SNFGE SNFGE
 
Thématique :
- Colo-proctologie
Originalité :
Intermédiaire
Solidité :
Très solide
Doit faire évoluer notre pratique :
Immédiatement
 
 
Nom du veilleur :
Docteur Pauline JOUET
Coup de coeur :
 
 
Gastroenterology
  2018/04  
 
  2018 Apr;154(5):1290-1297.e1.  
  doi: 10.1053/j.gastro.2017.12.006.  
 
  No Significant Association Between Proton Pump Inhibitor Use and Risk of Stroke After Adjustment for Lifestyle Factors and Indication.  
 
  Nguyen LH, Lochhead P, Joshi AD, Cao Y, Ma W, Khalili H, Rimm EB, Rexrode KM, Chan AT  
  https://www.ncbi.nlm.nih.gov/pubmed/29269313  
 
 

Abstract

BACKGROUND & AIMS:

Proton pump inhibitors (PPI) are among the top 10 most prescribed medications worldwide. We investigated the association between PPI use and ischemic stroke.

METHODS:

We collected data on 68,514 women (mean age, 65 ± 7 years) enrolled in the Nurses' Health Study since 2000 and 28,989 men (mean age, 69 ± 8 years) in the Health Professionals Follow-up Study since 2004, without a history of stroke. We used Cox proportional hazards models to examine the association between risk of incident stroke and PPI use among participants. The primary end point was first incident stroke.

RESULTS:

In the 2 cohorts, we documented 2599 incident strokes (2037 in women and 562 in men) over a 12-year period, encompassing 949,330 person-years. After adjustment for established risk factors for stroke, PPI use was associated with a significant increase in risk of ischemic stroke (hazard ratio, 1.18; 95% confidence interval, 1.02-1.37). The association was reduced after we adjusted for potential indications for PPI use, including history of peptic ulcer disease, gastroesophageal reflux disease, or gastrointestinal bleeding, and prior use of histamine-2 receptor antagonist therapy (hazard ratio, 1.08; 95% confidence interval, 0.91-1.27). Regular PPI use was not associated with increased risk of stroke overall or hemorrhagic stroke.

CONCLUSIONS:

In an analysis of data from the Nurses' Health Study and the Health Professionals Follow-up Study, we did not find a significant association between PPI use and ischemic stroke, after accounting for indications for PPI use. Prior reports of an increased risk of stroke may be due to residual confounding related to chronic conditions associated with PPI use.

 

 
Question posée
 
La prise d’inhibiteur de la pompe à protons est-elle associée à un risque augmenté d’accident vasculaire cérébral (AVC ) ischémique?
 
Question posée
 
Dans cette large étude prospective portant sur deux cohortes de patients (68,514 femmes et 28,989 hommes), après ajustement pour les facteurs de risque d’AVC et les potentielles indications de traitement par IPP, la prise régulière d’IPP n’était pas associée à un risque augmenté d’AVC ischémique.
 
Commentaires

Un article très solide pour rassurer les patients sur la bonne tolérance vasculaire (au moins cérébrale) des IPP.

 
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