Allopurinol Linked to Reduction in Stroke Risk in Elderly

WASHINGTON, DC – Allopurinol use, especially for 6 months or longer, appears to exert a neuroprotective effect against stroke in elderly people, according to data presented at the 2016 American College of Rheumatology Annual Meeting, in Washington, DC.

To better understand the modifying effect of allopurinol use on the risk of stroke, researchers led by Jasvinder A. Singh, MD, MPH, of the University of Alabama at Birmingham, analyzed a sample of Medicare beneficiaries from 2006 to 2012 for initiation of allopurinol and incident stroke.

In order to calculate hazard ratios (HR), the researchers used Cox regressions models adjusted for age, gender, race, Charlson index, and cardio-protective medications, including beta-blockers, ACE inhibitors, diuretics, and statins. Researchers also adjusted for risk factors of coronary artery disease, including hypertension, hyperlipidemia, diabetes, and smoking.

The sample ultimately included 28,488 episodes of incident allopurinol use, of which 2177 ended in incident stroke (7.6%). After adjustments, allopurinol use was found to be associated with a 9% reduced risk for stroke (hazard ratio [HR] 0.91; 95% CI, 0.83-0.99).

Compared to those patients with no history of allopurinol use, those with allopurinol use of 181 days to 2 years and greater than 2 years had a significantly decreased risk of stroke (HR 0.88; 95% CI, 0.78-0.99 and HR 0.79; 95% CI, 0.65-0.96, respectively). The findings remained significant after adjustment for coronary artery disease risk factors.

In secondary analyses, allopurinol use was found to be associated with a reduced risk of ischemic stroke (HR 0.89; 95% CI, 0.81-0.98); however no significant reduction in risk was noted for hemorrhagic stroke (HR 1.01; 95% CI, 0.79-1.29).

Further studies will be required to better understand the mechanisms behind this neuroprotective effect, the authors concluded.

Disclosures

Dr Singh reports relationships with TAP, Savient, Takeda, Regeneron, Merz, Iroko, Bioiberica, Crealta, and Allergan Pharmaceuticals, WebMD, UBM LLC, and the American College of Rheumatology.

Reference

Singh JA, Yu S. Allopurinol use and the risk of stroke in the elderly. Presented at: the 2016 American College of Rheumatology/ Association of Rheumatology Health Professionals (ACR/ARHP) Annual Meeting. November 11-16, 2016; Washington, DC. Abstract #1230