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Allopurinol use and risk of non-fatal acute myocardial infarction
  1. Francisco J de Abajo1,
  2. Miguel J Gil2,
  3. Antonio Rodríguez1,
  4. Patricia García-Poza1,
  5. Arturo Álvarez2,
  6. Verónica Bryant2,
  7. Luis A García-Rodríguez3
  1. 1Clinical Pharmacology Unit, University Hospital “Príncipe de Asturias”, Department of Biomedical Sciences, School of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Madrid, Spain
  2. 2BIFAP Research Unit, Division of Pharmacoepidemiology and Pharmacovigilance, Spanish Agency for Medicines and Medical Devices, Madrid, Spain
  3. 3Spanish Centre for Pharmacoepidemiological Research (CEIFE), Madrid, Spain
  1. Correspondence to Professor Francisco J de Abajo, Departamento de Ciencias Biomédicas, Universidad de Alcalá, Ctra. Madrid-Barcelona km. 33.6, Alcalá de Henares, Madrid 28871, Spain; francisco.abajo{at}uah.es

Abstract

Objectives To quantify the risk of non-fatal acute myocardial infarction (AMI) among users of allopurinol.

Methods We carried out a population-based case–control study over the period 2001–2007 in patients aged 40–90 years. Patients who had prescriptions of allopurinol or an episode of AMI before the start date of follow-up were excluded from the main analysis. Allopurinol initiators were classified as current users if their last prescription ended in the 30-day window before the recorded date of AMI for cases and a random date for controls. The association between use of allopurinol and non-fatal AMI was measured through an OR and adjusted for confounding factors by an unconditional logistic regression.

Results We identified 3171 cases of non-fatal AMI and 18 525 controls. Cases had a lower prevalence of current use of allopurinol (0.82%) than controls (1.03%), yielding to an OR of 0.52 (95% CI 0.33 to 0.83). The decreased risk was driven by men (OR in men=0.44; 95% CI 0.25 to 0.76; OR in women=0.90; 0.36 to 2.23). No difference by age was observed. The effect was only observed at higher doses (300 mg or greater OR=0.30; 0.13 to 0.72; <300 mg OR=0.67; 0.37 to 1.23) and with prolonged treatments (<31 days, OR=1.12 (0.55 to 2.29); 31–180 days, OR=0.61; 0.29 to 1.29; >180 days OR=0.21; 0.08 to 0.53; p for trend=0.001). Among those with a previous AMI, allopurinol use also showed a significant reduced risk of recurrence (OR=0.16; 0.04 to 0.76).

Conclusions The present study supports the hypothesis that allopurinol is associated with a reduced risk of non-fatal AMI, which seems to be dose-dependent and duration-dependent.

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