Allopurinol and the risk of atrial fibrillation in the elderly: a study using Medicare data

Singh, Jasvinder A.; Yu, Shaohua

doi:10.1136/annrheumdis-2015-209008

Cited by 34 publications

(35 citation statements)

References 49 publications

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“…In contrast, a recent randomised clinical trial with 1922 patients failed to show significant prevention of AF after cardiac surgery by rosuvastatin (20 mg/day) 36. Clinical benefit of allopurinol or other UA-lowering agents has not been critically tested by large randomised clinical trials, though allopurinol use was shown to be independently associated with a lower risk of new onset of AF in a cohort of elderly patients (78.2±7.2 years) 37. Interestingly, longer duration of allopurinol administration achieved greater risk reduction, supporting the notion that suppression of atrial remodelling over a long period by the antioxidative property of the agent was involved in the clinical effects 37.…”

Section: Discussionmentioning

confidence: 99%

“…Clinical benefit of allopurinol or other UA-lowering agents has not been critically tested by large randomised clinical trials, though allopurinol use was shown to be independently associated with a lower risk of new onset of AF in a cohort of elderly patients (78.2±7.2 years) 37. Interestingly, longer duration of allopurinol administration achieved greater risk reduction, supporting the notion that suppression of atrial remodelling over a long period by the antioxidative property of the agent was involved in the clinical effects 37. Causal relationships between elevation of serum UA level, AF development and CAD remain to be examined in future studies.…”

Section: Discussionmentioning

confidence: 99%

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Distinct risk factors of atrial fibrillation in patients with and without coronary artery disease: a cross-sectional analysis of the BOREAS-CAG Registry data

et al. 2017

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ObjectiveAlthough risk factors of atrial fibrillation (AF) in the general population have been characterised, their impacts on patients with specific diseases are unclear. Our aim was to determine whether risk factors of AF are different in patients with and those without coronary artery disease (CAD).MethodsWe enrolled 1871 consecutive patients who underwent coronary angiography for evaluation of symptoms suggestive of CAD in the BOREAS-CAG Registry between August 2014 and January 2015. After exclusion of patients with valvular heart disease or a history of PCI/cardiac surgery, 1150 patients contributed to multivariate logistic regression analysis to identify risk factors of AF. We also retrieved data for 361 consecutive patients with CAD admitted to Sapporo Medical University Hospital between April 2013 and July 2014 and analysed data for 166 patients using the same inclusion and exclusion criteria as those in the BOREAS-CAG Registry.ResultsUnexpectedly, CAD was independently associated with the absence of AF. The patients were then divided into a non-CAD group (n=576) and a CAD group (n=574) for further analysis. The brain natriuretic peptide level showed a strong association with AF regardless of the presence or absence of CAD. In the non-CAD group, lack of statin use was independently associated with AF, whereas high serum uric acid level was an independent explanatory variable of AF in the CAD group. The association of AF with uric acid was confirmed in a separate group of patients (n=166) enrolled in the CAD cohort in Sapporo Medical University Hospital.ConclusionsMajor risk factors of AF are different in patients with CAD and those without CAD. Patients with CAD are more likely to develop AF when the serum uric acid level is high, whereas no statin administration predicts development of AF in patients without CAD.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Distinct risk factors of atrial fibrillation in patients with and without coronary artery disease: a cross-sectional analysis of the BOREAS-CAG Registry data

et al. 2017

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“…In addition, the drawing quality (lines, arrows, boxes) is often rudimentary. An example of these issues is shown in figure 11 20. Following the design guidelines given above, great improvements can be obtained (figure 12; online supplementary appendix figures S3–S6, including Word templates for personal use).…”

Section: Special Casesmentioning

confidence: 99%

“…Example of a Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram (reprinted with permission20), suffering from poor or non-existent alignment, text redundancy, category switching, exaggerated precision and sloppy design of boxes and arrows.…”

Section: Special Casesmentioning

confidence: 99%

Graphics and statistics for cardiology: designing effective tables for presentation and publication

