Risk of stroke associated with proton pump inhibitor use among individuals with and without pre-existing cardiovascular diseases: a systematic review and meta-analysis
Abstract Background Proton pump inhibitors (PPIs) are commonly used for managing gastroesophageal disorders but concerns about their potential association with increased stroke risk have emerged, especially among patients with pre-existing cardiovascular conditions such as acute coronary syndrome (A...
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BMC
2025-01-01
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| Series: | Journal of Cardiothoracic Surgery |
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| Online Access: | https://doi.org/10.1186/s13019-024-03161-4 |
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| author | Muhammed Shabil Bijaya K. Padhi Mahalaqua Nazli Khatib Soumya V. Menon Mandeep Kaur Mukesh Kumari Puneet Sudan K. Satyam Naidu Quazi Syed Zahiruddin Sarvesh Rustagi Divya Sharma Mithhil Arora Rakesh Kumar Sharma Edward Mawejje Prakasini Satapathy Sanjit Sah |
| author_facet | Muhammed Shabil Bijaya K. Padhi Mahalaqua Nazli Khatib Soumya V. Menon Mandeep Kaur Mukesh Kumari Puneet Sudan K. Satyam Naidu Quazi Syed Zahiruddin Sarvesh Rustagi Divya Sharma Mithhil Arora Rakesh Kumar Sharma Edward Mawejje Prakasini Satapathy Sanjit Sah |
| author_sort | Muhammed Shabil |
| collection | DOAJ |
| description | Abstract Background Proton pump inhibitors (PPIs) are commonly used for managing gastroesophageal disorders but concerns about their potential association with increased stroke risk have emerged, especially among patients with pre-existing cardiovascular conditions such as acute coronary syndrome (ACS). This systematic review and meta-analysis aim to assess the risk of stroke associated with PPI use, stratified by the presence or absence of pre-existing CVD. Methods This review was conducted following the PRISMA guidelines and included studies up to March 2024 from PubMed, Embase, and Web of Science. Eligible studies were longitudinal, including prospective cohorts, nested case-controls, and post-hoc analyses of RCTs that reported stroke outcomes in relation to PPI use. Data were synthesized using random-effects meta-analysis models in R software version 4.3. Results Our search yielded 41 studies encompassing over 800,000 participants globally. Meta-analysis of 14 observational studies revealed a slight but non-significant increased stroke risk among patients with prior CVD (pooled HR = 1.222, 95% CI: 0.963 to 1.481, I² = 78%). In contrast, analysis of 15 studies without prior CVD showed a modestly increased risk (pooled HR = 1.15, 95% CI: 1.023 to 1.288, I² = 98%). Five RCTs involving patients with CVD reported a pooled RR of 1.158 (95% CI: 0.914 to 1.466), indicating no significant risk increase. Conclusion The association between PPI use and stroke risk appears modest and is influenced by the presence of cardiovascular conditions. Clinical decision-making should consider individual patient risk profiles, and further high-quality studies are needed to guide safer PPI prescribing practices. |
| format | Article |
| id | doaj-art-9d958ad314c84755992ea9703eae2ad6 |
| institution | Kabale University |
| issn | 1749-8090 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Cardiothoracic Surgery |
| spelling | doaj-art-9d958ad314c84755992ea9703eae2ad62025-02-02T12:42:08ZengBMCJournal of Cardiothoracic Surgery1749-80902025-01-0120111410.1186/s13019-024-03161-4Risk of stroke associated with proton pump inhibitor use among individuals with and without pre-existing cardiovascular diseases: a systematic review and meta-analysisMuhammed Shabil0Bijaya K. Padhi1Mahalaqua Nazli Khatib2Soumya V. Menon3Mandeep Kaur4Mukesh Kumari5Puneet Sudan6K. Satyam Naidu7Quazi Syed Zahiruddin8Sarvesh Rustagi9Divya Sharma10Mithhil Arora11Rakesh Kumar Sharma12Edward Mawejje13Prakasini Satapathy14Sanjit Sah15University Center for Research and Development, Chandigarh UniversityPostgraduate Institute of Medical Education and Research, Department of Community Medicine and School of Public HealthDivision of Evidence Synthesis, Global Consortium of Public Health and Research, Datta Meghe Institute of Higher EducationDepartment of Chemistry and Biochemistry, School of Sciences, JAIN (Deemed to be University)Department of Allied Healthcare and Sciences, Vivekananda Global UniversityNIMS Institute of Engineering & Technology, Department of Applied Sciences-Chemistry, NIMS University