Impact of allopurinol on risk of myocardial infarction

Grimaldi-Bensouda, Lamiae; Alpérovitch, Annick; Aubrun, Elodie; Danchin, Nicolás; Rossignol, Michel; Abenhaim, Lucien; Richette, Pascal

doi:10.1136/annrheumdis-2012-202972

Cited by 98 publications

(71 citation statements)

References 42 publications

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“…The pathogenic role of influenza vaccine is also debated, particularly in older patients. [45][46][47][48] Further studies are ongoing in our cohort to study the impact of influenza vaccination on the occurrence of ITP.…”

Section: Discussionmentioning

confidence: 99%

Epidemiology of incident immune thrombocytopenia: a nationwide population-based study in France

Moulis

Palmaro

Montastruc

et al. 2014

Blood

286

250

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Key Points• Incidence of ITP was 2.9/100 000 person-years with age, seasonal, and regional variations; in adults, 18% were secondary. • Severe (gastrointestinal or central nervous system) bleeding at ITP onset was rare (,1%); the risk increased with age.The epidemiology of immune thrombocytopenia (ITP) is not well known. The purpose of this study was to assess ITP incidence at a nationwide level (France) with recent data (mid-2009 to mid-2011; 129 248 543 person-years). The data source is the French health insurance database. We selected cases with diagnosis codes for in-hospital stays and long-term disease attributions, thus restricting our search to ITPs necessitating health care. We studied incidence by age, gender, calendar month, regions, and proportion of secondary ITPs, of ITPs becoming persistent or chronic, and of severe bleeding at disease onset. We identified 3771 incident ITP patients. Incidence was 2.9/100 000 person-years, with peaks among children and in those >60 years of age. ITP was more frequent among males in these subgroups. The incidence was lower in overseas Caribbean French departments, suggesting a lower incidence among Afro-American people. There was a northsouth gradient in mainland France and seasonal variations (peak in winter and nadir in summer). Persistence or chronicity occurred in 36% of children compared with 67% of adults. Among adults, 18% of ITPs were secondary. Malignancy was the main cause (10.9%). Myelodysplastic syndromes were not rare (2.3%). Severe gastrointestinal or central nervous system bleeding at ITP onset was rare (<1%). (Blood. 2014;124(22):3308-3315)

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Section: Discussionmentioning

confidence: 99%

Epidemiology of incident immune thrombocytopenia: a nationwide population-based study in France

Moulis

Palmaro

Montastruc

et al. 2014

Blood

286

250

View full text Add to dashboard Cite

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“…Allopurinol, a xanthine oxidase inhibitor, has been shown to improve oxidative stress and endothelial dysfunction in patients with stable CAD 17, 18. Considerable observational data suggest that allopurinol is associated with cardiovascular benefit 10, 19, 20. Yet, febuxostat, a more potent xanthine oxidase inhibitor and hypouricemic agent, has recently been shown in a randomized clinical trial to lead to increased cardiovascular and all‐cause mortality compared with allopurinol 21.…”

Section: Discussionmentioning

confidence: 99%

Association of Gout With Long‐Term Cardiovascular Outcomes Among Patients With Obstructive Coronary Artery Disease

Pagidipati

Clare

Keenan

et al. 2018

JAHA

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BackgroundEpidemiological studies demonstrating a relationship between gout and cardiovascular disease are older and predate modern cardiovascular preventive therapy. We assessed the contemporary association between gout and cardiovascular disease in patients with obstructive coronary artery disease.Methods and ResultsData were from the Duke Databank for Cardiovascular Diseases, which followed up patients undergoing cardiac catheterization with obstructive coronary artery disease at Duke University Medical Center (1998–2013). We assessed the relationship between gout diagnosis at baseline or during follow‐up and the primary composite outcome of cardiovascular death, myocardial infarction, or stroke, adjusting for differences in baseline clinical factors. Secondary end points included cardiovascular death and all‐cause mortality. New, postbaseline, gout diagnosis was included as a time‐dependent covariate. Among 17 201 patients, 1406 (8.2%) had baseline gout and a high burden of cardiovascular risk factors, but high rates of optimal medical therapy. Over a median follow‐up of 6.4 years, gout diagnosis at time of catheterization was not associated with the primary outcome (hazard ratio [95% confidence interval], 1.05 [0.96–1.15]; P=0.31) or cardiovascular death (hazard ratio [95% confidence interval], 1.10 [0.99–1.22]; P=0.08), but was associated with increased all‐cause mortality (hazard ratio [95% confidence interval], 1.13 [1.05–1.23]; P=0.002). After including new, postbaseline, gout diagnosis, the instantaneous risk of the primary outcome was significantly associated with prior gout diagnosis (hazard ratio [95% confidence interval], 1.15 [1.07–1.25]; P=0.0004).ConclusionsA clinical history of gout is associated with worse outcomes in a contemporary population of patients with obstructive coronary artery disease. This increased risk exists despite high levels of optimal baseline cardiovascular disease medical therapy, suggesting that residual cardiovascular risk is not addressed by standard medical therapy.

