting does not reduce the risk of cardiovascular death, MI or stroke compared with usual care.

They add that apart from lowering the incidence of gout, allopurinol demonstrated “no other clinical or quality-of-life benefits” and has “no clear place” in cardiovascular care.

Their strong recommendation is based on findings from the large, prospective ALL-HEART trial involving some 5700 gout-free older adults with ischaemic heart disease who were randomised to receive oral allopurinol up-titrated to 600mg daily or continue usual care.