PPIs increase risk of stroke, MI and death in older diabetics

Excerpt

Proton pump inhibitors (PPIs) increase the risk of ischaemic stroke and death in older patients with diabetes mellitus (DM), according to findings of a study published in Drugs & Aging. Data from administrative health databases in the Lombardy region of Italy were used to investigate the effects of PPI (omeprazole, esomeprazole, lansoprazole or rabeprazole) use on the risk of ischaemic stroke, myocardial infarction (MI) and all-cause death in 88 876 patients 65 years of age and older with DM, compared with the same number of propensity score-matched non-users of PPIs. The median duration of follow-up was 6.7 years.PPI use was associated with an increased risk of ischaemic stroke (hazard ratio [HR] 1.14; 95% CI 1.08, 1.20), MI (HR 1.36; 95% CI 1.31, 1.41) and all-cause death (HR 1.24; 95% CI 1.22, 1.26) compared with no PPI use. These risks were increased irrespective of the type of PPI. The risks of ischaemic stroke and MI were greatest in lansoprazole users, and the risk of all-cause death was greatest in omeprazole users, compared with non-PPI users.Subgroup analysis found that use of PPIs was correlated with significantly increased risks of ischaemic stroke and MI in men, in patients without a history of cardiovascular (CV) disease, and in those who were not treated with insulin. PPI use was also correlated with a significantly higher risk of total mortality in men and in patients not treated with insulin."Our findings confirmed an increased risk of CV events and all-cause mortality in a large population of older adults with DM exposed to PPIs," the authors concluded. The results suggest caution in prolonged use of PPIs in patients with DM, and regular assessment of their appropriateness, particularly in older patients, they commented. …