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The long‐term risk for myocardial infarction or stroke after proton pump inhibitor therapy (2008‐2018)
Author(s) -
Nolde Michael,
Ahn Nayeon,
Dreischulte Tobias,
RückertEheberg InaMaria,
Güntner Florian,
Günter Alexander,
Gerlach Roman,
Tauscher Martin,
Amann Ute,
Linseisen Jakob,
Meisinger Christa,
Baumeister SebastianEdgar
Publication year - 2021
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/apt.16565
Subject(s) - medicine , hazard ratio , myocardial infarction , confounding , stroke (engine) , proportional hazards model , confidence interval , observational study , cardiology , mechanical engineering , engineering
Summary Background Proton pump inhibitors (PPIs) are well tolerated in the short term but have recently been associated with increased long‐term cardiovascular risk in observational studies. Aims To evaluate long‐term risks of myocardial infarction (MI) and ischaemic stroke (IS) associated with PPI vs H 2 ‐receptor antagonist (H 2 RA) therapy in adults without pre‐existing cardiovascular or cerebrovascular disease Methods Using administrative claims data (2008–2018), we emulated a target trial comparing MI and IS risks in new users of PPIs vs H 2 RAs. Treatment was identified using dispensed prescriptions. MI and IS were defined using hospital discharge codes. Inverse probability weighting was used to adjust for confounding, and Cox models to estimate hazard ratios (HRs). Survival curves were estimated using weighted Kaplan‐Meier estimators. Results We identified 1 143 948 new users of PPIs and 36 229 new users of H 2 RAs who were free of prevalent cardiovascular or cerebrovascular disease. The mean follow‐up time was 6.2 years for PPI initiators and 5.3 years for H 2 RA initiators. After 10 years, the HRs for MI and IS were 0.96 (95% confidence interval (CI): 0.80‐1.16) and 0.98 (95% CI: 0.89‐1.08), respectively. Conclusions This analysis of claims data of a large German health insurer did not provide evidence that PPI therapy increased the risk of MI or IS in the first decade after treatment initiation.