Department of Pharmacy Practice, Tri-Service General Hospital, National Defense Medical Center, Taipei City 114, Taiwan.
School of Public Health, National Defense Medical Center, Taipei City 114, Taiwan.
Int J Environ Res Public Health. 2020 Nov 9;17(21):8271. doi: 10.3390/ijerph17218271.
Results of studies regarding the potential link between acid suppressant use and dementia risk are inconsistent. This study aimed to evaluate the association of cumulative exposure to histamine 2 receptor antagonists (H2RAs) and proton pump inhibitors (PPIs) with dementia risk in an Asian older cohort aged ≥65 years.
Patients initiating H2RA (the H2RA user cohort, = 21,449) or PPI (the PPI user cohort, = 6584) and those without prescription for H2RA (the H2RA non-user cohort, = 21,449) or PPI (the PPI non-user cohort, = 6584) between 1 January 2000 and 31 December 2005 without a prior history of dementia were identified from Taiwan's National Health Insurance Research Database (NHIRD). The outcome of interest was all-cause dementia. Patients' exposure to H2RAs or PPIs was followed-up from dates of initial prescription to the earliest outcome of incident dementia, death, or the end of 2013. Potential associations between acid suppressant use and dementia risk were analyzed using time-dependent Cox regression estimated hazard ratios (HRs) and 95% confidence intervals (CIs).
After mutual adjustment for H2RA and PPI use and other potential confounders, patients with H2RA use had significantly higher risk of developing dementia as compared to those not treated with H2RAs (adjusted HR, 1.84; 95% CI, 1.49-2.20). Likewise, PPI users had significantly elevated risk of dementia compared to PPI non-users (adjusted HR, 1.42; 95% CI, 1.07-1.84).
Our results indicate that exposures to H2RAs and PPIs are associated with increased dementia risk.
关于抑酸剂使用与痴呆风险之间潜在关联的研究结果并不一致。本研究旨在评估在≥65 岁的亚洲老年队列中，累积暴露于组胺 2 受体拮抗剂（H2RAs）和质子泵抑制剂（PPIs）与痴呆风险的相关性。
从台湾全民健康保险研究数据库（NHIRD）中确定了 2000 年 1 月 1 日至 2005 年 12 月 31 日期间无痴呆病史且首次处方 H2RA（H2RA 用户队列，n=21449）或 PPI（PPI 用户队列，n=6584）、无 H2RA（H2RA 非用户队列，n=21449）或 PPI（PPI 非用户队列，n=6584）的患者。主要结局为全因痴呆。从初始处方日期到首发痴呆、死亡或 2013 年底的最早结局，对 H2RAs 或 PPIs 的暴露情况进行随访。采用时间依赖性 Cox 回归估计风险比（HRs）和 95%置信区间（CIs）分析抑酸剂使用与痴呆风险之间的潜在关联。
在相互调整了 H2RA 和 PPI 使用以及其他潜在混杂因素后，与未接受 H2RA 治疗的患者相比，使用 H2RA 的患者发生痴呆的风险显著更高（调整后的 HR，1.84；95%CI，1.49-2.20）。同样，与 PPI 非使用者相比，PPI 使用者痴呆的风险显著升高（调整后的 HR，1.42；95%CI，1.07-1.84）。
我们的研究结果表明，暴露于 H2RAs 和 PPIs 与痴呆风险增加相关。
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