Background/Purpose: To assess whether allopurinol use reduces the risk of myocardial infarction (MI) in the elderly.

Methods: We used the 2006-2012 5% random sample of Medicare beneficiaries to study the association of new allopurinol initiation and the risk of incident MI, in a cohort study. Multivariable-adjusted Cox regression models adjusted for age, gender, race and Charlson index, in addition to various cardio-protective medications (beta-blockers, ACE inhibitors, diuretics, statins). We calculated hazards ratio (HR) with 95% confidence intervals (CI). Sensitivity analyses adjusted for coronary artery disease (CAD) risk factors including hypertension, hyperlipidemia, diabetes, and smoking.

Results: 1,544 of the 29,298 episodes of incident allopurinol use were associated with incident MI (5.3% episodes). Allopurinol use was associated with reduced hazards of MI, with HR of 0.85 (95% CI, 0.77 to 0.95). Compared to no allopurinol use, longer allopurinol use durations were associated with lower HR of MI: 1-180 days, 0.98 (95% CI, 0.84 to 1.14); 181 days to 2 years, 0.83 (95% CI, 0.72 to 0.95); and >2 years, 0.70 (95% CI, 0.56 to 0.88). Other factors associated with higher hazard of MI were: age 75-<85 and ≥85, male gender, higher Charlson index score and the use of ACE-inhibitor. Adjustment for CAD risk factors confirmed these findings.

Conclusion: Incident allopurinol use was associated with a reduction in the risk of incident MI. Longer allopurinol use durations reduced the risk of incident MI incrementally. Future studies need to assess underlying mechanisms of this association and to assess risk-benefit ratio of allopurinol use for MI prevention.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/allopurinol-reduces-the-risk-of-myocardial-infarction-mi-in-the-elderly-a-study-of-medicare-claims/