Effect of Allopurinol on Cardiovascular Outcomes in Hyperuricemic Patients: A Cohort Study

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Resumé

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.

OriginalsprogEngelsk
TidsskriftAmerican Journal of Medicine
Vol/bind129
Udgave nummer3
Sider (fra-til)299-306
ISSN0002-9343
DOI
StatusUdgivet - 14. nov. 2015

Fingeraftryk

Allopurinol
Cohort Studies
Uric Acid
Propensity Score
Cause of Death
Confidence Intervals
Denmark
Prescriptions
Registries
Inpatients
Outpatients

Citer dette

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title = "Effect of Allopurinol on Cardiovascular Outcomes in Hyperuricemic Patients: A Cohort Study",
abstract = "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.",
author = "Larsen, {Kasper S{\o}ltoft} and Anton Potteg{\aa}rd and Lindegaard, {Hanne M} and Jesper Hallas",
note = "Copyright {\circledC} 2015 Elsevier Inc. All rights reserved.",
year = "2015",
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doi = "10.1016/j.amjmed.2015.11.003",
language = "English",
volume = "129",
pages = "299--306",
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Effect of Allopurinol on Cardiovascular Outcomes in Hyperuricemic Patients : A Cohort Study. / Larsen, Kasper Søltoft; Pottegård, Anton; Lindegaard, Hanne M; Hallas, Jesper.

I: American Journal of Medicine, Bind 129, Nr. 3, 14.11.2015, s. 299-306.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Effect of Allopurinol on Cardiovascular Outcomes in Hyperuricemic Patients

T2 - A Cohort Study

AU - Larsen, Kasper Søltoft

AU - Pottegård, Anton

AU - Lindegaard, Hanne M

AU - Hallas, Jesper

N1 - Copyright © 2015 Elsevier Inc. All rights reserved.

PY - 2015/11/14

Y1 - 2015/11/14

N2 - 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.

AB - 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.

U2 - 10.1016/j.amjmed.2015.11.003

DO - 10.1016/j.amjmed.2015.11.003

M3 - Journal article

C2 - 26589484

VL - 129

SP - 299

EP - 306

JO - American Journal of Medicine

JF - American Journal of Medicine

SN - 0002-9343

IS - 3

ER -