RajasthanDepartment of Pharmacy Chandigarh Pharmacy College, Chandigarh Group of Colleges-JhanjeriDepartment of Chemistry, Raghu Engineering CollegeSouth Asia Infant Feeding Research Network (SAIFRN), Division of Evidence Synthesis, Global Consortium of Public Health and Research, Datta Meghe Institute of Higher EducationSchool of Applied and Life Sciences, Uttaranchal UniversityCentre of Research Impact and Outcome, Chitkara UniversityChitkara Centre for Research and Development, Chitkara UniversityGraphic Era (Deemed to be University)School of Public Health, Makerere University College of Health SciencesCenter for Global Health Research, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha UniversityDepartment of Paediatrics, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil VidyapeethAbstract Background Proton pump inhibitors (PPIs) are commonly used for managing gastroesophageal disorders but concerns about their potential association with increased stroke risk have emerged, especially among patients with pre-existing cardiovascular conditions such as acute coronary syndrome (ACS). This systematic review and meta-analysis aim to assess the risk of stroke associated with PPI use, stratified by the presence or absence of pre-existing CVD. Methods This review was conducted following the PRISMA guidelines and included studies up to March 2024 from PubMed, Embase, and Web of Science. Eligible studies were longitudinal, including prospective cohorts, nested case-controls, and post-hoc analyses of RCTs that reported stroke outcomes in relation to PPI use. Data were synthesized using random-effects meta-analysis models in R software version 4.3. Results Our search yielded 41 studies encompassing over 800,000 participants globally. Meta-analysis of 14 observational studies revealed a slight but non-significant increased stroke risk among patients with prior CVD (pooled HR = 1.222, 95% CI: 0.963 to 1.481, I² = 78%). In contrast, analysis of 15 studies without prior CVD showed a modestly increased risk (pooled HR = 1.15, 95% CI: 1.023 to 1.288, I² = 98%). Five RCTs involving patients with CVD reported a pooled RR of 1.158 (95% CI: 0.914 to 1.466), indicating no significant risk increase. Conclusion The association between PPI use and stroke risk appears modest and is influenced by the presence of cardiovascular conditions. Clinical decision-making should consider individual patient risk profiles, and further high-quality studies are needed to guide safer PPI prescribing practices.https://doi.org/10.1186/s13019-024-03161-4Proton pump inhibitorMeta-analysisSystematic reviewStrokeGood health and well being |
| spellingShingle | Muhammed Shabil Bijaya K. Padhi Mahalaqua Nazli Khatib Soumya V. Menon Mandeep Kaur Mukesh Kumari Puneet Sudan K. Satyam Naidu Quazi Syed Zahiruddin Sarvesh Rustagi Divya Sharma Mithhil Arora Rakesh Kumar Sharma Edward Mawejje Prakasini Satapathy Sanjit Sah Risk of stroke associated with proton pump inhibitor use among individuals with and without pre-existing cardiovascular diseases: a systematic review and meta-analysis Journal of Cardiothoracic Surgery Proton pump inhibitor Meta-analysis Systematic review Stroke Good health and well being |
| title | Risk of stroke associated with proton pump inhibitor use among individuals with and without pre-existing cardiovascular diseases: a systematic review and meta-analysis |
| title_full | Risk of stroke associated with proton pump inhibitor use among individuals with and without pre-existing cardiovascular diseases: a systematic review and meta-analysis |
| title_fullStr | Risk of stroke associated with proton pump inhibitor use among individuals with and without pre-existing cardiovascular diseases: a systematic review and meta-analysis |
| title_full_unstemmed | Risk of stroke associated with proton pump inhibitor use among individuals with and without pre-existing cardiovascular diseases: a systematic review and meta-analysis |
| title_short | Risk of stroke associated with proton pump inhibitor use among individuals with and without pre-existing cardiovascular diseases: a systematic review and meta-analysis |
| title_sort | risk of stroke associated with proton pump inhibitor use among individuals with and without pre existing cardiovascular diseases a systematic review and meta analysis |
| topic | Proton pump inhibitor Meta-analysis Systematic review Stroke Good health and well being |
| url | https://doi.org/10.1186/s13019-024-03161-4 |
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