J Rheum Dis.  2024 Apr;31(2):108-115. 10.4078/jrd.2023.0059.

Urate-lowering therapy is associated with a reduced risk of arrhythmias: a systematic review and meta-analysis

Affiliations
  • 1Department of Medicine, MetroWest Medical Center, Tufts University School of Medicine, Framingham, MA, USA
  • 2Department of Internal Medicine, University of Hawaii, Honolulu, HI, USA
  • 3Department of Medicine, Srinakharinwirot University, Bangkok, Thailand
  • 4Department of Cardiology, Loma Linda University Medical Center, Loma Linda, CA, USA

Abstract


Objective
While urate-lowering therapy (ULT) is linked to increased cardioprotective benefits on primary prevention of cardiovascular events such myocardial infarction or heart failure, little is known regarding their effects on arrhythmia risk. The purpose of this study was to investigate the relationship between incident arrhythmias and ULT.
Methods
We searched MEDLINE and Embase from inception to May 2023. Included studies were randomized controlled trials and cohort studies that compared the risk of cardiac arrhythmias among ULT users with non-ULT users.
Results
A total of 12,420 patients from five studies were analyzed, comprising 7,359 subjects in the ULT group and 5,061 subjects in the non-ULT group. Our results showed that ULT users had significant reductions in the risk of arrhythmias (pooled relative risk [RR] 0.82, 95% confidence interval [CI]: 0.74~0.92, p<0.001, I2 =0.0%) compared to non-ULT users. Subgroup analysis did not show that ULT users had a significant reduced risk of atrial fibrillation (pooled RR 0.76, 95% CI: 0.54~1.05, p=0.096 with I2 =15.4%) compared to non-ULT users.
Conclusion
ULT is associated with lower risk of overall arrhythmias. Further studies are warranted to confirm our findings.

Keyword

Arrhythmias; cardiac; Allopurinol; Febuxostat

Figure

  • Figure 1 Study identification and literature review process.

  • Figure 2 Risk of bias results for the included studies.

  • Figure 3 Risk of bias summary chart for the included studies.

  • Figure 4 Forest plot of the meta-analysis for urate-lowering therapy and risk of arrhythmias. DL: DerSimonian-Laird method used for the random effects model, CI: confidence interval.

  • Figure 5 Forest plot of the meta-analysis for urate-lowering therapy and atrial fibrillation. DL: DerSimonian-Laird method used for the random effects model, CI: confidence interval.

  • Figure 6 Sensitivity analysis of the meta-analysis for urate-lowering therapy and risk of arrhythmias. CI: confidence interval.


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