Could PPIs Lead to First-Time Stroke?

Regular use of proton pump inhibitors (PPIs)—which are among the top 10 most prescribed medications worldwide—is not associated with an increased risk for first incident ischemic stroke, according to findings from a new study.

The study included data from 68,514 women and 28,989 men without history of stroke who were enrolled in the Nurse’s Health Study since 2000 and the Health Professionals Follow-up Study since 2004, respectively.
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The association between risk of incident stroke and PPI use was evaluated via Cox proportional hazards models.

A total of 2599 incident strokes (2037 in women and 562 in men) occurred over the course of 12 years (949,330 person-years). PPI use was found to be associated with a significant increase in ischemic stroke risk (hazard ratio [HR] 1.18) after adjustment for established stroke risk factors.

However, this association was mitigated following adjustment for potential indications for PPI use, including history of peptic ulcer disease, gastroesophageal reflux disease, or gastrointestinal bleeding, and prior use of histamine-2 receptor antagonist therapy (HR 1.08).

Ultimately, the researchers concluded that regular use of PPIs was not associated with an increased risk of stroke overall or hemorrhagic stroke, noting that “prior reports of an increased risk of stroke may be due to residual confounding related to chronic conditions associated with PPI use.”

—Christina Vogt

Reference:

Nguyen LH, Lochhead P, Joshi AD, et al. No significant association between proton pump inhibitor use and risk of stroke after adjustment for lifestyle factors and indication [Published online December 18, 2018]. Gastroenterology.  https://doi.org/10.1053/j.OKgastro.2017.12.006.