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Multicenter Study
. 2011 May 11:342:d2690.
doi: 10.1136/bmj.d2690.

Proton pump inhibitor use and risk of adverse cardiovascular events in aspirin treated patients with first time myocardial infarction: nationwide propensity score matched study

Mette Charlot  1 , Erik L Grove, Peter Riis Hansen, Jonas B Olesen, Ole Ahlehoff, Christian Selmer, Jesper Lindhardsen, Jan Kyst Madsen, Lars Køber, Christian Torp-Pedersen, Gunnar H Gislason
Affiliations
Multicenter Study

Proton pump inhibitor use and risk of adverse cardiovascular events in aspirin treated patients with first time myocardial infarction: nationwide propensity score matched study

Mette Charlot et al. BMJ. .

Abstract

Objective: To examine the effect of proton pump inhibitors on adverse cardiovascular events in aspirin treated patients with first time myocardial infarction.

Design: Retrospective nationwide propensity score matched study based on administrative data. Setting All hospitals in Denmark.

Participants: All aspirin treated patients surviving 30 days after a first myocardial infarction from 1997 to 2006, with follow-up for one year. Patients treated with clopidogrel were excluded.

Main outcome measures: The risk of the combined end point of cardiovascular death, myocardial infarction, or stroke associated with use of proton pump inhibitors was analysed using Kaplan-Meier analysis, Cox proportional hazard models, and propensity score matched Cox proportional hazard models. Results 3366 of 19,925 (16.9%) aspirin treated patients experienced recurrent myocardial infarction, stroke, or cardiovascular death. The hazard ratio for the combined end point in patients receiving proton pump inhibitors based on the time dependent Cox proportional hazard model was 1.46 (1.33 to 1.61; P<0.001) and for the propensity score matched model based on 8318 patients it was 1.61 (1.45 to 1.79; P<0.001). A sensitivity analysis showed no increase in risk related to use of H(2) receptor blockers (1.04, 0.79 to 1.38; P=0.78). Conclusion In aspirin treated patients with first time myocardial infarction, treatment with proton pump inhibitors was associated with an increased risk of adverse cardiovascular events.

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Conflict of interest statement

Competing interests: All authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare that (1) none haS company support for the submitted work; (2) the authors have no relationships with companies that might have an interest in the submitted work in the previous 3 years; (3) their spouses, partners, or children have no financial relationships that may be relevant to the submitted work; and (4) the authors have no non-financial interests that may be relevant to the submitted work.

Figures

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Fig 1 Flow chart of patients through study
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Fig 2 Propensity score matched Kaplan-Meier analysis of risk of cardiovascular death, myocardial infarction, or stroke
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Fig 3 Time dependent adjusted propensity score matched Cox proportional hazard analysis of risk of cardiovascular death, myocardial infarction, or stroke for subtypes of proton pump inhibitors and H2 receptor blockers
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Fig 4 Time dependent adjusted Cox proportional hazard analysis of cardiovascular death, myocardial infarction, or stroke in high risk patient subgroups treated with proton pump inhibitors. Diabetes=requiring glucose lowering drugs
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Fig 5 Requested size of unmeasured confounder to fully explain increase in risk from 1.00 to 1.61
See this image and copyright information in PMC

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