Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose: Gout is associated with higher cardiovascular disease risk. Based on our previous work, there is evidence that allopurinol use reduces the risk of myocardial infarction and cardiovascular disease in the elderly. This work attempts to assess whether allopurinol use reduces the risk of peripheral vascular disease.
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 peripheral vascular disease, 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).
Results: 3,167 of the 26,985 episodes of incident allopurinol use were associated with incident peripheral vascular disease (11.74% episodes). Allopurinol use was associated with reduced hazards of peripheral vascular disease, with unadjusted HR of 0.91 (95% CI, 0.84 to 0.98); multivariable-adjusted HR 0.89 (95% CI, 0.82 to 0.96) (Table 1). Compared to no allopurinol use, only the longest allopurinol use duration was associated with lower HR of peripheral vascular disease: >2 years, 0.77 (95% CI, 0.65 to 0.91). Other factors associated with higher hazard of peripheral vascular disease were: age 75-<85 and ≥85, male gender, higher Charlson index score, and the use of beta-blockers. Allopurinol dose was also significant in univariate analysis but not in the multivariate analysis (Table 2).
Conclusion: Incident allopurinol use was associated with a reduction in the risk of incident peripheral vascular disease; allopurinol dose was not. Only allopurinol use durations greater than 2 years reduced the risk of incident peripheral vascular disease. Future studies need to assess underlying mechanisms of this association and to assess risk-benefit ratio of allopurinol use for peripheral vascular disease prevention. Table 1: Univariate and multivariate adjusted hazard ratios for peripheral vascular disease based on allopurinol use.
|Unadjusted HR (95% CI) [pvalue]||Multivariable-adjusted HR (95% CI) [pvalue]|
|Allopurinol use- ref, no|
|Yes||0.91 (0.84, 0.98) [0.01]||0.89 (0.82, 0.96) [0.002]|
Table 2: Univariate and multivariate adjusted hazard ratios for peripheral vascular disease based on allopurinol dose and duration.
|Unadjusted HR (95% CI) [pvalue]||Multivariable-adjusted M6 HR (95% CI) [pvalue]|
|Allopurinol dose use1|
|200-299 mg/day||0.87 (0.77, 0.99) [0.03]||0.91 (0.81, 1.04) [0.17]|
|>300 mg/day||0.83 (0.75, 0.92) [0.0003]||0.96 (0.87, 1.06) [0.42]|
|Allopurinol use duration dur2|
|1-180 days||0.97 (0.88, 1.08) [0.64]||0.99 (0.88, 1.11) [0.83]|
|181 days -2 years||0.91 (0.82, 1.00) [0.56]||0.90 (0.81, 1.00) [0.54]|
|> 2 years||0.77 (0.65, 0.91) [0.01]||0.77 (0.65, 0.92) [0.003]|
To cite this abstract in AMA style:Singh JA, Cleveland J. Allopurinol Use Is Associated with Lower Risk of Peripheral Vascular Disease in the US Elderly [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/allopurinol-use-is-associated-with-lower-risk-of-peripheral-vascular-disease-in-the-us-elderly/. Accessed January 20, 2021.
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