Background/Purpose: To examine the effect of allopurinol on the risk of incident myocardial infarction (MI) or stroke in patients with gout and diabetes

Methods: We 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 whether current allopurinol use, defined as a new filled prescription for allopurinol, was associated with the risk of first Incident hospitalized MI or stroke (composite acute cardiovascular event), after which observations were censored. Multivariable-adjusted Cox proportional hazards models included demographics, cardiovascular risk factors and comorbidities; hazard ratios [HR] (95% confidence intervals [CI]) were calculated. Sensitivity analyses included additional adjustment for immune diseases and colchicine use.

Results: There were 2,053,185 person days of current allopurinol use and 1,671,583 person days 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 stroke or MI, HR=0.67 (95% CI, 0.53, 0.84). Compared to previous allopurinol use for 0-6 months, current allopurinol use for 0-6 months was associated with significantly lower risk of incident MI or stroke, 0.61 (95% CI, 0.46, 0.81). Sensitivity analyses confirmed these findings.

Conclusion: Allopurinol use was protective against the occurence of acute cardiovascular events in patients with gout and diabetes. Future studies should explore the key mechanisms of allopurinol’s potential cardio-protective effect.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/allopurinol-use-and-the-risk-of-acute-cardiovascular-events-in-patients-with-gout-and-diabetes/