Allopurinol use linked to lower risk of first-ever coronary event

For the first time ever, investigators have found allopurinol use is associated with a decreased risk of first-ever acute coronary syndromen(ACS) for patients with gout.

A team, led by Panagiota Drivelegka, Department of Rheumatology, Sahlgrenska University Hospital, examined whether allopurinol use impacts the risk of first-ever acute coronary syndrome in patients with incident gout in data presented during the American College of Rheumatology Convergence 2022.

Patients with gout are at an increased risk of cardiovascular disease, with more and more evidence identifying gout as an independent risk factor.

In the study, the investigators identified data from regional and national population-based registered for 19,054 patients in Western Sweden with first ICD-coded diagnosis for gout between 2007-2017. The participants did not have previous exposure to allopurinol or a prior history of coronary heart disease.

The investigators sought outcomes of interest of the occurrence of a first-ever ACS event. The investigators began follow-up from the first ICD-coded diagnosis for gout and ended after either the outcome, death, emigration, or the end of study on December 31, 2017.

They defined exposure to allopurinol as none (no dispensed prescription within 125 days from the end of follow-up) (reference group), 100mg, or >100mg, according to the last dispensed prescription within 125 days from the end of follow-up.

The team used logistic regression models with adjustments for age, sex, education level, comorbidity index, dispended prescriptions for cardiovascular drugs, anticoagulants/platelet aggregation inhibitors, and/or cortisone within 6 months from the end follow-up, and follow-up time.

Overall, women were older than men in all exposure categories, while exposure to allopurinol was linked to older age, longer follow-up time, and more comorbidities.

There were lower odds ratios for first-ever ACS events in groups exposed to 100 mg and >100mg allopurinol compared to those not exposed (OR, 0.72; 95% CI, 0.59-0.88; and OR, 0.54; 95% CI, 0.40-0.72, respectively). This was also true for just male patients (OR, 0.72; 95% CI, 0.57-0.92; and OR, 0.57; 95% CI, 0.40-0.79, respectively).

For women, exposure to more than 100 mg was linked to significantly lower odds ratios for first-ever ACS event (OR, 0.46; 95% CI, 0.25-0.85). On the other hand, exposure to 100 mg was not associated with a lower risk of first-ever ACS event (OR, 0.72; 95% CI, 0.50-1.02).

Exposure to more than 100 mg allopurinol was associated with lower odds ratios for first-ever ACS event than exposure to 100mg in both men and women.Finally, the risk of first-ever ACS event was similar between men and women.

“Current allopurinol use was associated with significantly lower risk of first-ever ACS event in patients with incident gout in a dose-dependent fashion, suggesting a protective effect for allopurinol,” the authors wrote. “The effect of allopurinol was similar in men and women.”

The study, “Allopurinol Use and Risk of Acute Coronary Syndrome in Patients with Incident Gout: A Population-based Study in Sweden,” was published online by ACR.