STUDY OBJECTIVE: To determine if the use of acid-suppressing drugs is increased before the occurrence of ischemic events. DESIGN: Population-based, nested case-control analysis. DATA SOURCE: Administrative databases in Saskatchewan, Canada. PATIENTS: Cases were 1612 patients (aged ≥ 40 yrs) who started a first-ever antihypertensive drug between January 1, 1994, and December 31, 2003, and were hospitalized for a first ischemic heart event of either myocardial infarction (1002 patients) or unstable angina (610 patients); five control patients were matched to each case patient by age, sex, and year of first antihypertensive prescription (8060 controls). MEASUREMENTS AND MAIN RESULTS: Within the case and control groups, we calculated exposure to acid-suppressing therapy, defined as proton pump inhibitors (PPIs) or histamine(2)-receptor antagonists (H(2)RAs), within 90 days leading up to the event. Exposure to acid-suppressing therapy was higher among cases than controls (15.3% [246/1612] vs 10.4% [837/8060], adjusted odds ratio [AOR] 1.26, 95% confidence interval [CI] 1.06-1.49, p<0.009). Exposure to each acid suppressant was similarly higher among cases than controls: H(2)RA users (11.7% [188/1612] vs 8.4% [678/8060], AOR 1.21, 95% CI 1.00-1.46, p<0.048) and PPI users (4.0% [64/1612] vs 2.2% [179/8060], AOR 1.32, 95% CI 0.95-1.84, p=0.094). Use of other drugs was also significantly increased during this period. CONCLUSIONS: Use of acid-suppressing drugs increased before the occurrence of ischemic events regardless of the type (PPI or H(2)RA) or whether other drugs, such as clopidogrel, were concurrently administered. In addition, significant increases in overall drug use were observed during this time frame, suggesting that many patients exhibit warning signs before an acute hospitalization. Thus, PPI use before the occurrence of ischemic events may simply be a marker of unmeasured and uncontrolled confounding in observational studies that have implicated a PPI-clopidogrel interaction as a cause of recurrent ischemic events.
STUDY OBJECTIVE: To determine if the use of acid-suppressing drugs is increased before the occurrence of ischemic events. DESIGN: Population-based, nested case-control analysis. DATA SOURCE: Administrative databases in Saskatchewan, Canada. PATIENTS: Cases were 1612 patients (aged ≥ 40 yrs) who started a first-ever antihypertensive drug between January 1, 1994, and December 31, 2003, and were hospitalized for a first ischemic heart event of either myocardial infarction (1002 patients) or unstable angina (610 patients); five control patients were matched to each case patient by age, sex, and year of first antihypertensive prescription (8060 controls). MEASUREMENTS AND MAIN RESULTS: Within the case and control groups, we calculated exposure to acid-suppressing therapy, defined as proton pump inhibitors (PPIs) or histamine(2)-receptor antagonists (H(2)RAs), within 90 days leading up to the event. Exposure to acid-suppressing therapy was higher among cases than controls (15.3% [246/1612] vs 10.4% [837/8060], adjusted odds ratio [AOR] 1.26, 95% confidence interval [CI] 1.06-1.49, p<0.009). Exposure to each acid suppressant was similarly higher among cases than controls: H(2)RA users (11.7% [188/1612] vs 8.4% [678/8060], AOR 1.21, 95% CI 1.00-1.46, p<0.048) and PPI users (4.0% [64/1612] vs 2.2% [179/8060], AOR 1.32, 95% CI 0.95-1.84, p=0.094). Use of other drugs was also significantly increased during this period. CONCLUSIONS: Use of acid-suppressing drugs increased before the occurrence of ischemic events regardless of the type (PPI or H(2)RA) or whether other drugs, such as clopidogrel, were concurrently administered. In addition, significant increases in overall drug use were observed during this time frame, suggesting that many patients exhibit warning signs before an acute hospitalization. Thus, PPI use before the occurrence of ischemic events may simply be a marker of unmeasured and uncontrolled confounding in observational studies that have implicated a PPI-clopidogrel interaction as a cause of recurrent ischemic events.
Authors: Elizabeth J Bell; Suzette J Bielinski; Jennifer L St Sauver; Lin Y Chen; Mary R Rooney; Nicholas B Larson; Paul Y Takahashi; Aaron R Folsom Journal: Mayo Clin Proc Date: 2021-10 Impact factor: 11.104
Authors: Steven P Dunn; Steven R Steinhubl; Deborah Bauer; Richard J Charnigo; Peter B Berger; Eric J Topol Journal: J Am Heart Assoc Date: 2013-01-15 Impact factor: 5.501
Authors: Ana Ruigómez; Saga Johansson; Péter Nagy; Mar Martín-Pérez; Luis A García Rodríguez Journal: BMC Gastroenterol Date: 2014-12-10 Impact factor: 3.067