Residual confounders might explain much, though not all, of the link between proton pump inhibitor (PPI) use and ischemic stroke.
Why this matters
- 6.5% of women and 16.1% of men reported regular PPI use; users had higher rates of multiple chronic diseases.
- 2599 incident strokes occurred in study period.
- Age-adjusted analysis for PPI users vs nonusers:
- Total and hemorrhagic stroke rates similar (HRs, 1.11 [95% CI, 1.00-1.24] and 1.00 [95% CI, 0.72-1.38], respectively);
- Ischemic stroke rate higher among users (HR, 1.25; 95% CI, 1.08-1.46).
- Ischemic stroke analysis adjusted for multiple confounders: HR, 1.18; 95% CI, 1.02-1.37.
- Ischemic stroke analysis adjusted further for several PPI indications, including history of peptic ulcer disease or gastroesophageal reflux disease (GERD): HR, 1.08; 95% CI, 0.91-1.27.
- Analysis of PPI use during Nurses’ Health Study since 2000 (n=68,514 women) and Health Professionals Follow-up Study since 2004 (n=28,989 men) (both prospective cohort studies).
- Primary outcome: first incident stroke.
- Funding: NIH.
- Researchers included probable and chart-confirmed strokes.
- Dosage information not available.
- Analyses did not adjust for metabolic syndrome.