WSO - June 2023 - 590

1133219
WSO
International Journal of StrokeKim et al.
Research
Risks of long-term use of proton pump
inhibitor on ischemic vascular events:
A distributed network analysis of 5 realworld
observational Korean databases
using a common data model
Yerim Kim1 , Seung In Seo2, Kyung Joo Lee3, Jinseob Kim4,
Jong Jin Yoo2, Won-Woo Seo2 and Woon Geon Shin2
Abstract
Background: Proton pump inhibitors (PPIs) are frequently prescribed drugs. However, it has been suggested that
they are associated with an increased risk of ischemic vascular events (IVE) including stroke, although the data are
inconsistent.
Aims: We investigated the association between PPIs use and IVE in five observational Korean databases using a common
data model (CDM).
Methods: This study included patient-based retrospective, observational cohort data of subjects aged over 18 years
between January 1, 2004, and December 31, 2020, from five medical centers as part of the Observational Medical Outcomes
Partnership (OMOP) CDM. Subjects who were included in both cohorts or had a previous history of ischemic
stroke were excluded. After propensity matching, 8007 propensity-matched pairs between the PPIs and H2 receptor
antagonist (H2RA) users were included in this study.
Results: In the 1:1 propensity score matching with 8007 in each group, long-term PPIs use (⩾365 days) was not associated
with ischemic stroke (odds ratio (OR) = 1.05, 95% confidence interval (CI) 0.71-1.56; I2 = 57%), ischemic stroke
and transient ischemic attack (OR = 1.02, 95% CI 0.71-1.48; I2 = 53%), and net adverse clinical events (OR = 1.08, 95% CI
0.83-1.40; I2 = 47%) compared with H2RAs users.
Conclusions: Our analysis in a large dataset found no evidence that long-term use of PPIs was associated with an
increased risk of ischemic stroke.
Keywords
Common data model, H2 receptor antagonist, ischemic stroke, proton pump inhibitors, stroke
Received: 4 August 2022; accepted: 26 September 2022
Introduction
Proton pump inhibitors (PPIs) are the most effective medicine
for gastric acid-related diseases and are recommended
in patients receiving antiplatelet therapies to reduce the risk
of gastrointestinal hemorrhage.1 Because PPIs are known
to be more effective than histamine 2 receptor antagonists
(H2RAs),2 PPIs remain among the most widely used medications
in the world. However, several post-PPI complications
including pneumonia, Clostridium difficile infection,
osteoporosis, acute kidney injury, and ischemic stroke (IS)
have been reported.3 Preclinical studies have demonstrated
International Journal of Stroke, 18(5)
1 Department of Neurology, Kangdong Sacred Heart Hospital, Hallym
University College of Medicine, Seoul, Korea
2 Department of Internal Medicine, Kangdong Sacred Heart Hospital,
Hallym University College of Medicine, Seoul, Korea
3 University Industry Foundation, Hallym University, Chuncheon, Korea
4 Department of Epidemiology, School of Public Health, Seoul National
University, Seoul, Korea
Corresponding author:
Woon Geon Shin, Division of Gastroenterology, Department of Internal
Medicine, Kangdong Sacred Heart Hospital, 150, Seongan-ro, Gangdonggu,
Seoul 05355, Korea.
Email: sgun9139@gmail.com
Correction (January 2023): This article has been updated to correct the
Grant ID for the Basic Science Research Program
International Journal of Stroke
2023, Vol. 18(5) 590 -598
© 2022 World Stroke Organization
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DOI: 10.1177/17474930221133219
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https://doi.org/10.1177/17474930221133219
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