心肌梗死、胃食管反流病与抑酸药物之间是否存在关联？

Is there any association between myocardial infarction, gastro-oesophageal reflux disease and acid-suppressing drugs?

作者信息

Johansson S, Wallander M-A, Ruigómez A, García Rodríguez L A

机构信息

The Cardiovascular Institute, Department of Medicine, Sahlgrenska University Hospital/Ostra, Göteborg, Sweden.

出版信息

Aliment Pharmacol Ther. 2003 Nov 15;18(10):973-8. doi: 10.1046/j.1365-2036.2003.01798.x.

DOI:10.1046/j.1365-2036.2003.01798.x

PMID:14616162

Abstract

BACKGROUND

A link between gastro-oesophageal reflux disease and coronary heart disease has been suggested.

AIM

To estimate the incidence of myocardial infarction in patients with newly diagnosed gastro-oesophageal reflux disease in comparison with that in the general population.

METHODS

A population-based cohort study was performed in the UK. Patients aged 18-79 years with a first diagnosis of gastro-oesophageal reflux disease (n = 7084) were identified and a group of 10,000 patients free of gastro-oesophageal reflux disease were sampled. A nested case-control analysis was performed to assess the risk factors for myocardial infarction.

RESULTS

The incidence of myocardial infarction in the general population was 4.0 per 1,000 person-years [95% confidence interval (CI), 3.2-4.9] and 5.1 per 1,000 person-years (95% CI, 4.1-6.4) in patients with gastro-oesophageal reflux disease. The relative risk of myocardial infarction in patients with gastro-oesophageal reflux disease was 1.4 (95% CI, 1.0-1.9). The increased risk of myocardial infarction was limited to the immediate days after the diagnosis of gastro-oesophageal reflux disease. Previous chest pain was an important predictor of myocardial infarction in patients free of gastro-oesophageal reflux disease. No association was found between the use of acid-suppressing drugs and the risk of myocardial infarction.

CONCLUSION

Our results suggest that gastro-oesophageal reflux disease is not an independent predictor of myocardial infarction. Rather, the increased risk of myocardial infarction in patients with gastro-oesophageal reflux disease in the immediate days after diagnosis indicates that prodromal ischaemic symptoms were misinterpreted as reflux symptoms.

摘要

背景

已有研究表明胃食管反流病与冠心病之间存在联系。

目的

评估新诊断的胃食管反流病患者中心肌梗死的发病率，并与普通人群进行比较。

方法

在英国开展了一项基于人群的队列研究。确定了年龄在18 - 79岁之间首次诊断为胃食管反流病的患者（n = 7084），并抽取了10000名无胃食管反流病的患者作为对照。进行巢式病例对照分析以评估心肌梗死的危险因素。

结果

普通人群中心肌梗死的发病率为每1000人年4.0例[95%置信区间（CI），3.2 - 4.9]，胃食管反流病患者为每1000人年5.1例（95% CI，4.1 - 6.4）。胃食管反流病患者发生心肌梗死的相对风险为1.4（95% CI，1.0 - 1.9）。心肌梗死风险的增加仅限于胃食管反流病诊断后的即刻。既往胸痛是无胃食管反流病患者发生心肌梗死的重要预测因素。未发现使用抑酸药物与心肌梗死风险之间存在关联。