Proton pump inhibitor use and the risk of adverse cardiovascular events in aspirin-treated patients with coronary artery disease
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Background: Concomitant use of aspirin and proton pump inhibitors (PPIs) may lead to decreased aspirin bioavailability and antiplatelet effects. PPIs are recommended by the American Heart Association to treat or prevent gastrointestinal events amongst selected patients taking a daily aspirin for cardioprophylaxis. This study will assess the impact of concomitant aspirin and PPI use in patients with coronary artery disease (CAD).
Methods: Using administrative data, we identified CAD patients aged 40 years or older with no history of PPI use. New PPI users were matched by propensity score to non-users. Outcomes of interest included myocardial infarction (MI), coronary revascularization, stroke, and all-cause mortality. Cox proportional hazards regression was used to examine the associations between PPI use and outcomes.
Results: The study population included 1199 patients who used a PPI during the study period matched to 1199 non-PPI users. There were 317 MIs, 521 strokes, 171 revascularizations, and 419 deaths during an average of 2.4 years of follow-up. Compared to CAD patients taking aspirin alone, those also taking a PPI had an increased risk of stroke and all-cause mortality (Hazard ratios 1.21 [1.03, 1.23] and 1.10 [1.01, 1.20], respectively). We did not observe an increased risk of MI or revascularization associated with PPI use.
Conclusion: Concomitant aspirin and PPI use may increase the risk of stroke and all-cause mortality in CAD patients. Future research will examine the impact of adherence to PPI therapy and will investigate any differences between primary and secondary prevention in CAD patients taking aspirin and PPIs.