Allopurinol: novel indications in cardiovascular disease

Struthers, Allan D.; Shearer, Fiona

doi:10.1136/heartjnl-2012-302249

Cited by 30 publications

(22 citation statements)

References 17 publications

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“…Allopurinol reduces uric acid production and oxidative stress, processes that have been hypothesized to be associated with endothelial dysfunction, inflammation and progression of atherosclerosis [9]. Thus, allopurinol might have beneficial effects on cardiac physiology [10, 11]. …”

Section: Introductionmentioning

confidence: 99%

Allopurinol use and the risk of acute cardiovascular events in patients with gout and diabetes

Singh

Ramachandaran

et al. 2017

BMC Cardiovasc Disord

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BackgroundFew studies, if any, have examined cardiovascular outcomes in patients with diabetes and gout. Both diabetes and gout are risk factors for cardiovascular disease. The objective of this study was to examine the effect of allopurinol on the risk of incident acute cardiovascular events in patients with gout and diabetes.MethodsWe used the 2007–2010 Multi-Payer Claims Database (MPCD) that linked health plan data from national commercial and governmental insurances, representing beneficiaries with United Healthcare, Medicare, or Medicaid coverage. In patients with gout and diabetes, we assessed the current allopurinol use, defined as a new filled prescription for allopurinol, as the main predictor of interest. Our outcome of interest was the occurrence of the first Incident hospitalized myocardial infarction (MI) or stroke (composite acute cardiovascular event), after which observations were censored. We employed multivariable-adjusted Cox proportional hazards models that simultaneously adjusted for patient demographics, cardiovascular risk factors and other medical comorbidities. We calculated hazard ratios [HR] (95% confidence intervals [CI]) for incident composite (MI or stroke) acute cardiovascular events. We performed sensitivity analyses that additionally adjusted for the presence of immune diseases and colchicine use, as potential confounders.ResultsThere were 2,053,185 person days (5621.3 person years) of current allopurinol use and 1,671,583 person days (4576.5 person years) of prior allopurinol use. There were 158 incident MIs or strokes in current and 151 in prior allopurinol users, respectively. Compared to previous allopurinol users, current allopurinol users had significantly lower adjusted hazard of incident acute cardiovascular events (incident stroke or MI), with an HR of 0.67 (95% CI, 0.53, 0.84). Sensitivity analyses, additionally adjusted for immune diseases or colchicine use, confirmed this association.ConclusionsCurrent allopurinol use protected against the occurrence of acute cardiovascular events in patients with gout and diabetes. The underlying mechanisms for this potential cardio-protective effect of allopurinol need further exploration.Electronic supplementary materialThe online version of this article (doi:10.1186/s12872-017-0513-6) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Allopurinol use and the risk of acute cardiovascular events in patients with gout and diabetes

Singh

Ramachandaran

et al. 2017

BMC Cardiovasc Disord

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“…These products cause oxidative stress that is thought to exert harmful effects in the vasculature such as inflammation, endothelial dysfunction and progression of atherosclerosis 3 – 5. Allopurinol reduces both the formation of uric acid and the production of oxidative free radicals3 and has been recently viewed as a drug with promising cardiovascular (CV) benefits 6. Recently, Grimaldi-Bensouda et al 7 found a 20% reduction in non-fatal acute myocardial infarction (AMI) in patients exposed to allopurinol, but the result did not reach statistical significance in the main analysis and had the limitation that they did not distinguish between prevalent and incident users of allopurinol.…”

Section: Introductionmentioning

confidence: 99%

Allopurinol use and risk of non-fatal acute myocardial infarction

Abajo

Gil²,

Rodríguez

et al. 2015

Heart

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“…However, in recent years, there has been a resurgence of interest in allopurinol in cardiovascular medicine based on its significant pleiotropic effects, including congestive heart failure, angina, atrial fibrillation, and endothelial dysfunction. 3 Of note, the use of thiazide diuretics has been reported to increase urate level by as much as 20%. 4 Consequently, in patients with refractory hypertension who need a thiazide diuretic, allopurinol may be necessary to control uric acid levels.…”

Section: To the Editormentioning

confidence: 99%

Erratum

2013

J of Clinical Hypertension

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Allopurinol: novel indications in cardiovascular disease

Cited by 30 publications

References 17 publications

Allopurinol use and the risk of acute cardiovascular events in patients with gout and diabetes

Allopurinol use and the risk of acute cardiovascular events in patients with gout and diabetes

Allopurinol use and risk of non-fatal acute myocardial infarction

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