质子泵抑制剂与心血管疾病和心力衰竭风险增加的关联。
Association of Proton Pump Inhibitors With Higher Risk of Cardiovascular Disease and Heart Failure.
机构信息
Department of Life Sciences, Optum, Eden Prairie, MN.
Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN.
出版信息
Mayo Clin Proc. 2021 Oct;96(10):2540-2549. doi: 10.1016/j.mayocp.2021.02.025.
OBJECTIVE
To examine associations of cumulative exposure to proton pump inhibitors (PPIs) with total cardiovascular disease (CVD; composed of stroke, coronary heart disease, and heart failure [HF]) and HF alone in a cohort study of White and African American participants of the Atherosclerosis Risk in Communities (ARIC) study.
METHODS
Use of PPIs was assessed by pill bottle inspection at visit 1 (January 1, 1987 to 1989) and up to 10 additional times before baseline (visit 5; 2011 to 2013). We calculated cumulative exposure to PPIs as days of use from visit 1 to baseline. Participants (n=4346 free of total CVD at visit 5; mean age, 75 years) were observed for incident total CVD and HF events through December 31, 2016. We used Cox regression to measure associations of PPIs with total CVD and HF.
RESULTS
After adjustment for potential confounding variables, participants with a cumulative exposure to PPIs of more than 5.1 years had a 2.02-fold higher risk of total CVD (95% CI, 1.50 to 2.72) and a 2.21-fold higher risk of HF (95% CI, 1.51 to 3.23) than nonusers.
CONCLUSION
Long-term PPI use was associated with twice the risk of total CVD and HF compared with nonusers. Our findings are in concordance with other research and suggest another reason to be cautious of PPI overuse.
目的
在一项针对社区动脉粥样硬化风险研究（ARIC）中白人和非裔美国参与者的队列研究中，检查质子泵抑制剂（PPIs）累积暴露与总心血管疾病（CVD；包括中风、冠心病和心力衰竭[HF]）和 HF 单独的关联。
方法
通过在第一次就诊（1987 年至 1989 年）时检查药瓶以及基线前的 10 次就诊（2011 年至 2013 年）评估 PPIs 的使用情况。我们将 PPIs 的累积暴露计算为从第一次就诊到基线的使用天数。参与者（n=4346，在第五次就诊时无总 CVD；平均年龄 75 岁）观察到总 CVD 和 HF 事件的发生，截至 2016 年 12 月 31 日。我们使用 Cox 回归来衡量 PPIs 与总 CVD 和 HF 的关联。
结果
在调整了潜在混杂变量后，累积暴露于 PPIs 超过 5.1 年的参与者发生总 CVD 的风险增加了 2.02 倍（95%CI，1.50 至 2.72），HF 的风险增加了 2.21 倍（95%CI，1.51 至 3.23），而非使用者。
结论
与非使用者相比，长期使用 PPI 与总 CVD 和 HF 的风险增加两倍有关。我们的研究结果与其他研究一致，表明 PPI 过度使用的另一个原因需要谨慎对待。
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