老年绝经后妇女质子泵抑制剂的使用与心血管疾病的发生率

IF 4.3 2区 医学 Q1 GERIATRICS & GERONTOLOGY
Ahmed I. Soliman, Jean Wactawski-Wende, Amy E. Millen, Shelly L. Gray, Charles B. Eaton, Kathleen M. Hovey, Chris A. Andrews, Aladdin H. Shadyab, Bernhard Haring, Nazmus Saquib, Karen C. Johnson, Matthew Allison, JoAnn E. Manson, Michael J. LaMonte
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引用次数: 0

摘要

背景:关于质子泵抑制剂(PPI)使用与原发性心血管疾病(CVD)事件风险之间的关联,流行病学研究并不一致。方法:我们研究了85,189名绝经后妇女(基线时平均年龄63岁),在妇女健康倡议观察研究(1993-1998)登记时没有已知的心血管疾病。根据基线和第3年的药物清单确定PPI使用情况。CVD事件由医生判定并定义为冠心病、中风和CVD死亡率的复合。随访时间从基线至2010年9月。使用多变量Cox比例风险模型,根据基线PPI使用情况(否/是)、使用持续时间(未使用,3年)和基于更新的第3年信息的时变,估计CVD事件的风险比(HR)和95%置信区间(CI)。倾向评分调整用于控制残留混杂。结果:基线时,1747名(2.1%)女性报告使用PPIs。在平均11年的随访中,发现5778例(6.8%)原发性心血管疾病。在完全调整后的模型中(HR: 1.21, 95% CI: 1.02-1.43)和倾向评分调整后(HR: 1.27, 95% CI: 1.21-1.32), PPI使用者患心血管疾病的风险明显高于非PPI使用者。PPI使用时间越长,心血管疾病风险越高(hr: 3年:1.33;P代表趋势= 0.02)。结论:使用PPI与老年绝经后妇女发生原发性心血管疾病的高风险相关。这些发现强调了指导使用PPI以避免不良事件的重要性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Proton Pump Inhibitor Use and Incident Cardiovascular Disease in Older Postmenopausal Women

Background

Epidemiological studies have been inconsistent regarding an association between proton pump inhibitor (PPI) use and risk of primary cardiovascular disease (CVD) events.

Methods

We studied 85,189 postmenopausal women (mean age 63 years at baseline) without known CVD at enrollment into the Women's Health Initiative Observational Study (1993–1998). PPI use was determined from medication inventories at baseline and Year-3. CVD events were physician adjudicated and defined as a composite of coronary heart disease, stroke, and CVD mortality. Follow up was from baseline to September 2010. Multivariable Cox proportional hazard models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for incident CVD according to baseline PPI use (no/yes), use duration (non-user, < 1 year, 1–3 years, > 3 years), and time-varying based on updated Year-3 information. Propensity score adjustment was used to control for residual confounding.

Results

At baseline, 1747 (2.1%) women reported using PPIs. During a mean follow-up of 11 years, 5778 (6.8%) cases of primary CVD were identified. PPI users had significantly higher risk of CVD compared with non-users in the fully adjusted model (HR: 1.21, 95% CI: 1.02–1.43), and after propensity score adjustment (HR: 1.27, 95% CI: 1.21–1.32). Longer PPI use duration was associated with incrementally higher CVD risk (HRs: < 1 year: 1.11, 1–3 years: 1.27, > 3 years: 1.33; p for trend = 0.02).

Conclusions

PPI use was associated with higher risk of incident primary CVD in older postmenopausal women. These findings underscore the importance of guideline-directed PPI use to avoid unwanted adverse events.

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来源期刊
CiteScore
10.00
自引率
6.30%
发文量
504
审稿时长
3-6 weeks
期刊介绍: Journal of the American Geriatrics Society (JAGS) is the go-to journal for clinical aging research. We provide a diverse, interprofessional community of healthcare professionals with the latest insights on geriatrics education, clinical practice, and public policy—all supporting the high-quality, person-centered care essential to our well-being as we age. Since the publication of our first edition in 1953, JAGS has remained one of the oldest and most impactful journals dedicated exclusively to gerontology and geriatrics.
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