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Atrial Fibrillation Risk and Urate-Lowering Therapy in Patients with Gout: A Cohort Study Using a Clinical Database

Ching-Han Liu1,2,3, Shih-Chung Huang1,2,4, Chun-Hao Yin5,6

  • 1Division of Cardiology, Department of Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung 80284, Taiwan.

Biomedicines
|January 21, 2023
PubMed

Insights

Asian individuals with gout treated with urate-lowering therapy (ULT) showed no increased risk of atrial fibrillation (AF) with febuxostat compared to allopurinol. This study investigated AF development after ULT in an Asian population.

Area of Science:

  • Cardiology
  • Rheumatology
  • Pharmacology

Background:

  • Asian populations have a higher predisposition to hyperuricemia and gout.
  • Urate-lowering therapy (ULT) is crucial for managing gout.
  • Previous studies suggested febuxostat may increase atrial fibrillation (AF) risk in elderly individuals, but this remains uninvestigated in Asian populations.

Purpose of the Study:

  • To investigate the association between different ULTs (allopurinol, benzbromarone, febuxostat) and the incidence of AF in an Asian gout patient cohort.
  • To compare the risk of developing AF among patients treated with febuxostat versus other ULTs.

Main Methods:

  • A retrospective cohort study was conducted using a clinical database.
  • Patients newly diagnosed with gout between 2013-2020 with baseline serum uric acid levels and no prior AF diagnosis were included.
  • Patients were categorized into allopurinol, benzbromarone, or febuxostat user groups for comparative risk assessment of incident AF.

Main Results:

  • Out of 713 eligible patients, 43 (6%) developed incident AF during a mean follow-up of 49.4 months.
  • Febuxostat users exhibited higher rates of comorbidities like diabetes mellitus, heart failure, and chronic kidney disease, along with elevated CHA2DS2-VASc scores.
  • Adjusted hazard ratios showed no significant increase in AF risk for febuxostat or benzbromarone compared to allopurinol (HR: 1.20, 95% CI: 0.43-3.34 and HR: 0.68, 95% CI: 0.22-2.08, respectively).

Conclusions:

  • In this Asian cohort, no significant difference in the risk of incident AF was observed among patients with gout receiving febuxostat, allopurinol, or benzbromarone.
  • The findings suggest that febuxostat does not elevate AF risk in Asian patients with gout compared to other common ULTs.
  • Further long-term studies are warranted to comprehensively evaluate cardiovascular outcomes associated with different ULTs in diverse patient populations.

Keywords:
allopurinolfebuxostatgoutincident atrial fibrillationurate-lowering therapy

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