title: Treatment of asymptomatic hyperuricemia and prevention of vascular disease: a decision analytic approach.
abstract: OBJECTIVE
  Elevated serum urate may be associated with an increase in cardiovascular (CV) disease. Treating asymptomatic hyperuricemia with urate-lowering drugs such as allopurinol may reduce CV events. We designed a model to simulate the effect of allopurinol treatment on reducing frequency of CV events in individuals with elevated serum urate.
  
  
  METHODS
  A Markov state-transition model was constructed to assess occurrence of vascular events (VE) for 2 treatment strategies: treat all asymptomatic individuals with allopurinol (Treat All) and treat only if symptomatic (Treat Symptomatic). The model simulated a hypothetical cohort of 50-year-old men with different serum urate concentrations (6-6.9 and 7-7.9 mg/dl) followed over 20 years. Age and sex subgroups were analyzed. Model inputs were derived from current literature. The main outcome measures were mean number of VE and mean number of deaths from VE.
  
  
  RESULTS
  For 50-year-old men with serum urate 6.0-6.9 mg/dl, individuals in the Treat All strategy have a 30% reduction in the mean number of VE compared to those in the Treat Symptomatic strategy (mean VE: 0.078 vs 0.11), and a 39% reduction in mean number of deaths from VE. At higher serum urate concentrations, treatment is more effective in reducing the mean number of VE and mean number of deaths from VE (38% event, 54% death). Results for women show similar trends. As the cohort ages, treatment has less effect on reducing VE. The number needed to treat to prevent 1 event is 20 (men, 7.0-7.9 mg/dl).
  
  
  CONCLUSIONS
  The model predicts that treating asymptomatic hyperuricemia with allopurinol is most effective in preventing VE at a serum urate above 7.0 mg/dl in men and 5.0 mg/dl in women.
authors.affiliation: From the Dartmouth-Hitchcock Medical Center, Rheumatology; Geisel School of Medicine at Dartmouth, The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire; Veterans Affairs, VA National Center for Patient Safety, White River Junction, New Hampshire; Northeastern Ohio Universities College of Medicine, Rootstown, Ohio; Boston University School of Medicine, Department of Medicine and Department of Clinical Epidemiology, Boston, Massachusetts, USA.
authors.forename: Roopa
authors.initials: R
authors.lastname: Akkineni
authors.forename: Stephanie
authors.initials: S
authors.lastname: Tapp
authors.forename: Anna N A
authors.initials: AN
authors.lastname: Tosteson
authors.forename: Alexandra
authors.initials: A
authors.lastname: Lee
authors.forename: Katherine L
authors.initials: KL
authors.lastname: Miller
authors.forename: Hyon K
authors.initials: HK
authors.lastname: Choi
authors.forename: Yanyan
authors.initials: Y
authors.lastname: Zhu
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Albert
mesh_terms: D000368:Aged; D000493:Allopurinol / Q000627:therapeutic use*; D003661:Decision Support Techniques; D005260:Female; D005500:Follow-Up Studies; D006074:Gout Suppressants / Q000627:therapeutic use*; D006801:Humans; D033461:Hyperuricemia / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy*; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D016896:Treatment Outcome; D014527:Uric Acid / Q000097:blood; D014652:Vascular Diseases / Q000209:etiology / Q000517:prevention & control*
chemical_list: D006074:Gout Suppressants; D014527:Uric Acid; D000493:Allopurinol
keywords: CARDIOVASCULAR DISEASE; DECISION ANALYSIS; HYPERURICEMIA