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Text
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URL Address
<a href="http://doi.org/10.3899/jrheum.121231" target="_blank" rel="noreferrer noopener">http://doi.org/10.3899/jrheum.121231</a>
Pages
739–748
Issue
4
Volume
41
Dublin Core
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Title
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Treatment of asymptomatic hyperuricemia and prevention of vascular disease: a decision analytic approach.
Publisher
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The Journal of rheumatology
Date
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2014
2014-04
Subject
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Female; Humans; Male; Middle Aged; Aged; Follow-Up Studies; Treatment Outcome; Severity of Illness Index; Prospective Studies; Sex Factors; Risk Assessment; Decision Support Techniques; Probability; Human; Middle Age; *Markov Chains; Allopurinol/*therapeutic use; CARDIOVASCULAR DISEASE; DECISION ANALYSIS; Gout Suppressants/*therapeutic use; HYPERURICEMIA; Hyperuricemia/complications/*diagnosis/*drug therapy; Uric Acid/blood; Vascular Diseases/etiology/*prevention & control; Treatment Outcomes; Severity of Illness Indices; Gout Suppressants – Therapeutic Use; Allopurinol – Therapeutic Use; Hyperuricemia – Complications; Hyperuricemia – Diagnosis; Hyperuricemia – Drug Therapy; Uric Acid – Blood; Vascular Diseases – Etiology; Vascular Diseases – Prevention and Control
Creator
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Akkineni Roopa; Tapp Stephanie; Tosteson Anna N A; Lee Alexandra; Miller Katherine L; Choi Hyon K; Zhu Yanyan; Albert Daniel A
Description
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OBJECTIVE: Elevated serum urate may be associated with an increase in cardiovascular (CV) disease. Treating asymptomatic hyperuricemia with urate-lowering drugs such as allopurinol may reduce CV events. We designed a model to simulate the effect of allopurinol treatment on reducing frequency of CV events in individuals with elevated serum urate. METHODS: A Markov state-transition model was constructed to assess occurrence of vascular events (VE) for 2 treatment strategies: treat all asymptomatic individuals with allopurinol (Treat All) and treat only if symptomatic (Treat Symptomatic). The model simulated a hypothetical cohort of 50-year-old men with different serum urate concentrations (6-6.9 and 7-7.9 mg/dl) followed over 20 years. Age and sex subgroups were analyzed. Model inputs were derived from current literature. The main outcome measures were mean number of VE and mean number of deaths from VE. RESULTS: For 50-year-old men with serum urate 6.0-6.9 mg/dl, individuals in the Treat All strategy have a 30% reduction in the mean number of VE compared to those in the Treat Symptomatic strategy (mean VE: 0.078 vs 0.11), and a 39% reduction in mean number of deaths from VE. At higher serum urate concentrations, treatment is more effective in reducing the mean number of VE and mean number of deaths from VE (38% event, 54% death). Results for women show similar trends. As the cohort ages, treatment has less effect on reducing VE. The number needed to treat to prevent 1 event is 20 (men, 7.0-7.9 mg/dl). CONCLUSION: The model predicts that treating asymptomatic hyperuricemia with allopurinol is most effective in preventing VE at a serum urate above 7.0 mg/dl in men and 5.0 mg/dl in women.
Identifier
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<a href="http://doi.org/10.3899/jrheum.121231" target="_blank" rel="noreferrer noopener">10.3899/jrheum.121231</a>
Rights
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Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
*Markov Chains
2014
Aged
Akkineni Roopa
Albert Daniel A
Allopurinol – Therapeutic Use
Allopurinol/*therapeutic use
CARDIOVASCULAR DISEASE
Choi Hyon K
DECISION ANALYSIS
Decision Support Techniques
Female
Follow-Up Studies
Gout Suppressants – Therapeutic Use
Gout Suppressants/*therapeutic use
Human
Humans
HYPERURICEMIA
Hyperuricemia – Complications
Hyperuricemia – Diagnosis
Hyperuricemia – Drug Therapy
Hyperuricemia/complications/*diagnosis/*drug therapy
Lee Alexandra
Male
Middle Age
Middle Aged
Miller Katherine L
Probability
Prospective Studies
Risk Assessment
Severity of Illness Index
Severity of Illness Indices
Sex Factors
Tapp Stephanie
The Journal of rheumatology
Tosteson Anna N A
Treatment Outcome
Treatment Outcomes
Uric Acid – Blood
Uric Acid/blood
Vascular Diseases – Etiology
Vascular Diseases – Prevention and Control
Vascular Diseases/etiology/*prevention & control
Zhu Yanyan