E is smaller or events fewer.Singh et al. BMC CardiovascularE is smaller or events fewer.Singh

E is smaller or events fewer.Singh et al. BMC Cardiovascular
E is smaller or events fewer.Singh et al. BMC Cardiovascular Disorders (2017) 17:Page 6 ofTable 4 Multivariable-adjusted associations of allopurinol use with incident composite outcome (MI and stroke)Incident MI or stroke Hazard ratio (95 CI) Allopurinol User Current Previous Gender Male Female Age, in years 50 51?0 66?0 71?5 76?0 > 80 61?5 Race Asian Black Hispanic Other Missing White Comorbidity Hypertension Nutlin-3a chiral cost Hyperlipidemia COPD Renal PubMed ID:https://www.ncbi.nlm.nih.gov/pubmed/27196668 disease PVD 0.96 (0.69, 1.35) 0.91 (0.69, 1.20) 1.07 (0.74, 1.55) 1.36 (1.07, 1.73) 0.93 (0.63, 1.39) 0.83 0.51 0.73 0.01 0.74 0.92 (0.54, 1.55) 0.97 (0.72, 1.31) 1.41 (0.76, 2.59) 1.55 (0.79, 3.03) 0.71 (0.36, 1.40) Ref 0.74 0.84 0.27 0.20 0.32 0.40 (0.17, 0.93) 0.85 (0.49, 1.49) 0.88 (0.54, 1.45) 1.64 (1.02, 2.62) 1.59 (0.97, 2.60) 2.70 (1.69, 4.34) Ref 0.03 0.57 0.61 0.04 0.07 <0.0001 1.00 (0.80, 1.26) Ref 0.99 0.67 (0.53, 0.84) Ref 0.0006 p-valueSignificant odds ratios are in bold PVD peripheral vascular disease, COPD chronic obstructive pulmonary diseaseOur findings must be interpreted in the context of current knowledge in this area. Most previous studies examined stroke as part of a composite cardiovascular outcome that included multiple cardiovascular outcomes, not just stroke and MI. In a 7-year follow-up of a 2-year RCT in patients with chronic kidney disease with glomerular filtration rate of < 60 ml/min, adjusted for race, sex and renal function, allopurinol use was associated with lower risk of 0.43 (95 CI, 0.21?.88) of cardiovascular events (including CAD, cerebrovascular disease, heart failure and peripheral vascular disease) [35]. In an observational study of 187 patients with hypertensive nephropathy, allopurinol use was associated with a reduced hazard of 0.34 (p = 0.04) for cardiovascular disease (CAD, heart failure and stroke) [36]. In a study using Scottish database, allopurinol use was associated with no difference in adjusted hazards of cardiovascular events (non-fatal myocardial infarction, nonfatal stroke and cardiovascular mortality) compared to non-users 1.10 (95 CI, 0.95?.26) [14]. Differences in the conditions included in the composite cardiovascular outcome, study populations and study designs, likely explain the differences in findings. The three key studies examining the risk of MI reported that compared to non-use, allopurinol use was associated with a 48 decrease [13] vs. a 25 increase [14] vs. no significant change [12] in the risk of MI. The studies were similar in that they all used clinical databases, assessed non-fatal MI and controlled for several cardiovascular risk factors. However, several differences were evident. Two studies used prevalent-user design [12, 14], which puts them at the risk of adjusting for the mediating factors and missing early events. Thus, it was not surprising that the two studies that used prevalent design showed increased risk [14] or no difference in risk [12], while the only new user design study showed risk reduction for MI [13]. Our study, using a new user design, also shows statistically significant benefits of allopurinol for risk reduction of acute cardiovascular events, and these findings were confirmed in several sensitivityTable 5 Sensitivity analyses with inclusion of colchicine in the main model or with immune disease in the modelMain modela + colchicine Incident MI or stroke Hazard ratio (95 CI) Allopurinol User Current Previous Immune disease Colchicine 0.68 (0.54, 0.85) Ref ?0.80 (0.55, 1.18) ?0.26 0.001 0.67 (0.53, 0.