Effect of Baseline Gastrointestinal Risk and Use of Proton Pump Inhibitors on Frequency of Discontinuation of Aspirin for Secondary Cardiovascular Prevention in United Kingdom Primary Care

• Published in: The American journal of cardiology 2013-10, Vol.112 (8), p.1075-1082
• Main Authors: Martín Merino, Elisa, PhD, Johansson, Saga, MD, PhD, Nagy, Péter, MD, García Rodríguez, Luis A., MD, MSc
• Format: Article
• Language: English
• Subjects: Administration, Oral; Aged; Aged, 80 and over; Anticoagulants; Aspirin; Aspirin - administration & dosage; Aspirin - adverse effects; Cardiovascular; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - prevention & control; Confidence intervals; Disease prevention; Dose-Response Relationship, Drug; Drug dosages; Drug therapy; Drug Therapy, Combination; Female; Follow-Up Studies; Gastrointestinal Diseases - chemically induced; Gastrointestinal Diseases - drug therapy; Gastrointestinal Diseases - epidemiology; Gastrointestinal Tract - drug effects; Heart attacks; Hormone replacement therapy; Humans; Incidence; Male; Middle Aged; Nonsteroidal anti-inflammatory drugs; Patients; Platelet Aggregation Inhibitors - administration & dosage; Platelet Aggregation Inhibitors - adverse effects; Primary Health Care - methods; Prognosis; Proton Pump Inhibitors - administration & dosage; Retrospective Studies; Risk Factors; Secondary Prevention - methods; Time Factors; Ulcers; United Kingdom - epidemiology
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2013.05.051

For patients at high cardiovascular and high gastrointestinal (GI) risk, coprescription of a proton pump inhibitor (PPI) with low-dose aspirin is recommended. We aimed to quantify the extent to which low-dose aspirin discontinuation in patients at high cardiovascular risk is affected by PPI use and baseline GI risk. Patients aged 50 to 84 years who had evidence of ischemic heart disease or cardiovascular disease and who were new users of low-dose aspirin in 2000 to 2007 were identified using The Health Improvement Network (n = 35,604). Aspirin discontinuation was defined as a period of at least 90 days after completion of the last prescribed course during which no repeat prescription was issued. The incidence of low-dose aspirin discontinuation was 26.8 per 100 person-years (95% confidence interval [CI] 26.2 to 27.4). The age-, gender-, and indication-adjusted risk of aspirin discontinuation was 15% less among continuous PPI users than among PPI nonusers (hazard ratio [HR] 0.85, 95% CI 0.78 to 0.92); after further adjusting for number of coprescribed medications, the HR was 0.95 (95% CI 0.87 to 1.03). Continuous PPI use was associated with a reduced risk of aspirin discontinuation among patients at high GI risk (HR 0.83; 95% CI 0.74 to 0.93) but not among those at low GI risk (HR 1.08; 95% CI 0.96 to 1.21). In conclusion, among patients at high GI risk, concomitant users of aspirin and PPI showed a greater aspirin adherence than aspirin users not on PPI. Further studies need to confirm factors with the potential to increase adherence to long-term aspirin.