PPIs: risk for stroke, MI rises with long-term use and high doses

  • J Intern Med

  • Susan London
  • Clinical Essentials
L'accesso ai contenuti di questo sito è riservato agli operatori del settore sanitario italiano L'accesso ai contenuti di questo sito è riservato agli operatori del settore sanitario italiano

Takeaway

  • Use of proton pump inhibitors (PPIs) at higher dose or for longer duration is associated with elevated risks for ischemic stroke and myocardial infarction (MI).

Why this matters

  • Use of PPIs may be a modifiable risk factor for adverse cardiovascular outcomes.

Key results

  • Overall, 3.7% and 2.6% of patients experienced first ischemic stroke and first MI, respectively.
  • Relative to peers using neither PPIs nor histamine H2 receptor antagonists, current PPI users had elevated risks for ischemic stroke (HR, 1.13; P<.001 and mi p>
  • Patients using high doses of PPI had greatest elevations of risk for ischemic stroke and MI (HR, 1.31; P<.001 and hr p>
  • During a 6-mo period, relative to nonusers, long-term PPI users (defined daily dose >84 d during 6-mo period) had 29% and 36% greater absolute risks for ischemic stroke and MI, respectively.
  • Histamine H2 receptor antagonist users did not have significantly elevated risks.

Study design

  • A cohort study of 214,998 Danish patients ≤6 mo out from elective upper gastrointestinal endoscopy and without known atherosclerotic disease.
  • Main outcomes were ischemic stroke and MI over median 5.8 y.
  • Funding: Danish Heart Foundation.

Limitations

  • Potential confounders.
  • Observed associations may not be causal.
  • Limited power for histamine H2 receptor antagonists.