Gout is associated with CHF, subclinical measures of
systolic dysfunction and mortality according to an analysis
of the Framingham Offspring Study [42]. However,
there also seems to be increased XO activity in the failing
myocardium, perhaps due to hypoxia and apoptosis,
resulting in accumulation of uric acid precursors (hypoxanthine
and xanathine) and XO-induced production of
ROS, causing a vicious cycle of damage [43]. There are
several studies showing an association between increased
serum urate levels in CHF and morbidity and mortality
[43-45]. Gotsman et al. [45] in an Israeli heart failure
register-based study found that treatment with allopurinol
in CHF was associated with improved survival.