Allopurinol and the risk of atrial fibrillation in the elderly: a study using Medicare data. Issue 1 (10th May 2016)

• Record Type: Journal Article
• Authors: Singh, Jasvinder A; Yu, Shaohua
• Is Part Of: Annals of the rheumatic diseases. Volume 76:Issue 1(2017)
• Page Start: 72
• Page End: 78
• Publication Date: 2016-05-10
• Subjects: Cardiovascular Disease -- Epidemiology -- Health services research; Rheumatism -- Periodicals; 616.723005
• DOI: 10.1136/annrheumdis-2015-209008
• Languages: English
• ISSNs: 0003-4967

Abstract

Abstract : 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.