Background/Purpose: Xanthine oxidase inhibitors (XOI) reduce both urate levels and the oxidative stress in the vasculature, which are known cardiovascular risk factors. However, the effects of XOI on major cardiac events such as myocardial infarction (MI) are unknown. The objective was to investigate whether XOI use is associated with a modified risk of myocardial infarction.

Methods: We used a matched case-control study comparing patients with first ever MI with controls. Cases were retrieved from a myocardial infarction registry consisting of 63 cardiology centers, whereas controls were selected from general practice settings. The association between XOI or colchicine use and MI was assessed by adjusted OR from conditional logistic regression.

Results: Data are from 2277 MI patients matched to 4849 controls. Allopurinol was by far the most frequent XOI taken by participants of this study. The adjusted OR (95% CI) for MI in allopurinol users was 0.75 (0.56-1.01), and it was 0.66 (0.49-0.89) using the whole pool of referents (n=8444). The effect of allopurinol persisted across subgroups by sex, presence of hypertension, and in ST-segment elevation MI patients. In contrast, colchicine use was not associated with a modified risk of MI: aOR= 1.17 (0.70-1.93).

Conclusion: Allopurinol, but not colchicine use, is associated with around a 30% reduction in the risk of myocardial infarction. Besides its urate lowering property, allopurinol might have a cardio protective effect.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/allopurinol-use-is-associated-with-a-decreased-risk-of-myocardial-infarction/