Use of proton pump inhibitors and the risk of coronary events in new users of low-dose acetylsalicylic acid in UK primary care

• Published in: Thrombosis and haemostasis Vol. 111; no. 1; p. 131
• Main Authors: García Rodríguez, Luis A, Johansson, Saga, Nagy, Péter, Cea Soriano, Lucía
• Format: Journal Article
• Language: English
• Published: Germany 01.01.2014
• Subjects: Aged; Aged, 80 and over; Aspirin - administration & dosage; Aspirin - adverse effects; Cardiovascular Diseases - drug therapy; Cardiovascular Diseases - prevention & control; Case-Control Studies; Cohort Studies; Drug Interactions; Female; Humans; Male; Middle Aged; Myocardial Infarction - mortality; Myocardial Infarction - prevention & control; Platelet Aggregation Inhibitors - administration & dosage; Platelet Aggregation Inhibitors - adverse effects; Primary Health Care; Proton Pump Inhibitors - administration & dosage; Proton Pump Inhibitors - adverse effects; Risk; United Kingdom; proton pump inhibitors; aspirin; Acetylsalicylic acid; cardiovascular; myocardial infarction
• ISSN: 0340-6245
• DOI: 10.1160/TH13-07-0542

This study evaluated the risk of cardiovascular events associated with the use of proton pump inhibitors (PPIs) in new users of acetylsalicylic acid (ASA) for the secondary prevention of cardiovascular events. Two cohorts of patients aged 50-84 years were identified from UK primary care databases: individuals with a first prescription for ASA (75-300 mg/day) for secondary prevention of cardiovascular events (n = 39,513; CVD cohort) or with a record of hospitalisation for an acute coronary event (n = 42,542; ACS cohort) in 2000-2007. Cases of non-fatal myocardial infarction (MI) and coronary death were identified: 1,222 in the CVD cohort and 604 among new users of ASA in the ACS cohort. A nested case-control analysis estimated the relative risk (RR) of non-fatal MI or coronary death associated with use vs non-use of PPI therapy. Current continuous use of PPI therapy was not associated with a significant increase in RR overall: in the CVD cohort (RR = 1.14 [95% confidence interval = 0.91-1.43]); in the ACS cohort (0.88 [0.66-1.18]); or among current continuous users of ASA as antiplatelet monotherapy (CVD cohort: 1.15 [0.80-1.66]; ACS cohort: 0.73 [0.43-1.23]; pooled analysis of both cohorts: 0.96 [0.62-1.48]). In conclusion, among first-time users of ASA for the secondary prevention of cardiovascular events, PPI use was not shown to be associated with an increased risk of non-fatal MI or coronary death.