Use of Allopurinol Associated with Lower Risk of First Coronary Event among gout patients

Sweden: Gout patients who take allopurinol have a lower risk of developing their first acute coronary syndrome (ACS), according to research published online by the American College of Rheumatology.

Gout patients are more likely to develop cardiovascular disease because gout is increasingly being recognized as a distinct risk factor. It is unclear whether using allopurinol affects this risk.

The purpose of this study was to look into how allopurinol use affected patients with incident gout's chance of developing their first acute coronary syndrome (ACS).

Data from regional and national population-based registers for 19,054 individuals in Western Sweden with their first gout ICD-coded diagnosis between 2007 and 2017 was retrieved by the researchers. The subjects had no prior history of coronary heart disease or allopurinol exposure.

The researchers were seeking to find out what would happen if a first-ever ACS event occurred. The study began monitoring patients following their first gout diagnosis with an ICD code and stopped until the patient died, moved abroad, or the trial finished on December 31, 2017. According to the latest distributed prescription within 125 days of the end of follow-up, they classified allopurinol exposure as zero (no prescription dispensed within that time; reference group), 100 mg, or greater than 100 mg. The team employed logistic regression models with adjustments for age, sex, education level, comorbidity index, cardiovascular drug prescriptions dispensed within six months of the end of the follow-up, anticoagulants/platelet aggregation inhibitors, and/or corticosteroid use, and follow-up time.

Conclusive points of the study:

• In comparison to those who were not exposed, those who had taken 100 mg or more of allopurinol had significantly lower odds of having their first ACS event (OR, 0.72; 95% CI, 0.59-0.88; and OR, 0.54; 0.40-0.72, respectively). This was also true for men (OR, 0.72; 95% CI, 0.57-0.92; and OR, 0.57; 0.40-0.79, respectively).
• Women who were exposed to >100mg had a significantly reduced OR for their first-ever ACS occurrence than those who were exposed to 100mg (OR, 0.46; 95%CI, 0.25-0.85), but those who were exposed to 100mg did not (OR, 0.72; 95%CI, 0.50-1.02).
• In both men and women, exposure to more than 100 mg of allopurinol was linked to a lower OR for the very first ACS episode than exposure to 100 mg.
• Men and women in the OR for the initial ACS event were comparable.

The authors concluded that there may be a protective effect for allopurinol since "current allopurinol use was related with considerably decreased risk of first-ever ACS occurrence in patients with acute gout in a dose-dependent manner."

"Both men and women experienced the same effects from allopurinol", they continued.

REFERENCE

Drivelegka P, Jacobsson L, Bengtsson K, Dehlin M. Allopurinol Use and Risk of Acute Coronary Syndrome in Patients with Incident Gout: A Population-based Study in Sweden [abstract]. Arthritis Rheumatol. 2022; 74 (suppl 9). https://acrabstracts.org/abstract/allopurinol-use-and-risk-of-acute-coronary-syndrome-in-patients-with-incident-gout-a-population-based-study-in-sweden/. Accessed November 13, 2022.