Risk for Incident Atrial Fibrillation Similar With Different ULTs in Gout

No difference in risk for incident atrial fibrillation was noted with ULTs, including febuxostat, allopurinol, and benzbromarone, among patients with gout.

Treatment with febuxostat, allopurinol, and benzbromarone results in a similar incident risk for atrial fibrillation (AF) in Asian patients with gout, according to study results published in Biomedicines.

Previous studies have found that febuxostat increases AF risk among older adults with gout. However, the effects of ULTs on AF risk in gout are not well known among Asian populations.

Researchers of a retrospective cohort study aimed to study the incidence of AF after administering ULTs to Asian patients with gout.

Patients who received a gout diagnosis between January 2013, and December 2020 with a documented baseline serum uric acid level but no previous AF diagnosis were included in the study.

The outcome of interest was the development of incident AF during the follow-up period.

Of 713 patients with gout, 63 received allopurinol, 220 received benzbromarone, and 430 received febuxostat for more than 2 months.

There was no difference in the risk of incident AF among Asian patients with gout who received febuxostat, allopurinol, or benzbromarone.

Researchers did not observe a difference in risk for incident AF with all 3 ULTs. Follow-up (mean, 49.4±26.6 months) assessment revealed that 6% (n=43/713) of patients developed incident AF. Febuxostat and benzbromarone was not significantly correlated with an increased adjusted hazard ratio (HR) for incident AF (HR, 1.20; 95% CI, 0.43-3.34 and HR, 0.68; 95% CI, 0.22-2.08, respectively).

Patients who received febuxostat vs the other ULTs had an increased risk for stroke (P <.001) and a higher prevalence of chronic kidney disease (P <.001), diabetes mellitus (P <.001), and heart failure (P <.05).

The study authors noted several limitations, including the potential bias attributed to confounding variables; the lack of a control group; the lack of electrocardiographic data; the potential for gout misdiagnoses in some participants; the inability to determine accurate drug adherence; and possible selection bias due to the use of hospital records.

Researchers concluded, “There was no difference in the risk of incident AF among Asian patients with gout who received febuxostat, allopurinol, or benzbromarone.” However, they noted, “Further studies are needed to evaluate long-term cardiovascular outcomes in patients receiving different ULT drugs.”


Liu CH, Huang SC, Yin CH, et al. Atrial fibrillation risk and urate-lowering therapy in patients with gout: a cohort study using a clinical database. Biomedicines. Published online December 26, 2022. doi:10.3390/biomedicines11010059