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PPIs not tied to higher stroke risk
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Individuals who regularly used proton pump inhibitors showed no increased risk for stroke in a new study published in Gastroenterology.
Andrew T. Chan, MD, MPH, of Massachusetts General Hospital and Harvard Medical School, and colleagues reported that they did not find a significant association between PPI use and ischemic stroke after accounting for indications of PPI use.
“Several studies have identified a potential association between PPI use and stroke, but have been limited by assessment of PPI use or stroke events through either retrospective recall or administrative claims, the inclusion of only individuals with a prior history of cardiovascular disease (CVD), use of composite CVD outcome measures and a lack of detailed information on lifestyle risk factors for stroke or indications for PPI use,” they wrote.
The researchers studied data from two large cohorts: 68,514 women (mean age, 65±7 years) enrolled in the Nurses’ Health Study (NHS) since 2000; and 28,989 men (mean age, 69±8 years) in the Health Professionals Follow-up Study since 2004. The individuals had no history of prior stroke.
Over 12 years, researchers documented 2,599 incident strokes (2,037 in women and 562 in men), and found there was no observed difference in the combined cohort in the summary estimate risk for total stroke or hemorrhagic stroke.
Although researchers did observe a significant difference in age-adjusted risk for ischemic stroke associated with PPI use (HR = 1.25; 95% CI, 1.08-1.46), the association was attenuated somewhat after multivariable adjustment for smoking status, BMI and other lifestyle risk factors for stroke (HR = 1.18; 95% CI, 1.02-1.37.) After additional analyses adjusting for several indications for PPI use found that the association between PPI use and ischemic stroke was further attenuated (HR = 1.08; 95% CI, 0.91-1.27), the researchers said they could not find a single indication that was the dominant source of confounding.
“These findings suggest that previously reported associations relating PPI therapy and ischemic stroke or other adverse events may have resulted from residual confounding, highlighting the need for caution in the interpretation of pharmacoepidemiologic data in which modest associations are detected,” they wrote. – by Alex Young
Disclosures: The authors report no relevant financial disclosures.
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