Aims With the high prevalence of gout and associated cardiovascular (CV) diseases, information on the comparative CV safety of individual urate-lowering drugs becomes increasingly important. However, few studies examined the CV risk of uricosuric agents. We compared CV risk among patients with gout who initiated allopurinol vs. benzbromarone. Methods and results Using the Korean National Health Insurance claims data (2002–17), we conducted a cohort study of 124 434 gout patients who initiated either allopurinol (n = 103 695) or benzbromarone (n = 20 739), matched on propensity score at a 5:1 ratio. The primary outcome was a composite CV endpoint of myocardial infarction, stroke/transient ischaemic attack, or coronary revascularization. To account for competing risk of death, we used cause-specific hazard models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the outcomes comparing allopurinol initiators with benzbromarone. Over a mean follow-up of 1.16 years, 2258 patients developed a composite CV event. The incidence rate of the composite CV event was higher in allopurinol initiators (1.81 per 100 person-years) than benzbromarone (1.61 per 100 person-years) with a HR of 1.22 (95% CI 1.05–1.41). The HR for all-cause mortality was 1.66 (95% CI 1.43–1.93) among allopurinol initiators compared with benzbromarone. Conclusion In this large population-based cohort of gout patients, allopurinol was associated with an increased risk of composite CV events and all-cause mortality compared to benzbromarone. Benzbromarone may reduce CV risk and mortality in patients with gout, although more studies are necessary to confirm our findings and to advance our understanding of the underlying mechanisms.

中文翻译：

---

痛风患者与别嘌醇与苯溴马隆相关的心血管风险

目的随着痛风和相关心血管 (CV) 疾病的高发病率，关于单个降尿酸药物的比较 CV 安全性的信息变得越来越重要。然而，很少有研究检查排尿酸药物的心血管风险。我们比较了使用别嘌醇与苯溴马隆的痛风患者的心血管风险。方法和结果 使用韩国国民健康保险索赔数据 (2002-17)，我们对 124 434 名痛风患者进行了一项队列研究，这些患者使用别嘌醇 (n = 103 695) 或苯溴马隆 (n = 20 739)，根据倾向评分进行匹配5:1 的比例。主要结局是心肌梗死、中风/短暂性脑缺血发作或冠状动脉血运重建的复合 CV 终点。考虑到死亡的竞争风险，我们使用特定原因的风险模型来估计别嘌醇起始剂与苯溴马隆的比较结果的风险比 (HR) 和 95% 置信区间 (CI)。在平均 1.16 年的随访中，2258 名患者发生了复合 CV 事件。别嘌醇起始者复合 CV 事件的发生率（1.81/100 人年）高于苯溴马隆（1.61/100 人年），HR 为 1.22（95% CI 1.05-1.41）。与苯溴马隆相比，别嘌醇引发剂的全因死亡率 HR 为 1.66 (95% CI 1.43–1.93)。结论 在这个以人群为基础的大型痛风患者队列中，与苯溴马隆相比，别嘌醇与复合心血管事件和全因死亡率的风险增加相关。苯溴马隆可降低痛风患者的心血管风险和死亡率，