Heartburn medication may increase ischemic stroke risk

NEW ORLEANS — Proton pump inhibitors, used to treat heartburn and reduce stomach acid, may elevate risk for ischemic stroke, according to a presentation at the American Heart Association Scientific Sessions.

Thomas S.G. Sehested, MD, a researcher at the Danish Heart Foundation in Copenhagen, Denmark, and colleagues assessed for incidence of first time ischemic stroke in the records of Danish patients (n = 244,679; mean age, 57 years) who had an endoscopy.

“[Proton pump inhibitors (PPIs)] have been associated with unhealthy vascular function, including [MIs], kidney disease and dementia,” Sehested said in a press release. “We wanted to see if PPIs also posed a risk for ischemic stroke, especially given their increasing use in the general population.”

Sehested and colleagues looked for first time stroke while patients were using one of four PPIs: omeprazole (Prilosec, AstraZeneca), pantoprazole (Protonix, Wyeth), lansoprazole (Prevacid, Takeda) and esomeprazole (Nexium, AstraZeneca). PPI users were older than nonusers and had more comorbidities such as baseline atrial fibrillation (PPI users, 3.8%; nonusers, 3.4%).

During the 6 years of follow-up, 3.9% of patients (n = 9,489) had a first ischemic stroke. After adjustment for age, sex, comorbidities and use of non-steroidal anti-inflammatory drugs, time-dependent PPI exposure was associated with stroke (incidence rate ratio [IRR] = 1.21; 95% CI, 1.16-1.27; P < .0001), according to the researchers.

At the lowest doses of PPIs, slight or no increase in stroke risk was found (IRR for omeprazole 10 mg = 0.95; 95% CI, 0.59-1.5, P = .8; IRR for pantoprazole 20 mg = 1.19; 95% CI, 1.03-1.38, P = .02; IRR for lansoprazole 15 mg = 0.98; 95% CI, 0.83 to 1.18; P = .02; IRR for esomeprazole 20 mg = 0.99; 95% CI, 0.87 to 1.14; P = .9).

In the highest doses, stroke risk increased 40% for omeprazole, 30% for lansoprazole, 58% for esomeprazole and 94% for pantoprazole (all P < .005), according to the researchers.

Histamine H2 receptor antagonists were not found to be associated with stroke (IRR = 0.99; 95% CI, 0.83-1.21; P = 0.99). Sehested and colleagues could not say that these agents are better than PPIs for patients with heartburn.

“At one time, PPIs were thought to be safe, without major side effects,” Sehested said. “This study further questions the [CV] safety of these drugs.” – by Cassie Homer

Reference:

Sehested TS, et al. Presentation 391. Presented at: American Heart Association Scientific Sessions; Nov. 12-16, 2016; New Orleans.

Disclosure: Sehested reports no relevant financial disclosures.