The Risk of Dementia with Proton Pump Inhibitor Use: A Study of the Atherosclerosis Risk in Communities
Key Highlights :
The use of prescription proton pump inhibitors (PPIs) has increased significantly over the past decade, with more than half of PPI prescriptions not linked to a documented diagnosis of a gastrointestinal problem. The rampant use of PPIs has raised serious health concerns, as these drugs have been linked to adverse effects such as chronic kidney disease, cardiovascular disease, stroke, and dementia.
To determine whether current and cumulative use of PPIs increases the risk of incident dementia, researchers conducted a study using data from the Atherosclerosis Risk in Communities (ARIC) study. The ARIC study recruited Black and White men and women between the ages of 45 and 64 years from four communities in the United States. Data collected from the fifth visit of the ARIC study was used to assess PPI use and its impact on incident dementia.
Information on all prescription and over-the-counter medications was gathered from all participants and inventoried to assess PPI use. Information gathered through annual phone calls was also used to determine chronic PPI use. The current use of PPIs was defined based on the use of PPIs reported at Visit 5, whereas cumulative PPI exposure was determined based on the number of years of PPI use reported from Visit 1 to the 2011 annual phone call.
Dementia was assessed using neuropsychological examinations during in-person visits, screening tools completed during bi-annual telephonic follow-ups, death records, and hospital discharge codes. A range of covariates, including race, age, sex, smoking behavior, body mass index (BMI), and the use of aspirin, vitamin B12, and anti-hypertensive medications, were also included in the analysis.
The calculation of hazard ratios was adjusted for co-morbidities, the use of other medications, and demographic covariates. Positive associations were observed between the use of PPIs and the risk of dementia; however, these associations were not significant over a median follow-up period of 5.5 years.
Nevertheless, the analysis of cumulative PPI use and its association with incident dementia indicated a 33% increased risk of dementia in the later years of life. Individuals who had been using PPIs for over 4.4 years, while middle-aged have a comparatively higher risk of developing dementia later in life as compared to individuals who did not use PPIs.
The association between PPI use and dementia has been explained through two potential mechanisms, including amyloid metabolism impairments and vitamin B12 deficiency. The use of PPIs has been shown to decrease the levels of vitamin B12, which is essential for cognition. Additionally, studies using murine models have reported increased levels of β-amyloid in the brain after PPI use.
Although a positive association was observed between cumulative PPI use and incident dementia risk, the association was not significant for the current use of PPIs and increased risk of dementia. Further research is needed to elucidate the mechanisms and pathways involved in the development of dementia and its link to PPI use.
In conclusion, the study found that the cumulative use of PPIs is associated with an increased risk of dementia in later years of life. While the current use of PPIs was not significantly associated with an increased risk of dementia, further research is needed to better understand the potential mechanisms and pathways involved in the development of dementia and its link to PPI use.
Title:
The Risk of Dementia with Proton Pump Inhibitor Use: A Study of the Atherosclerosis Risk in Communities
