Use of proton pump inhibitors is associated with lower rates of first‐time ischemic stroke in community‐dwelling elderly

Abstract

Aim Data on cardiovascular outcomes in elderly using proton pump inhibitors (PPI) are scant. We aimed to test the association between PPI use and the occurrence of first‐time ischemic stroke (FTIS) among elderly. Methods The electronic database of a centrally located district branch of a large health maintenance organization in Israel was retrospectively screened (2002–2016) for community‐dwelling individuals (≥65–95 years) for demographics and co‐morbidities. Follow‐up was until FTIS, death or end of study. Findings were analyzed by PPI use and occurrence of FTIS. Results 29,639 subjects (without history of stroke and use of antiplatelet aggregation drugs) mean age of 82.2 ± 5.5 years (range: 65–95 years, 38% male) were analyzed: 8,600 (29%) used PPIs. Mean follow up was 10.58 years (SD ± 5.44). Similar total and annual occurrence rates of FTIS were depicted in PPI users and non‐users (20.9% vs. 21% and 2% vs. 2.1%, respectively). On a Cox regression analysis, upon adjustment for age, gender and cardiovascular disease related risk factors, PPI use was significantly associated with lower rates of FTIS (HR 0.73, 95% C.I. 0.69–0.77, p < 0.001). The risk for FTIS was significantly lower in subjects using PPI at any dose and for any time period compared to non‐users (HR 0.9, 95% C.I. 0.85–0.96 for 7–48 yearly prescriptions and HR 0.51, 95% C.I. 0.46–0.55 for ≥49 yearly prescriptions). Conclusions PPI use was associated with lower rates of FTIS in community‐dwelling elders. Prospective large‐scale studies are needed to fully elucidate the effect of PPI in this aging population.

Assessment of gastric-acid suppressants prescribing at an internal medicine service of a tertiary hospital in Latin America: A retrospective record review study

“…Several studies have shown an association between chronic use of PPIs and serious adverse effects, including Clostridium difficile and other enteric infections, intestinal colonization with multidrug-resistant microorganisms, hospital and community-acquired pneumonia, dementia, osteoporotic fractures, hypomagnesemia, and acute interstitial nephritis (4,8,10,11) . Recent retrospective observational studies suggest a likely association between long-term, high-dose PPIs use and a low increased risk of first-time ischemic stroke, especially in elderly patients (12,13) . In terms of economic burden, GASs prescription leads to a progressive increase of public health costs.…”

Proton pump inhibitors: Weighing the benefits and risks across various health conditions

“…In a population‐based cohort study, Schmilovitz‐Weiss et al 14 (BJCP 2020) evaluated 29 639 patients (with no history of stroke and/or use of antiplatelet aggregation drugs) with a mean age of 82.2 ± 5.5 years who were using PPIs. They discovered that the risk for a first‐time ischemic stroke was significantly lower in those using PPIs at any dose and for any time period compared to non‐users.…”

“…In their view, considering the low incidence of clinically important upper GIB in the ICU patients, prophylaxis with a PPI, if started, should be reserved only for severely ill patients with an increased risk for this complication (Figure 1). In a population-based cohort study, Schmilovitz-Weiss et al 14 (BJCP 2020) evaluated 29 639 patients (with no history of stroke and/or use of antiplatelet aggregation drugs) with a mean age of 82.2 ± 5.5 years who were using PPIs. They discovered that the risk for a first-time ischemic stroke was significantly lower in those using PPIs at any dose and for any time period compared to non-users.…”