Boers

2017

Heart

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Research is of little use if its results are not effectively communicated. Data visualised in tables (and graphs) are key components in any scientific report, but their design leaves much to be desired. This article focuses on table design, following two general principles: clear vision and clear understanding. Clear vision is achieved by maximising the signal to noise ratio. In a table, the signal is the data in the form of numbers, and the noise is the support structure necessary to interpret the numbers. Clear understanding is achieved when the story in the data is told effectively, through organisation of the data and use of text. These principles are illustrated by original and improved tables from recent publications. Two special cases are discussed separately: tables produced by the pharmaceutical industry (in clinical study reports

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“…Compared to MI patients without gout, only MI patients with untreated gout had higher all-cause mortality and CHD mortality, while the risk was not increased in patients with gout treated with gout medications (allopurinol, colchicine, or probenecid) [4]. An observational study reported that allopurinol use was associated with a reduction of the risk of incident atrial fibrillation in the elderly [16]. Together, these data raise an important question: Can allopurinol use reduce the risk of VA?…”

Section: Introductionmentioning

confidence: 99%

Allopurinol and the risk of ventricular arrhythmias in the elderly: a study using US Medicare data

Singh

Cleveland

2017

BMC Med

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BackgroundThere are no published human studies investigating whether the use of allopurinol, the most commonly used medication for the treatment of hyperuricemia in gout, the most common type of inflammatory arthritis in adults, has any beneficial effects on ventricular electrophysiology. The objective of our study was to assess whether allopurinol use is associated with a reduction in the risk of ventricular arrhythmias (VA).MethodsWe used the 5% random sample of Medicare beneficiaries from 2006–2012 to examine new allopurinol use and the risk of incident VA. Multivariable Cox regression analyses were adjusted for demographics (age, race, sex), comorbidity, cardiac medications, and conditions associated with VA. We calculated hazard ratios (HR) and 95% confidence intervals (CI).ResultsOf the 28,755 episodes of new allopurinol use, 2538 were associated with incident VA (8.8%). Among patients with incident VA, 54% were male, 78% were White, 75% had gout as the underlying diagnosis, and the mean Charlson–Romano comorbidity score was 4.8. The crude incidence of VA per 1,000,000 person-days declined as the duration of allopurinol use increased: 1–180 days, 151; 181 days to 2 years, 105; and > 2 years, 85. In multivariable-adjusted analyses, compared to non-use, allopurinol use was associated with lower HR of VA of 0.82 (95% CI, 0.76–0.90). Compared to allopurinol non-use, longer allopurinol use durations were significantly associated with lower multivariable-adjusted HR for VA: 1–180 days, 0.96 (95% CI, 0.85–1.08); 181 days to 2 years, 0.76 (95% CI, 0.68–0.85); and > 2 years, 0.72 (95% CI, 0.60–0.87). Multiple sensitivity analyses adjusting for cardiac conditions, anti-arrhythmic drugs and alternate definitions confirmed our findings with minimal/no attenuation of estimates.ConclusionAllopurinol use and use duration of more than 6 months were independently associated with a lower risk of VA. Future studies need to assess the pathophysiology of this potential benefit.Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-017-0816-6) contains supplementary material, which is available to authorized users.

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Allopurinol and the risk of atrial fibrillation in the elderly: a study using Medicare data

Abstract: Allopurinol use was associated with a reduced risk of incident AF in the elderly, especially its use for >6 months duration. Future studies should assess the mechanisms underlying this beneficial effect of allopurinol.

Cited by 34 publications

References 49 publications

Distinct risk factors of atrial fibrillation in patients with and without coronary artery disease: a cross-sectional analysis of the BOREAS-CAG Registry data

Distinct risk factors of atrial fibrillation in patients with and without coronary artery disease: a cross-sectional analysis of the BOREAS-CAG Registry data

Graphics and statistics for cardiology: designing effective tables for presentation and publication

Allopurinol and the risk of ventricular arrhythmias in the elderly: a study using US Medicare data

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