Xia Bin, He Qiangsheng, Smith Fang Gao, Gkoutos V Georgios, Nirantharakumar Krishnarajah, Kuo Zi Chong, Wang Danni, Feng Qi, Cheung Eddie C, Dai Lunzhi, Huang Junjie, Yu Yuanyuan, Meng Wenbo, Qin Xiwen, Yuan Jinqiu
Department of Epidemiology and Biostatistics, Clinical Big Data Research Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, China.
Chinese Health RIsk MAnagement Collaboration (CHRIMAC), Shenzhen, Guangdong, China.
Nat Commun. 2024 Apr 27;15(1):3591. doi: 10.1038/s41467-024-48007-8.
Proton pump inhibitors (PPIs) are commonly used for gastric acid-related disorders, but their safety profile and risk stratification for high-burden diseases need further investigation. Analyzing over 2 million participants from five prospective cohorts from the US, the UK, and China, we found that PPI use correlated with increased risk of 15 leading global diseases, such as ischemic heart disease, diabetes, respiratory infections, and chronic kidney disease. These associations showed dose-response relationships and consistency across different PPI types. PPI-related absolute risks increased with baseline risks, with approximately 82% of cases occurring in those at the upper 40% of the baseline predicted risk, and only 11.5% of cases occurring in individuals at the lower 50% of the baseline risk. While statistical association does not necessarily imply causation, its potential safety concerns suggest that personalized use of PPIs through risk stratification might guide appropriate decision-making for patients, clinicians, and the public.
质子泵抑制剂（PPIs）常用于治疗与胃酸相关的疾病，但其安全性及对高负担疾病的风险分层仍需进一步研究。通过分析来自美国、英国和中国的五项前瞻性队列研究中的200多万参与者，我们发现使用PPIs与15种全球主要疾病风险增加相关，如缺血性心脏病、糖尿病、呼吸道感染和慢性肾病。这些关联呈现剂量反应关系，且在不同类型的PPIs中具有一致性。与PPIs相关的绝对风险随基线风险增加而升高，约82%的病例发生在基线预测风险处于前40%的人群中，而只有11.5%的病例发生在基线风险处于后50%的个体中。虽然统计学关联不一定意味着因果关系，但其潜在的安全问题表明，通过风险分层进行PPIs的个性化使用可能会为患者、临床医生和公众指导适当的决策。
