Association between allopurinol and mortality in heart failure patients: a long-term follow-up study.
OBJECTIVE
The aim of the study was to explore the long-term effect of allopurinol on mortality and cardiovascular hospitalisations in heart failure (HF) patients.


METHODS
This is a population-based cohort study using a record-linkage database in Tayside, Scotland. A total of 4785 HF patients (4260 non-users, 267 incident users and 258 prevalent users) were studied between 1993 and 2002.


RESULTS
Compared with non-users, low-dose users in the incident group had a significant increased risk of all-cause mortality, cardiovascular mortality and cardiovascular recurrence (adjusted HR, 1.60, 95%CI 1.26-2.03; 1.70, 1.29-2.23 and 1.44, 1.01-2.07). For the prevalent users, the adjusted HR were 1.27, 0.98-1.64; 1.43, 1.07-1.90 and 1.27, 0.91-1.76 respectively. There was no increased risk of outcome for high-dose users when compared with non-users (adjusted HR, 1.18, 0.84-1.66; 1.14, 0.76-1.71 and 1.36, 0.88-2.10 for the incident users, and 0.86, 0.64-1.15; 0.90, 0.64-1.26; and 1.27, 0.93-1.74 for the prevalent users respectively). High-dose allopurinol was associated with reduced risk of all-course mortality for prevalent users when compared with low-dose (adjusted HR 0.65, 95%CI 0.42-0.99).


CONCLUSIONS
The prevalent high-dose allopurinol use had a lower risk of mortality than the prevalent low-dose use suggesting that allopurinol may be of benefit in HF patients.
Wei
L
L
Medicines Monitoring Unit (MEMO), Division of Medicine and Therapeutics, Ninewells Hospital and Medical School, Dundee, UK.
Fahey
T
T
Struthers
A D
AD
MacDonald
T M
TM
D000368:Aged; D000493:Allopurinol / Q000008:administration & dosage*; D002317:Cardiovascular Agents / Q000008:administration & dosage*; D002318:Cardiovascular Diseases / Q000401:mortality; D002423:Cause of Death; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000401:mortality*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D009203:Myocardial Infarction / Q000401:mortality*; D012008:Recurrence; D012606:Scotland; D049994:Sodium Potassium Chloride Symporter Inhibitors / Q000627:therapeutic use
D002317:Cardiovascular Agents; D049994:Sodium Potassium Chloride Symporter Inhibitors; D000493:Allopurinol