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Gout gives rise to increased risk of cardiovascular events.
Increased uric
acid serum levels are a common finding in the gout patients who suffers with
high blood pressure, obesity, insulin resistance and cardiovascular disease.
This study emphasis on the variance of dosage for allopurinol, a xanthin
oxidase inhibitor that helps as a urate lowering therapy. It has been said to provide the future basis of
study for the same.
Gout gives rise
to increased risk of cardiovascular events. Gout attacks can be effectively
prevented with urate lowering drugs, and allopurinol potentially reduces
cardiovascular risk. What target level of urate is required to reduce
cardiovascular risk is not known. To investigate the effect of achieving target
plasma urate with allopurinol on cardiovascular outcomes in a case-control
study nested within long-term users of allopurinol.
We identified
long-term users of allopurinol in Funen County, Denmark. Among these, we
identified all cases of cardiovascular events and sampled 4 controls to each
case from the same population. The cases and controls were compared with
respect to whether they reached a urate target below 0.36 mmol/l on
allopurinol. The derived odds ratios were controlled for potential confounders
available from data on prescriptions, laboratory values and in- and outpatient
contacts.
No association
between treatment-to-target urate level and cardiovascular events were found
(adjusted odds ratio of 1.01, 95% confidence interval 0.79–1.28). No
significant effect was seen in any subgroup defined by age, gender, renal
function, allopurinol dose or the achieved urate level. Overall, the doses of
allopurinol used in this study were low (mean ≈ 140 mg/day).
We were unable to
demonstrate a link between achieved urate level in patients treated with
allopurinol and risk of cardiovascular events. Possible explanations include
that allopurinol doses higher than those used in this study are required to
achieve cardiovascular risk reduction or that the cardiovascular effect of
allopurinol is not mediated through low urate levels. It remains to be seen
whether allopurinol has a dose-response relationship with cardiovascular events
at higher doses.
PLoS One 2016; 11(1): e0146172
Impact of Urate Level on Cardiovascular Risk in Allopurinol Treated Patients. A Nested Case-Control Study
Kasper Søltoft Larsen et al.
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