Effect of Allopurinol on Cardiovascular Outcomes in Hyperuricemic Patients: A Cohort Study

Am J Med. 2016 Mar;129(3):299-306.e2. doi: 10.1016/j.amjmed.2015.11.003. Epub 2015 Nov 14.


Background: Hyperuricemia and gout have been associated with increased cardiovascular risk. Allopurinol is an effective urate-lowering drug. Whether lowering of urate by allopurinol improves the cardiovascular risk in hyperuricemic patients remains to be established.

Objective: Our objective was to investigate the effect of allopurinol on cardiovascular outcomes in hyperuricemic patients in an observational setting.

Methods: We had access to a study population consisting of all patients from Funen County, Denmark with high urate levels (≥6 mg/dL) from 1992 to 2010. We linked 4 registries; all blood samples, all in- and outpatient contacts in hospitals, all reimbursed prescriptions and causes of death. We identified all incident allopurinol users and matched them 1:1 to nonusers of urate-lowering therapy, with similar urate levels, by using propensity scores. Hazard ratios were calculated using competing risk regression model, with respect to Antiplatelet Trialists' Collaboration composite outcome (myocardial infarction, stroke, or cardiovascular death) and all-cause mortality.

Results: Among 65,971 patients with hyperuricemia, we found 7127 patients on allopurinol treatment. In the propensity score-matched cohort we found a hazard ratio of 0.89 (95% confidence interval, 0.81-0.97) for the main outcome among allopurinol treated compared with nonusers of allopurinol. The corresponding hazard ratio for all-cause mortality was 0.68 (95% confidence interval, 0.62-0.74).

Conclusion: Allopurinol treatment is associated with a decreased cardiovascular risk among hyperuricemic patients.

Keywords: Allopurinol; Cardiovascular outcomes; Gout; Hyperuricemia.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Allopurinol / therapeutic use*
  • Cardiovascular Diseases / mortality*
  • Cohort Studies
  • Denmark / epidemiology
  • Female
  • Gout Suppressants / therapeutic use*
  • Humans
  • Hyperuricemia / drug therapy*
  • Hyperuricemia / epidemiology
  • Male
  • Matched-Pair Analysis
  • Middle Aged
  • Myocardial Infarction / epidemiology*
  • Propensity Score
  • Registries
  • Stroke / epidemiology*


  • Gout Suppressants
  • Allopurinol