Risk of myocardial infarction in adults with gout treated with allopurinol: A systematic review and meta-analysis
Abstract
Aims Although allopurinol is used for urate-lowering therapy, its effect on myocardial infarction risk remains unclear. This study assessed the association between allopurinol use and myocardial infarction in adults with gout. Methods A systematic review and meta-analysis was conducted following PROSPERO registration (CRD420261305257). PubMed, Scopus, and Web of Science were searched from inception to January 2026. Observational studies of adults with confirmed gout that reported adjusted hazard ratios (HRs) for myocardial infarction and separately identifiable allopurinol exposure were included. Pooled estimates were calculated using an inverse-variance random-effects model with the Paule–Mandel estimator. Robustness was assessed through leave-one-out, active-comparator, and Hartung–Knapp sensitivity analyses. Results Four retrospective cohort studies met the revised eligibility criteria. In the primary random-effects analysis, allopurinol use was associated with a lower risk of myocardial infarction (HR 0.84; 95% CI 0.76–0.94; I 2 = 0%). However, the association was not statistically significant after excluding the study contributing the greatest weight (HR 1.04; 95% CI 0.79–1.36), when restricted to active comparators (HR 1.04; 95% CI 0.79–1.36), or using the Hartung–Knapp adjustment (HR 0.84; 95% CI 0.71–1.00). Conclusion Allopurinol therapy was associated with a modest but significant reduction in myocardial infarction risk in adults with gout.
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BibTeX
@article{leonrodriguez2026risk,
title = {{Risk of myocardial infarction in adults with gout treated with allopurinol: A systematic review and meta-analysis}},
author = {Jhair Alexander Leon-Rodriguez and Ricardo Leonidas Agreda-Gil and Wagner Stalin Diaz-Rimarachin and Oscar Iván Muñoz-Tasilla and Nataly Lisde Sánchez-Díaz and María Dolores Mondéjar-Barrios},
journal = {Diabetes \& Vascular Disease Research},
year = {2026},
month = oct,
doi = {10.1177/14791641261495574},
url = {https://doi.org/10.1177/14791641261495574},
note = {CC BY},
}
RIS
TY - JOUR
TI - Risk of myocardial infarction in adults with gout treated with allopurinol: A systematic review and meta-analysis
AU - Jhair Alexander Leon-Rodriguez
AU - Ricardo Leonidas Agreda-Gil
AU - Wagner Stalin Diaz-Rimarachin
AU - Oscar Iván Muñoz-Tasilla
AU - Nataly Lisde Sánchez-Díaz
AU - María Dolores Mondéjar-Barrios
PY - 2026
DA - 2026/10/23
JO - Diabetes & Vascular Disease Research
DO - 10.1177/14791641261495574
UR - https://doi.org/10.1177/14791641261495574
AB - Aims Although allopurinol is used for urate-lowering therapy, its effect on myocardial infarction risk remains unclear. This study assessed the association between allopurinol use and myocardial infarction in adults with gout. Methods A systematic review and meta-analysis was conducted following PROSPERO registration (CRD420261305257). PubMed, Scopus, and Web of Science were searched from inception to January 2026. Observational studies of adults with confirmed gout that reported adjusted hazard ratios (HRs) for myocardial infarction and separately identifiable allopurinol exposure were included. Pooled estimates were calculated using an inverse-variance random-effects model with the Paule–Mandel estimator. Robustness was assessed through leave-one-out, active-comparator, and Hartung–Knapp sensitivity analyses. Results Four retrospective cohort studies met the revised eligibility criteria. In the primary random-effects analysis, allopurinol use was associated with a lower risk of myocardial infarction (HR 0.84; 95% CI 0.76–0.94; I 2 = 0%). However, the association was not statistically significant after excluding the study contributing the greatest weight (HR 1.04; 95% CI 0.79–1.36), when restricted to active comparators (HR 1.04; 95% CI 0.79–1.36), or using the Hartung–Knapp adjustment (HR 0.84; 95% CI 0.71–1.00). Conclusion Allopurinol therapy was associated with a modest but significant reduction in myocardial infarction risk in adults with gout.
SN - 1752-8984
SN - 1479-1641
ER -