Background Patients with gout are at an increased risk of cardiovascular disease (CVD) including myocardial infarction (MI), stroke and heart failure (HF). Objective We conducted a cohort study to examine comparative cardiovascular safety of the two gout treatments - probenecid and allopurinol - in patients with gout. Methods Among gout patients aged ≥65 years and enrolled in Medicare (2008–2013), we identified those who initiated probenecid or allopurinol. The primary outcome was a composite cardiovascular endpoint of hospitalization for MI or stroke. We assessed MI, stroke, coronary revascularization, HF and mortality separately as secondary outcomes. We estimated the incidence rate (IR) and hazard ratio (HR) of the primary and secondary outcomes in the 1:3 propensity score (PS) matched cohort of probenecid and allopurinol initiators. Results We included a total of 9,722 probenecid initiators PS-matched to 29,166 allopurinol initiators with mean age of 76 (±7) years, and 54% male. The IR of the primary composite endpoint of MI or stroke per 100 person-years was 2.36 in probenecid and 2.83 in allopurinol initiators with HR of 0.80 (95%CI 0.69–0.93). In the secondary analyses, probenecid was associated with a decreased risk of MI, stroke, HF exacerbation and mortality versus allopurinol. Our results were consistent in the subgroup analyses of patients without baseline CVD or those without baseline chronic kidney disease. Conclusions In this large cohort of 38,888 elderly gout patients, treatment with probenecid appears to be associated with a modestly decreased risk of cardiovascular events including MI, stroke and HF exacerbation compared to allopurinol.
Kim et al. (Mon,) studied this question.