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“…4 Allopurinol tedavisi alan gut hastalarında KVS prognozunun daha iyi olduğu çeşitli çalışmalarda gözlenmiştir. 17,18 Yakın gelecekte yayımlanacak yeni araştırmalarla gut hastalarında ve asemptomatik hiperürisemi saptanan bireylerde KVS koruma amacıyla allopurinol tedavisi önerilebilir, ancak gü-nümüz literatüründe kanıtlar hâlen yetersizdir. 19 …”

Section: Kardi̇yovasküler Hastalik Ve Hi̇perüri̇semi̇ İli̇şki̇si̇unclassified

Should We Treat Asymptomatic Hyperuricemia?: Review

Arı¹,

Göktaş²,

Yavuz³

2016

Turkiye Klinikleri J Intern Med

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Ö ÖZ ZE ET T Asemptomatik hiperürisemi, serum ürik asit düzeyinin, gut, ürik asit nefropatisi, nefrolitiazis gibi kristal depolanma hastalığı bulguları olmaksızın yüksek saptanmasıdır. Son yıllarda bütün dünyada gut ve asemptomatik hiperürisemi prevalansı artmaktadır. Son zamanlarda yapılan araş-tırmalarda asemptomatik hiperüriseminin önemli metabolik, renal ve kardiyovasküler hastalıklarla ilişkili olduğuna dair klinik, epidemiyolojik ve deneysel veriler artmaktadır. Hipertansiyon, kardiyovasküler hastalık, kronik böbrek hastalığı ve metabolik sendrom gibi hastalıklarla ilişkili olabileceği yönünde bulgular elde edilse de neden-sonuç ilişkisi net olarak kurulamamaktadır. Deneysel çalışmalarda, ürik asit düzeyi artışının renal arteriyolar hipertrofiye ve hipertansiyona yol açtığına dair kanıtlar saptanmıştır. Bazı klinik çalışmaların sonuçları da bu deneysel verileri desteklemektedir. Ancak, hâlen yanıtlanmamış önemli sorulardan biri asemptomatik hiperüriseminin hipertansiyon ve kronik böbrek hastalığı patogenezinde etkili olup olmadığı, diğeri ise asemptomatik hiperüriseminin ürat düşürücü ilaçlarla tedavi edilmesinin kardiyovasküler ve renal prognoz üze-rine olan etkisidir. Henüz kanıtlar yeterli olmasa da çok sık rastlanan bir laboratuvar anormalliği olan asemptomatik hiperüriseminin hipertansiyon, kardiyovasküler hastalık ve kronik böbrek hastalığı patogenezinde etkili olduğu, ürat düşürücü ilaçlarla tedavi edilmesinin bu hastalıkların gelişimi ve ilerlemesine engel olabileceği yönünde bulgular elde edilmiştir. Bu konuda hâlen devam eden çalışmaların sonuçları beklenmektedir. Bu çalışmamızda, hiperürisemi ile ilişkili olabilecek önemli hastalıklar ve hiperürisemi tedavisinin olası faydaları güncel literatür eşliğinde tartışılmış, tedavi hedefleri konusundaki son veriler sunulmuştur.A An na ah ht ta ar r K Ke el li im me el le er r: : Hiperürisemi; kalp ve damar hastalıkları A AB BS ST TR RA AC CT T Asymptomatic hyperuricemia is a term traditionally applied to settings in which the serum urate concentration is elevated but in which neither symptoms nor signs of monosodium urate crystal deposition disease, such as gout, or uric acid renal disease, have occured. Across the globe, both gout and asymptomatic hyperuricemia have become increasingly common over the last few decades. Hyperuricemia is clearly associated with several comorbid conditions, including hypertension, cardiovascular disease, chronic kidney disease and components of metabolic syndrome, but has not been established as a causal risk factor in any of these disorders. Experimental studies showed an association between increased uric acid and renal arteriolar hypertrophy and hypertension. These preliminary results were supported with clinical studies. Important questions that remain unanswered include whether addressing asymptomatic hyperuricemia forestalls the onset of hypertension and chronic renal failure, and whether treating asymptomatic hyperuricemia with urate-lowering agents improves cardiovascular and renal outcomes. Despite, being limited...

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Impact of allopurinol on risk of myocardial infarction

Abstract: Allopurinol may be associated with a reduced risk of MI. No decreased risk of MI was found in colchicine users. Besides its urate-lowering property, allopurinol might have a cardioprotective effect.

Cited by 98 publications

References 42 publications

Epidemiology of incident immune thrombocytopenia: a nationwide population-based study in France

Epidemiology of incident immune thrombocytopenia: a nationwide population-based study in France

Association of Gout With Long‐Term Cardiovascular Outcomes Among Patients With Obstructive Coronary Artery Disease

Should We Treat Asymptomatic Hyperuricemia?: Review

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