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Allopurinol saves lives

Issue 28 Synovium (Autumn 2009)

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It is known that hyperuricaemia and gout are associated with increased incidence of premature death largely due to cardiovascular disease. A recent study from the USA1 suggests that allopurinol may prevent this increased risk. In a 7-year cohort study of almost 10,000 hyperuricaemic patients fom the Vetarans Affairs medical centres, users of allopurinol were found to have a 23% lower mortality rate compared with non-users despite higher co-morbidities, including hypertension, cardiovascular disease, diabetes and raised BMI. The veterans were almost all hite males in the age range 40–93. There were 2483 subjects in the allopurinol group and 7441 in the control group. There were 745 deaths in the control group and 276 deaths in the allopurinol group during the 23,903 person-years of follow-up. 83% of allopurinol users had a diagnosis of gout (compared with 20% of non-users) and had a higher baseline urate level. The authors suggest that this benefit is comparable with that of other drugs used in cardiovascular disease, incuding ß-blockers and angiotensin-converting enzyme inhibitors. Perhaps we should be measuring more urate levels and using more allopurinol to treat them.

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