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Allopurinol and the risk of atrial fibrillation in the elderly: a study using Medicare data
  1. Jasvinder A Singh1,2,3,
  2. Shaohua Yu2
  1. 1Medicine Service, Birmingham VA Medical Center, Birmingham, Alabama, USA
  2. 2Department of Medicine at School of Medicine, and Division of Epidemiology at School of Public Health, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
  3. 3Department of Orthopedic Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
  1. Correspondence to Dr Jasvinder A Singh, University of Alabama, Faculty Office Tower 805B, 510 20th Street S, Birmingham, AL 35294, USA; Jasvinder.md{at}gmail.com

Abstract

Objective To assess the effect of allopurinol use on the risk of incident atrial fibrillation (AF) in the elderly.

Methods We used the 5% random Medicare Claims data from 2006 to 2012 to examine the association of allopurinol use and incident AF in a cohort of patients with an absence of AF at baseline (at least 365 days). Multivariable-adjusted Cox regression analyses compared allopurinol exposed and non-exposed periods for the risk of AF, controlling for age, sex, race, Charlson–Romano comorbidity index and use of statins, diuretics, ACE inhibitors and β-blockers. HR with 95% CIs was calculated. Sensitivity analyses considered a longer baseline period (365 days vs 183 days) and individual comorbidities.

Results There were 9244 episodes of incident allopurinol use in 8569 beneficiaries, of which 1366 episodes (14.8%) had incident AF. In multivariable-adjusted analyses, allopurinol use was associated with an HR of 0.83 (95% CI 0.74 to 0.93) for incident AF. In a separate multivariable-adjusted model, compared with no allopurinol use, longer allopurinol use durations were associated with a lower HR of AF: 180 days–2 years, 0.85 (95% CI 0.73 to 0.99) and >2 years, 0.65 (95% CI 0.52 to 0.82). Other factors significantly associated with a higher hazard of AF were: age 75–<85 years and ≥85 years, higher Charlson index score and current β-blocker use. Sensitivity analyses confirmed these findings with minimal/no attenuation of HRs.

Conclusions Allopurinol use was associated with a reduced risk of incident AF in the elderly, especially its use for >6 months duration. Future studies should assess the mechanisms underlying this beneficial effect of allopurinol.

  • Cardiovascular Disease
  • Epidemiology
  • Health services research

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Footnotes

  • Handling editor Tore K Kvien

  • Contributors JAS: Study design, study protocol, analytical plan, writing the first draft of the paper, critical revision of the paper and decision to submit the paper. SY: data programming, data management, review of the analytical plan, data analyses, critical revision of the paper and decision to submit the paper.

  • Funding This material is the result of work supported by research funds from the UAB Division of Rheumatology and the resources and use of facilities at the Birmingham VA Medical Center. JAS is also supported by a grant from the National Institute of Arthritis, Musculoskeletal, and Skin Diseases (NIAMS) P50 AR060772.

  • Competing interests JAS has received research grants from Takeda and Savient and consultant fees from Savient, Takeda, Regeneron, Iroko, Merz, Bioiberica, Crealta and Allergan pharmaceuticals. JAS serves as the principal investigator for an investigator-initiated study funded by Horizon pharmaceuticals through a grant to DINORA, a 501c3 entity. JAS is a member of the executive of OMERACT, an organisation that receives arms-length funding from 36 companies; a member of the American College of Rheumatology's Guidelines Subcommittee of the Quality of Care Committee; and a member of the Veterans Affairs Rheumatology Field Advisory Committee.

  • Ethics approval The Institutional Review Board at the University of Alabama at Birmingham' approved this study and all investigations were conducted in conformity with ethical principles of research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement These data are available in the public domain for any author groups to conduct the analyses. We would be happy to share any information with any author groups after approval from relevant committees at our institution (human ethics and patient privacy protection, etc).

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