Singh Jasvinder A, Ramachandaran Rekha, Yu Shaohua, Curtis Jeffrey R
Medicine Service, VA Medical Center, 700 19th St S, Birmingham, AL, 35233, USA.
Department of Medicine at School of Medicine, University of Alabama at Birmingham, 510, 20th street South, Faculty office tower (FOT), Birmingham, AL, 35294, USA.
BMC Cardiovasc Disord. 2017 Mar 14;17(1):76. doi: 10.1186/s12872-017-0513-6.
Few studies, if any, have examined cardiovascular outcomes in patients with diabetes and gout. Both diabetes and gout are risk factors for cardiovascular disease. The objective of this study was to examine the effect of allopurinol on the risk of incident acute cardiovascular events in patients with gout and diabetes.
We used the 2007-2010 Multi-Payer Claims Database (MPCD) that linked health plan data from national commercial and governmental insurances, representing beneficiaries with United Healthcare, Medicare, or Medicaid coverage. In patients with gout and diabetes, we assessed the current allopurinol use, defined as a new filled prescription for allopurinol, as the main predictor of interest. Our outcome of interest was the occurrence of the first Incident hospitalized myocardial infarction (MI) or stroke (composite acute cardiovascular event), after which observations were censored. We employed multivariable-adjusted Cox proportional hazards models that simultaneously adjusted for patient demographics, cardiovascular risk factors and other medical comorbidities. We calculated hazard ratios [HR] (95% confidence intervals [CI]) for incident composite (MI or stroke) acute cardiovascular events. We performed sensitivity analyses that additionally adjusted for the presence of immune diseases and colchicine use, as potential confounders.
There were 2,053,185 person days (5621.3 person years) of current allopurinol use and 1,671,583 person days (4576.5 person years) of prior allopurinol use. There were 158 incident MIs or strokes in current and 151 in prior allopurinol users, respectively. Compared to previous allopurinol users, current allopurinol users had significantly lower adjusted hazard of incident acute cardiovascular events (incident stroke or MI), with an HR of 0.67 (95% CI, 0.53, 0.84). Sensitivity analyses, additionally adjusted for immune diseases or colchicine use, confirmed this association.
Current allopurinol use protected against the occurrence of acute cardiovascular events in patients with gout and diabetes. The underlying mechanisms for this potential cardio-protective effect of allopurinol need further exploration.
很少有研究（如果有的话）探讨糖尿病合并痛风患者的心血管结局。糖尿病和痛风都是心血管疾病的危险因素。本研究的目的是检验别嘌醇对痛风合并糖尿病患者发生急性心血管事件风险的影响。
我们使用了2007 - 2010年多支付方索赔数据库（MPCD），该数据库链接了来自国家商业和政府保险的健康计划数据，代表联合健康保险、医疗保险或医疗补助覆盖的受益人。在痛风合并糖尿病患者中，我们将当前别嘌醇的使用情况（定义为新开具的别嘌醇处方）作为主要研究预测因素。我们感兴趣的结局是首次发生住院心肌梗死（MI）或中风（复合急性心血管事件），在此之后观察被截尾。我们采用多变量调整的Cox比例风险模型，同时对患者人口统计学、心血管危险因素和其他合并症进行调整。我们计算了发生复合（MI或中风）急性心血管事件的风险比[HR]（95%置信区间[CI]）。我们进行了敏感性分析，额外调整了免疫疾病的存在和秋水仙碱的使用情况，作为潜在的混杂因素。
当前使用别嘌醇的人天数为2,053,185天（5621.3人年），既往使用别嘌醇的人天数为1,671,583天（4576.5人年）。当前使用别嘌醇的患者中有158例发生MI或中风，既往使用别嘌醇的患者中有151例发生。与既往使用别嘌醇的患者相比，当前使用别嘌醇的患者发生急性心血管事件（中风或MI）的调整后风险显著降低，HR为0.67（95% CI，0.53，0.84）。敏感性分析在额外调整免疫疾病或秋水仙碱使用情况后，证实了这种关联。
当前使用别嘌醇可预防痛风合并糖尿病患者发生急性心血管事件。别嘌醇这种潜在心脏保护作用的潜在机制需要进一步探索。
