The Impact of Urate‐Lowering Therapy in Post‐Myocardial Infarction Patients: Insights From a Population‐Based, Propensity Score‐Matched Analysis

Abstract

The role of urate‐lowering therapy (ULT) for the primary prevention of cardiovascular (CV) events has been widely discussed, but its evidence for the secondary prevention of myocardial infarction (MI) is limited. Therefore, we conduct a population‐based, propensity score‐matched cohort study to investigate the CV outcomes among patients with post‐MI with and without ULT. A total of 19,042 newly diagnosed in‐hospital patients with MI were selected using the Taiwan National Health Insurance Database between January 1, 2005, and December 31, 2016. After 1:1 propensity score matching with covariates, patients with MI with (n = 963) and without (n = 963) ULT were selected for further analysis. The primary outcome was the all‐cause mortality and the secondary outcomes were composite CV outcomes, including hospitalization for recurrent MI, stroke, heart failure, and cardiac arrhythmias. ULT users were associated with lower all‐cause mortality (adjusted hazard ratio (adjHR), 0.67; 95% confidence interval (CI), 0.51–0.87) compared to the ULT nonusers. In addition, ULT users had a significantly lower risk of recurrent MI, which needed revascularization by percutaneous coronary intervention or coronary artery bypass grafting (adjHR, 0.67; 95% CI, 0.53–0.86) than the ULT nonusers. The primary and secondary outcomes were not different between patients with post‐MI who received uricosuric agents and xanthine oxidase inhibitors. The anti‐inflammatory effect of ULT plays an essential role in MI management. From a real‐world setting, this study shows that ULT is associated with the lower risk of all‐cause mortality in patients with post‐MI. In addition, the result shows the possible lower incidence of repeat revascularization procedures in the ULT users.

Urate-lowering therapy is associated with a reduced risk of arrhythmias: a systematic review and meta-analysis

“…No additional articles were found through manual search. Thus, a total of 5 articles [ 11 , 12 , 16 - 18 ] met all the eligibility criteria and were included in the data analysis. Figure 1 provides an overview of the search methodology and selection process used in this study.…”

“…Additional characteristics of the included studies can be found in Table 1 . Both retrospective cohort studies [ 11 , 18 ] were of high quality, as indicated by the high Newcastle-Ottawa score ( Table 1 ). The risk of bias assessment for RCTs [ 12 , 16 - 17 ] shown in Figures 2 and 3 demonstrated some concerns arising from the randomization process and the deviations from the intervention but there were no apparent factors that affect the results and outcome evaluations.…”