COMMENTARY

Can Allopurinol Reduce Heart Attack Risk?

Kevin Deane, MD, PhD

Disclosures

May 21, 2015

Impact of Allopurinol on Risk of Myocardial Infarction

Grimaldi-Bensouda L, Alpérovitch A, Aubrun E, et al; PGRx MI Group
Ann Rheum Dis. 2015;74:836-842

Study Summary

In this case-control study, Grimaldi-Bensouda and colleagues used a large French registry to evaluate the relationship between allopurinol use and first-ever myocardial infarction (MI). Patients from the Pharmacoepidemiological General Research on MI registry were included if they had a history of an initial nonfatal MI and were matched with controls from general practice settings who did not have a history of MI.

The prevalence of a clinical diagnosis of gout was 0.6% among the 2277 MI patients and 0.9% in the 4849 matched controls. Among the MI patients, 3.1% used allopurinol; and among the controls, 3.8% used allopurinol. The use of colchicine and nonsteroidal anti-inflammatory drugs was similar in both groups, with approximately 1% and 21% of participants using these agents, respectively. When the matching criteria for controls to cases included matching for the number of visits to a general practitioner (GP), the protective association of allopurinol use and MI was not statistically significant (adjusted odds ratio [aOR], 0.80; 95% confidence interval [CI], 0.59-1.09).

However, when the authors removed the matching factor of number of visits to a GP, their sample sizes increased (cases, n = 2593; controls, n = 5185). With this change and in a model adjusting for multiple cardiovascular risk factors, the protective association of allopurinol use and MI was statistically significant (aOR, 0.73; 95% CI, 0.54-0.99). On the basis of these findings, the authors concluded that allopurinol may be associated with reduced risk for MI, which may be related to its urate-lowering effect.

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