Proton pump inhibitors and dementia risk: Evidence from a cohort study using linked routinely collected national health data in Wales, UK.
Proton pump inhibitors and dementia risk: Evidence from a cohort study using linked routinely collected national health data in Wales, UK.
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DOI：
10.1371/journal.pone.0237676
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发表时间：
2020
期刊：
影响因子：
3.7
通讯作者：
Brophy S
中科院分区：
文献类型：
--
作者：
Cooksey R;Kennedy J;Dennis MS;Escott-Price V;Lyons RA;Seaborne M;Brophy S
质子泵抑制剂（PPI）通常用于预防和治疗胃肠道疾病或保护胃免受其他药物的影响。研究表明它们与痴呆风险增加有关。我们使用关联的国家健康数据来检查 PPI 使用与痴呆症发生之间的关联。一项以人群为基础的研究，使用 1999 年至 2015 年英国威尔士安全匿名信息链接 (SAIL) 数据库的电子健康数据。在 3,765,744 名个人的可用数据中，针对 55 岁及以上的人建立了一个曾经服用过 PPI 处方的队列 (n = 183,968)，并将其与未暴露于 PPI 的个人 (131,110) 进行比较。那些既往患有痴呆症、轻度认知障碍或谵妄代码的人被排除在外。混杂因素包括合并症和/或与之相关的药物。合并症可能包括头部受伤，药物的一些例子包括抗抑郁药、抗血小板药和抗凝药。由于不可能在本研究中探索所有药物，因此对这些常用处方药物进行了研究。主要结果是诊断为突发性痴呆。 Cox 比例风险回归模型用于计算 PPI 暴露者与未暴露者相比发生痴呆的风险比 (HR)，同时控制潜在的混杂因素。 PPI暴露者的平均年龄为69.9岁，男性占39.8%，而未暴露者的平均年龄为72.1岁，男性占41.1%。 PPI 使用率为 58.4%（183,968），痴呆发生率为 11.8%（37,148/315,078）。 PPI 的使用与痴呆风险降低相关（HR：0.67，95% CI：0.65 至 0.67，p<0.01）。这项研究使用大规模、多中心的健康数据，无法证实 PPI 使用与痴呆风险增加之间的关联。之前报道的联系可能与使用 PPI 的人的混杂因素有关，例如心血管疾病和/或抑郁症的风险增加以及相关药物可能导致患痴呆症的风险增加。
Proton pump inhibitors (PPIs) are commonly prescribed for prevention and treatment of gastrointestinal conditions or for gastroprotection from other drugs. Research suggests they are linked to increased dementia risk. We use linked national health data to examine the association between PPI use and the development of incident dementia. A population-based study using electronic health-data from the Secure Anonymised Information Linkage (SAIL) Databank, Wales (UK) from 1999 to 2015. Of data available on 3,765,744 individuals, a cohort who had ever been prescribed a PPI was developed (n = 183,968) for people aged 55 years and over and compared to non-PPI exposed individuals (131,110). Those with prior dementia, mild-cognitive-impairment or delirium codes were excluded. Confounding factors included comorbidities and/or drugs associated with them. Comorbidities might include head injury and some examples of medications include antidepressants, antiplatelets and anticoagulants. These commonly prescribed drugs were investigated as it was not feasible to explore all drugs in this study. The main outcome was a diagnosis of incident dementia. Cox proportional hazard regression modelling was used to calculate the Hazard ratio (HR) of developing dementia in PPI-exposed compared to unexposed individuals while controlling for potential confounders. The mean age of the PPI exposed individuals was 69.9 years and 39.8% male while the mean age of the unexposed individuals was 72.1 years and 41.1% male. The rate of PPI usage was 58.4% (183,968) and incident dementia rate was 11.8% (37,148/315,078). PPI use was associated with decreased dementia risk (HR: 0.67, 95% CI: 0.65 to 0.67, p<0.01). This study, using large-scale, multi-centre health-data was unable to confirm an association between PPI use and increased dementia risk. Previously reported links may be associated with confounders of people using PPI’s, such as increased risk of cardiovascular disease and/or depression and their associated medications which may be responsible for any increased risk of developing dementia.
影响因子：
168.9
作者：
Bhala, N.;Emberson, J.;Merhi, A.;Abramson, S.;Arber, N.;Baron, J. A.;Bombardier, C.;Cannon, C.;Farkouh, M. E.;FitzGerald, G. A.;Goss, P.;Halls, H.;Hawk, E.;Hawkey, C.;Hennekens, C.;Hochberg, M.;Holland, L. E.;Kearney, P. M.;Laine, L.;Lanas, A.;Lance, P.;Laupacis, A.;Oates, J.;Patrono, C.;Schnitzer, T. J.;Solomon, S.;Tugwell, P.;Wilson, K.;Wittes, J.;Baigent, C.;Adelowo, O.;Aisen, P.;Al-Quorain, A.;Altman, R.;Bakris, G.;Baumgartner, H.;Bresee, C.;Carducci, M.;Chang, D-M.;Chou, C-T.;Clegg, D.;Cudkowicz, M.;Doody, L.;El Miedany, Y.;Falandry, C.;Farley, J.;Ford, L.;GarciLosa, M.;Gonzalez-Ortiz, M.;Haghighi, M.;Hala, M.;Iwama, T.;Jajic, C.;Kerr, D.;Kim, H-S.;Kohne, C.;Koo, B-K.;Martin, B.;Meinert, C.;Muller, N.;Myklebust, G.;Neustadt, D.;Omdal, R.;Ozgocmen, S.;Papas, A.;Patrignani, P.;Pelliccia, F.;Roy, V.;Schlegelmilch, I.;Umar, A.;Wahlstrom, O.;Wollheim, F.;Yocum, S.;Zhang, X. Y.;Hall, E.;McGettigan, P.;Midgley, R.;Moore, R. A.;Philipson, R.;Curtis, S.;Reicin, A.;Bond, J.;Moore, A.;Essex, M.;Fabule, J.;Morrison, B.;Tive, L.;Davies, K.;Holland, L. E.;Merhi, A.;Yau, F.
通讯作者：
Yau, F.
影响因子：
2.8
作者：
Ford, David V.;Jones, Kerina H.;Leake, Ken
通讯作者：
Leake, Ken