Background Recent studies have shown that hyperuricemia and gout, a condition with hyperuricemia associated with joint inflammation and/or renal manifestations, are associated with a higher risk of coronary artery disease (CAD), acute cardiovascular events including myocardial infarction (MI) and stroke, and cardiovascular mortality. Emerging data suggest that gout and hyperuricemia may also be associated with cardiac arrhythmias such as atrial fibrillation
Objectives To assess whether allopurinol use is associated with a reduction in the risk of ventricular arrhythmias (VA).
Methods We used the 5% random sample of Medicare beneficiaries from 2006–2012 to examine new allopurinol use and the risk of incident VA. Multivariable Cox regression analyses were adjusted for demographics (age, race, gender), comorbidity, cardiac medications and conditions associated with VA. We calculated hazard ratios (HR) and 95% confidence intervals (CI).
Results Of the 28,755 episodes of new allopurinol use, 2,538 were associated with incident VA (8.8%). Among patients with incident VA, 54% were male, 78% were White, and the mean Charlson-Romano comorbidity score was 4.8. The crude incidence of VA per 1,000,000 person-days declined as the duration of allopurinol use increased: 1–180 days, 151; 181 days-2 years, 105; and >2 years, 85. In multivariable-adjusted analyses, compared to non-use, allopurinol use was associated with lower HR of VA of 0.82 (95% CI, 0.76 to 0.90). Compared to allopurinol non-use, longer allopurinol use durations were significantly associated with lower multivariable-adjusted HR for VA: 1–180 days, 0.96 (95% CI, 0.85 to 1.08); 181 days to 2 years, 0.76 (95% CI, 0.68 to 0.85); and >2 years, 0.72 (95% CI, 0.60 to 0.87). Multiple sensitivity analyses adjusting for cardiac conditions, anti-arrhythmic drugs and alternate definitions confirmed our findings with minimal/no attenuation of estimates.
Conclusions Allopurinol use and use duration >6 months were independently associated with a lower risk of VA. Future studies need to assess the pathophysiology of this potential benefit.
Disclosure of Interest J. Singh Grant/research support from: Takeda, Savient, Consultant for: from Savient, Takeda, Regeneron, Merz, Iroko, Bioiberica, Crealta and Allergan pharmaceuticals, WebMD, UBM LLC and the American College of Rheumatology, J. Cleveland: None declared
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