News: Proton pump inhibitors increase stroke risk
The use of proton pump inhibitors (PPIs) is associated with an increased risk of first stroke, according to a study conducted by researchers at the Danish Heart Foundation. The study included 244,679 people, of which 44% had received a prescription for a PPI. After adjusting for age, sex, hypertension, diabetes, NSAID use and other confounding factor the researchers found that there was a time-dependent relationship between the use of PPIs and stroke (with a 95% confidence interval).
Furthermore, a dose-response relationship was also found between the use of PPIs and the risk of ischaemic stroke, with risk of stroke increasing to up to 94% for patients that take pantoprazole.
PPIs are prescribed widely in general practice to those who suffer from various gastro-intestinal conditions or as a gastro-protective agent. Whilst PPIs were originally thought to be largely safe and without major side effects, more recent research has suggested an association between PPIs and vascular dysfunction, including an increased risk of heart attacks. And although the researchers noted that this study could not prove that PPIs are causally related to ischaemic stroke, their results further question the cardiovascular safety of these drugs and highlight a need to further clarify the details of such possible association.
In addition to PPIs, the researchers also looked at patients who had previously taken H2-receptor antagonists but found that there was no increased risk of stroke with the use of this class of medicines. They were however unable to determine whether the use of H2-receptor antagonists is safer than PPIs in this population and suggested that further randomized controlled trials are necessary to elucidate the cardiovascular safety of this class of drugs.
Sehested TSG, Charlot M, Fosbøl EL, et al. Proton pump inhibitor use increases the associated risk of first-time ischemic stroke: a nationwide cohort study. Presented at: American Heart Association Scientific Sessions 2016. November 15, 2016. New Orleans, LA.