PT  - JOURNAL ARTICLE
AU  - Jasvinder A Singh
AU  - Shaohua Yu
TI  - Allopurinol and the risk of atrial fibrillation in the elderly: a study using Medicare data
AID  - 10.1136/annrheumdis-2015-209008
DP  - 2017 Jan 01
TA  - Annals of the Rheumatic Diseases
PG  - 72--78
VI  - 76
IP  - 1
4099  - http://ard.bmj.com/content/76/1/72.short
4100  - http://ard.bmj.com/content/76/1/72.full
SO  - Ann Rheum Dis2017 Jan 01; 76
AB  - 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.