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Effect of Allopurinol on Cardiovascular Outcomes in Hyperuricemic Patients: A Cohort Study
Kasper Søltoft Larsen1, Anton Pottegård2, Hanne M Lindegaard3
1Department of Clinical Chemistry & Pharmacology, Odense University Hospital, Odense C, Denmark; Clinical Pharmacology, Institute of Public Health, University of Southern Denmark, Odense C, Denmark; Department of Rheumatology, Odense University Hospital, Odense C, Denmark.
Insights
Allopurinol treatment in patients with hyperuricemia is linked to reduced cardiovascular events and lower mortality. This study suggests allopurinol effectively lowers cardiovascular risk in this patient group.
Area of Science:
- Cardiology
- Pharmacology
- Epidemiology
Background:
- Hyperuricemia and gout are linked to increased cardiovascular disease (CVD) risk.
- Allopurinol is a recognized urate-lowering medication.
- The impact of allopurinol on cardiovascular outcomes in hyperuricemic patients requires further investigation.
Purpose of the Study:
- To examine the association between allopurinol use and cardiovascular outcomes.
- To evaluate the effect of allopurinol on cardiovascular risk in hyperuricemic individuals within an observational framework.
Main Methods:
- Utilized a large Danish population-based cohort (1992-2010) with hyperuricemia (urate ≥6 mg/dL).
- Linked multiple health registries for comprehensive patient data.
- Employed propensity score matching to compare 7127 allopurinol users with matched non-users, analyzing the composite cardiovascular outcome and all-cause mortality using competing risk regression.
Main Results:
- Allopurinol users showed a reduced hazard ratio of 0.89 (95% CI, 0.81-0.97) for the primary composite cardiovascular outcome compared to non-users.
- A significant reduction in all-cause mortality was observed, with a hazard ratio of 0.68 (95% CI, 0.62-0.74) for allopurinol users.
Conclusions:
- Allopurinol treatment is associated with a significant decrease in cardiovascular risk among patients with hyperuricemia.
- The findings support the use of allopurinol for managing hyperuricemia and mitigating associated cardiovascular risks.
Background:
Hyperuricemia and gout have been associated with increased cardiovascular risk. Allopurinol is an effective urate-lowering drug. Whether lowering of urate by allopurinol improves the cardiovascular risk in hyperuricemic patients remains to be established.
Objective:
Our objective was to investigate the effect of allopurinol on cardiovascular outcomes in hyperuricemic patients in an observational setting.
Methods:
We had access to a study population consisting of all patients from Funen County, Denmark with high urate levels (≥6 mg/dL) from 1992 to 2010. We linked 4 registries; all blood samples, all in- and outpatient contacts in hospitals, all reimbursed prescriptions and causes of death. We identified all incident allopurinol users and matched them 1:1 to nonusers of urate-lowering therapy, with similar urate levels, by using propensity scores. Hazard ratios were calculated using competing risk regression model, with respect to Antiplatelet Trialists' Collaboration composite outcome (myocardial infarction, stroke, or cardiovascular death) and all-cause mortality.
Results:
Among 65,971 patients with hyperuricemia, we found 7127 patients on allopurinol treatment. In the propensity score-matched cohort we found a hazard ratio of 0.89 (95% confidence interval, 0.81-0.97) for the main outcome among allopurinol treated compared with nonusers of allopurinol. The corresponding hazard ratio for all-cause mortality was 0.68 (95% confidence interval, 0.62-0.74).
Conclusion:
Allopurinol treatment is associated with a decreased cardiovascular risk among hyperuricemic patients.
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