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Allopurinol May Reduce Risk for Cardiovascular Events in Patients with Gout and Diabetes

VBCR - June 2017, Vol 6, No 2 - Gout
Rebecca Bailey

Use of the urate-lowering agent allopurinol in patients with gout and concomitant diabetes led to a reduced risk for the first incidence of hospitalization for myocardial infarction or stroke, according to a recent analysis by investigators from the University of Alabama at Birmingham (Singh JA, et al. BMC Cardiovasc Disord. 2017;17:76).

Jasvinder Singh, MD, MPH, Professor, Medicine and Epidemiology, School of Medicine, University of Alabama at Birmingham, and colleagues used data from the Multi-Payer Claims Database, which linked medical records from patients with Medicare, Medicaid, or UnitedHealthcare coverage, to conduct their analysis. For the purpose of this study, incident myocardial infarction and incident stroke were defined as inpatient hospitalization with respective International Classification of Diseases, Ninth Revision, Clinical Modification codes for these adverse events that required ≥1 days of hospitalization, unless the patient died.

Dr Singh and colleagues observed 2,053,185 person-days of current allopurinol use and 1,671,583 person-days of previous allopurinol use in patients with gout and concomitant diabetes, and identified 158 myocardial infarctions or strokes in current allopurinol users, and 151 myocardial infarctions or strokes in previous allopurinol users.

In multivariable-adjusted Cox proportional hazards models, hazards of incident acute cardiovascular events were significantly lower in current allopurinol users (hazard ratio, 0.67; 95% confidence interval, 0.53-0.84) than in previous users. In addition, compared with previous allopurinol use, current allopurinol use resulted in a 33% hazard reduction of these events.

“Our findings provide evidence for a potential cardiovascular protective effect of allopurinol in patients with gout and diabetes, a group of patients at high risk for cardiovascular events. Future studies need to explore the factors that mediate this protective effect, and examine what proportion of variability in this protective effect is explained by serum urate reduction and/or anti-oxidant effect of allopurinol,” they concluded.

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