de Abajo Francisco J, Gil Miguel J, Rodríguez Antonio, García-Poza Patricia, Álvarez Arturo, Bryant Verónica, García-Rodríguez Luis A
Clinical 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.
BIFAP Research Unit, Division of Pharmacoepidemiology and Pharmacovigilance, Spanish Agency for Medicines and Medical Devices, Madrid, Spain.
Heart. 2015 May;101(9):679-85. doi: 10.1136/heartjnl-2014-306670. Epub 2015 Jan 5.
To quantify the risk of non-fatal acute myocardial infarction (AMI) among users of allopurinol.
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.
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).
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.
量化使用别嘌醇的人群中非致死性急性心肌梗死（AMI）的风险。
我们在2001年至2007年期间对40至90岁的患者进行了一项基于人群的病例对照研究。在随访开始日期之前有别嘌醇处方或AMI发作的患者被排除在主要分析之外。如果别嘌醇起始使用者的最后一张处方在病例的AMI记录日期前30天窗口内结束，而对照为随机日期，则将其分类为当前使用者。通过比值比（OR）测量别嘌醇使用与非致死性AMI之间的关联，并通过无条件逻辑回归调整混杂因素。
我们确定了3171例非致死性AMI病例和18525例对照。病例中当前使用别嘌醇的患病率（0.82%）低于对照（1.03%），OR为0.52（95%CI为0.33至0.83）。风险降低由男性驱动（男性OR = 0.44；95%CI为0.25至0.76；女性OR = 0.90；0.36至2.23）。未观察到年龄差异。仅在高剂量（300毫克或更高，OR = 0.30；0.13至0.72；<300毫克，OR = 0.67；0.37至1.23）和长期治疗（<31天，OR = 1.12（0.55至2.29）；31至180天，OR = 0.61；0.29至1.29；>180天，OR = 0.21；0.08至0.53；趋势p值 = 0.001）时观察到该效应。在既往有AMI的患者中，使用别嘌醇也显示出复发风险显著降低（OR = 0.16；0.04至0.76）。
本研究支持以下假设，即别嘌醇与非致死性AMI风险降低相关，这似乎是剂量依赖性和持续时间依赖性的。
