Impact of allopurinol on risk of myocardial infarction.

BACKGROUND: Gout therapy includes xanthine oxidase inhibitors (XOI) and colchicine, which have both been associated with decreased cardiovascular risk. However, their effects on major cardiac events, such as myocardial infarction (MI), need to be investigated further. OBJECTIVES: To investigate whether XOIs and colchicine are associated with decreased risk of MI. METHODS: This case-control study compared patients with first-ever MI and matched controls. Cases were recruited from the Pharmacoepidemiological General Research on MI registry. Controls were selected from a referent population (n=8444) from general practice settings. RESULTS: The study sample consisted of 2277 MI patients and 4849 matched controls. Use of allopurinol was reported by 3.1% of cases and 3.8 of controls, and 1.1% of cases and controls used colchicine. The adjusted OR (95% CI) for MI with allopurinol use was 0.80 (0.59 to 1.09). When using less stringent matching criteria that allowed for inclusion of 2593 cases and 5185 controls, the adjusted OR was 0.73 (0.54 to 0.99). Similar results were found on analysis by sex and hypertension status. Colchicine used was not associated with a decreased risk of MI (aOR=1.17 (0.70 to 1.93)). CONCLUSIONS: Allopurinol may be associated with a reduced risk of MI. No decreased risk of MI was found in colchicine users. Besides its urate-lowering property, allopurinol might have a cardioprotective effect.

[Management of patients with acute manic or mixed episodes and outcome at three months]. / Modalités de prise en charge de l'accès maniaque ou mixte aigu et évolution à trois mois.

METHODS: EMBLEM is a prospective, multicenter observational study on the management of patients with a manic or mixed episode in routine clinical practice (total of 3566 subjects included in 14 European countries). The study consisted of a 12-week acute phase and a 24-month maintenance phase. Subjects were included if they initiated or changed oral medication, according to the decision of the treating psychiatrist, with antipsychotics, anticonvulsants and / or lithium, for the treatment of a manic or mixed episode. The present report describes the acute phase outcomes of the French subgroup. RESULTS: Between December 2002 and June 2004, 126 investigators included a total of 795 subjects as in- or outpatients (450 women, 320 men, mean age: 45.6 years). The episode was most often recurrent (74.7 %) and patients were suffering from either a manic (65.8 %) or a mixed episode (34.2 % vs. EMBLEM Europe, 24 %). The intensity of manic symptoms was elevated (YMRS mean total score: 26.6) and functional impairment of the individuals was high, with 41.9 % experiencing moderate to severe work impairment and 23.6 % being unable to work. The prevalence of suicide attempts was 35.8 % (lifelong), close to the prevalence in the other French cohort EPIMAN (32 %). Abuse / dependence on alcohol and cannabis were present in 10.2 % and 11.1 % of subjects, respectively. At entry, 37.4 % were receiving monotherapy while 27.3 % received a combined therapy. All patients received treatment for their manic / mixed episode, either in combination (59.2 %) or in monotherapy (40.8 %). Atypical antipsychotics were more often prescribed in association (34.0 % of subjects) than in monotherapy (21.1 %). In patients treated in monotherapy, atypical antipsychotics were the most often prescribed drug (51.9 %). Results showed an improvement within both monotherapy and combination therapy in effectiveness measures at week 12. After 12 weeks, 31.3 % were considered recovered and 67.9 % did not relapse. These results confirm current data on co-morbidities and give information on treatment for bipolar patients at three months of follow-up. The long-term evaluation of the French EMBLEM cohort - 12, 24 months and up to five years - is presently ongoing.