PPIs Increase Risk of Cerebrovascular Events

The use of proton-pump inhibitors (PPIs) is associated with an increased risk of ischemic stroke among the general population, according to a recent study. This risk is also independent of antiplatelet agents.

Previous studies have suggested that concomitant use of PPIs is associated with an increased risk of adverse cardiovascular (CV) events in patients taking antiplatelet agents.
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In their retrospective nationwide study, the researchers evaluated patients aged 20 years or older whose information was available in the Taiwan National Health Insurance database. Patients using PPIs were matched 1:1 with controls via propensity scores.

The researchers defined the primary outcome as hospitalization with a primary diagnosis of ischemic stroke over the course of a 120-day follow-up. A parallel analysis with a nested case-control design was conducted. Conditional logistic regression analyses focusing on pre-baseline PPI use was utilized to identify patients hospitalized for a first-time ischemic stroke and to match them with controls.

Overall, the researchers analyzed the propensity scores of 198,148 PPI treatment courses and control periods without PPI use. Results of the study indicated that PPI use was associated with a higher risk of hospitalization due to ischemic stroke. Risk was largely based on age, according to subgroup analysis, with patients younger than 60 years facing the greatest risk. The researchers noted that gender; history of myocardial infarction (MI), diabetes, hypertension, or use of antiplatelet agents of non-steroidal anti-inflammatory drugs (NSAIDs); or type of PPIs had no effect on this risk.

In the nested case-control analysis, 15,378 patients hospitalized for ischemic stroke were identified and compared with 15,378 matched controls. Through this analysis, the researchers found an association between PPI use and increased cerebrovascular risks.

“PPI use is associated with an increased risk of first-time ischemic stroke in the general population, and the risk is independent of antiplatelet agents,” the researchers concluded. “However, caution should be exercised when considering its clinical relevance, as the magnitude of association was modest and a cause-and-effect relationship remained to be established.”

—Christina Vogt

Reference:

Wang Y-F, Chen Y-T, Luo J-C, Chen T-J, Wu J-C, Wang S-J. Proton-pump inhibitor use and the risk of first-time ischemic stroke in the general population: a nationwide population-based study. Am J Gastroenterol. 2017;112:1084-1093; doi:10.1038/ajg.2017.101.