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Rheumatology (Oxford). 2018 Mar 1;57(3):451-461. doi: 10.1093/rheumatology/kex232.

Allopurinol and the risk of incident peripheral arterial disease in the elderly: a US Medicare claims data study.

Author information

1
Medicine Service, VA Medical Center, University of Alabama at Birmingham, Birmingham, AL, USA.
2
Department of Medicine at School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
3
Division of Epidemiology at School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA.

Abstract

Objective:

The aim was to examine whether allopurinol use is independently associated with a reduction in the risk of incident peripheral arterial disease (PAD) in the US elderly.

Methods:

We used the 5% random Medicare sample from 2006 to 2012 to examine the association of allopurinol use and duration of use with the risk or hazard of incident PAD in a retrospective cohort study using a new user design. Multivariable Cox regression models adjusted for demographics, co-morbidity, cardiac medications and cardiac conditions. Hazard ratios (HRs) and 95% CIs were calculated.

Results:

We identified 26 985 episodes of incident allopurinol use in 25 282 beneficiaries; 3167 allopurinol use episodes (12%) ended in incident PAD. In multivariable-adjusted analyses, allopurinol use was associated with an HR of 0.88 (95% CI: 0.81, 0.95) for incident PAD, as was female gender, HR 0.84 (95% CI: 0.78, 0.90). In a separate multivariable-adjusted model, compared with no allopurinol use, longer durations of allopurinol use were associated with lower HR of PAD: 181 days to 2 years, 0.88 (95% CI: 0.79, 0.97); and >2 years, 0.75 (95% CI: 0.63, 0.89). Other factors significantly associated with a higher HR of PAD were age 75 to < 85 and ⩾85 years, higher Charlson index score and black race. Sensitivity analyses that adjusted for cardiac conditions and medications confirmed these findings, with minimal to no attenuation of HRs.

Conclusion:

New allopurinol use was independently associated with a lower risk of PAD in the elderly. Longer allopurinol use durations seemed more protective. Mechanisms of the protective effect need to be investigated in future studies.

PMID:
29106674
DOI:
10.1093/rheumatology/kex232
[Indexed for MEDLINE]

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