{
    "abstract": "To investigate the impact of allopurinol use on the risk of first-ever acute coronary syndrome (ACS) event in patients with gout.\nUsing national and regional register data, we included all patients with a gout diagnosis at primary or specialised care in Western Sweden in the period 2007-2017 (n=18\u2009862; 67% male patients). Patients with a prior history of coronary heart disease (CHD) were excluded. Follow-up started at the first gout diagnosis and ended at the first-ever ACS event, death or study end. The main outcome was the risk of first-ever ACS in: (1) allopurinol users versus non-users, by defining three categories of allopurinol exposure: exposed to 100\u2009mg, >100\u2009mg and no exposure (reference) and (2) allopurinol initiators (within 125 days) versus long-term users (reference). Multivariable logistic regression analysis was used to calculate ORs and 95% CIs.\nIn analysis 1 (n=18\u2009862), 15.3% (n=2892) were exposed to 100\u2009mg, 9.1% (n=1717) to >100\u2009mg and 75.6% (n=14\u2009253) were not exposed. Allopurinol users were older and had more comorbidities compared with non-users. Allopurinol exposure (100\u2009mg and >100\u2009mg) was associated with significantly lower odds of first-ever ACS (OR 0.77; 95% CI 0.63 to 0.94, and OR 0.61; 95% CI 0.47 to 0.81, respectively). In Analysis 2, allopurinol initiators (n=489) had significantly higher odds of first-ever ACS compared with long-term users (n=2916) (OR 1.68; 95% CI 1.03 to 2.75).\nIn patients with gout and without CHD, long-term allopurinol use protects against first-ever ACS compared with non-users. In contrast, allopurinol initiators, possibly having more systemic inflammation, had a higher risk of first-ever ACS compared with long-term users.",
    "authors": [
        {
            "affiliation": "Department of Rheumatology and Inflammation Research, University of Gothenburg Sahlgrenska Academy, Goteborg, Sweden panagiota.drivelegka@vgregion.se.",
            "firstname": "Panagiota",
            "initials": "P",
            "lastname": "Drivelegka"
        },
        {
            "affiliation": "Department of Rheumatology and Inflammation Research, University of Gothenburg Sahlgrenska Academy, Goteborg, Sweden.",
            "firstname": "Lennart",
            "initials": "L",
            "lastname": "Jacobsson"
        },
        {
            "affiliation": "Department of Rheumatology and Inflammation Research, University of Gothenburg Sahlgrenska Academy, Goteborg, Sweden.",
            "firstname": "Tatiana Zverkova",
            "initials": "TZ",
            "lastname": "Sandstr\u00f6m"
        },
        {
            "affiliation": "Department of Rheumatology and Inflammation Research, University of Gothenburg Sahlgrenska Academy, Goteborg, Sweden.",
            "firstname": "Ulf",
            "initials": "U",
            "lastname": "Lindstr\u00f6m"
        },
        {
            "affiliation": "Department of Rheumatology and Inflammation Research, University of Gothenburg Sahlgrenska Academy, Goteborg, Sweden.",
            "firstname": "Karin",
            "initials": "K",
            "lastname": "Bengtsson"
        },
        {
            "affiliation": "Department of Rheumatology and Inflammation Research, University of Gothenburg Sahlgrenska Academy, Goteborg, Sweden.",
            "firstname": "Mats",
            "initials": "M",
            "lastname": "Dehlin"
        }
    ],
    "conclusions": null,
    "copyrights": "\u00a9 Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.",
    "doi": "10.1136/bmjopen-2024-092522\n10.1016/S0140-6736(21)02391-6\n10.1038/s41584-020-0441-1\n10.1002/acr.25018\n10.1136/ard.2009.122770\n10.1161/CIRCULATIONAHA.107.703389\n10.1093/rheumatology/kes169\n10.1002/art.22014\n10.1007/s00296-021-04876-6\n10.1093/rheumatology/keab335\n10.1136/rmdopen-2022-002348\n10.1186/1743-7075-1-10\n10.1002/art.41247\n10.1136/annrheumdis-2016-209707\n10.1136/ard.29.1.89\n10.1136/bmj.2.5509.321\n10.1056/NEJMoa050373\n10.1016/S0140-6736(18)32158-5\n10.1016/j.pharmthera.2016.12.004\n10.1186/s13075-016-1111-1\n10.1186/s12872-017-0513-6\n10.1016/j.amjmed.2015.11.003\n10.1093/rheumatology/kez576\n10.1016/j.amjmed.2015.01.013\n10.1161/CIRCULATIONAHA.106.651117\n10.1161/01.cir.0000017502.58595.ed\n10.1161/01.cir.0000022140.61460.1d\n10.1001/jama.300.8.924\n10.1136/heartjnl-2014-305683\n10.1113/EP087006\n10.1002/art.41749\n10.1097/HJH.0000000000002189\n10.1016/j.ekir.2020.10.025\n10.1016/S0140-6736(22)01657-9\n10.1056/NEJMoa1707914\n10.1001/jama.2022.11390\n10.1007/978-1-4615-5381-6_3\n10.1007/s40265-019-01081-5\n10.1186/s13075-018-1606-z\n10.1371/journal.pone.0099102\n10.1016/j.ijcard.2017.02.013\n10.1186/s13075-016-1211-y\n10.1080/03009742.2022.2132055\n10.1136/ard.2008.104018\n10.1186/s12891-015-0614-2\n10.1186/1471-2458-11-450",
    "journal": "BMJ open",
    "keywords": [
        "Cardiovascular Disease",
        "REGISTRIES",
        "RHEUMATOLOGY"
    ],
    "methods": null,
    "publication_date": "2025-03-01",
    "pubmed_id": "40021199\n35367005\n32541923\n36094855\n20124358\n17698728\n22787006\n16871533\n33987709\n31820724\n33839783\n35863863\n15507132\n32390306\n27457514\n5416104\n5920652\n16339094\n30343856\n27916655\n27655429\n28288564\n26589484\n31873735\n25660249\n17130343\n12045167\n12105162\n18728266\n24790069\n29750475\n33779064\n31268872\n33426394\n36216006\n28845751\n35916846\n9598023\n30868398\n29859125\n24897240\n28202260\n28095891\n36300710\n19433414\n26077041\n21658213",
    "results": "In analysis 1 (n=18\u2009862), 15.3% (n=2892) were exposed to 100\u2009mg, 9.1% (n=1717) to >100\u2009mg and 75.6% (n=14\u2009253) were not exposed. Allopurinol users were older and had more comorbidities compared with non-users. Allopurinol exposure (100\u2009mg and >100\u2009mg) was associated with significantly lower odds of first-ever ACS (OR 0.77; 95% CI 0.63 to 0.94, and OR 0.61; 95% CI 0.47 to 0.81, respectively). In Analysis 2, allopurinol initiators (n=489) had significantly higher odds of first-ever ACS compared with long-term users (n=2916) (OR 1.68; 95% CI 1.03 to 2.75).",
    "title": "Allopurinol use and risk of acute coronary syndrome in gout patients: a population-based cohort study in Sweden.",
    "xml": "<Element 'PubmedArticle' at 0x7885036a4cc0>"
}