Kim Seoyoung C, Schneeweiss Sebastian, Choudhry Niteesh, Liu Jun, Glynn Robert J, Solomon Daniel H
Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, Mass; Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, Mass; Department of Epidemiology, Harvard School of Public Health, Boston, Mass.
Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, Mass; Department of Epidemiology, Harvard School of Public Health, Boston, Mass.
Am J Med. 2015 Jun;128(6):653.e7-653.e16. doi: 10.1016/j.amjmed.2015.01.013. Epub 2015 Feb 3.
Hyperuricemia and gout are associated with an increased risk of cardiovascular disease (CVD). It is unknown whether treating hyperuricemia with xanthine oxidase inhibitors (XOIs), including allopurinol and febuxostat, modifies cardiovascular risks.
We used US insurance claims data to conduct a cohort study among gout patients, comparing XOI initiators with non-users with hyperuricemia defined as serum uric acid level ≥6.8 mg/dL. We calculated incidence rates of a composite nonfatal cardiovascular outcome that included myocardial infarction, coronary revascularization, stroke, and heart failure. Propensity score (PS)-matched Cox proportional hazards regression compared the risk of composite cardiovascular endpoint in XOI initiators vs those with untreated hyperuricemia, controlling for baseline confounders. In a subgroup of patients with uric acid levels available, PS-matched Cox regression further adjusted for baseline uric acid levels.
There were 24,108 PS-matched pairs with a mean age of 51 years and 88% male. The incidence rate per 1000 person-years for composite CVD was 24.1 (95% confidence interval [CI] 22.6-26.0) in XOI initiators and 21.4 (95% CI, 19.8-23.2) in the untreated hyperuricemia group. The PS-matched hazard ratio for composite CVD was 1.16 (95% CI, 0.99-1.34) in XOI initiators vs those with untreated hyperuricemia. In subgroup analyses, the PS-matched hazard ratio for composite CVD adjusted for serum uric acid levels was 1.10 (95% CI, 0.74-1.64) among XOI initiators.
Among patients with gout, initiation of XOI was not associated with an increased or decreased cardiovascular risk compared with those with untreated hyperuricemia. Subgroup analyses adjusting for baseline uric acid levels also showed no association between XOI and cardiovascular risk.
高尿酸血症和痛风与心血管疾病（CVD）风险增加相关。使用包括别嘌醇和非布司他在内的黄嘌呤氧化酶抑制剂（XOIs）治疗高尿酸血症是否会改变心血管风险尚不清楚。
我们使用美国保险理赔数据对痛风患者进行了一项队列研究，将开始使用XOIs的患者与血清尿酸水平≥6.8mg/dL的高尿酸血症非使用者进行比较。我们计算了包括心肌梗死、冠状动脉血运重建、中风和心力衰竭在内的复合非致命心血管结局的发生率。倾向评分（PS）匹配的Cox比例风险回归比较了开始使用XOIs的患者与未治疗的高尿酸血症患者发生复合心血管终点的风险，并对基线混杂因素进行了控制。在有尿酸水平数据的患者亚组中，PS匹配的Cox回归进一步根据基线尿酸水平进行了调整。
共有24108对PS匹配的患者，平均年龄51岁，男性占88%。开始使用XOIs的患者中，每1000人年复合CVD的发生率为24.1（95%置信区间[CI]22.6 - 26.0），未治疗的高尿酸血症组为21.4（95%CI，19.8 - 23.2）。开始使用XOIs的患者与未治疗的高尿酸血症患者相比，复合CVD的PS匹配风险比为1.16（95%CI，0.99 - 1.34）。在亚组分析中，根据血清尿酸水平调整后的开始使用XOIs的患者中，复合CVD的PS匹配风险比为1.10（95%CI，0.74 - 1.64）。
在痛风患者中，与未治疗的高尿酸血症患者相比，开始使用XOIs与心血管风险的增加或降低无关。根据基线尿酸水平进行调整的亚组分析也显示XOIs与心血管风险之间没有关联。
