Key result
A history of peptic ulcer disease increased the risk of developing uncomplicated peptic ulcer disease by over twofold (HR 2.22) in a cohort of new users of low-dose ASA for secondary prevention of cardiovascular events.
Why the study?
What is the incidence and what are the risk factors for developing uncomplicated peptic ulcer disease in new users of low-dose acetylsalicylic acid for secondary cardiovascular prevention?
Cohort (n=38,975)
What is the incidence and what are the risk factors for developing uncomplicated peptic ulcer disease in new users of low-dose acetylsalicylic acid for secondary cardiovascular prevention?
Hazard Ratio: 2.22 (95% CI 1.6–3.09)
Absolute Event Rate: 3.03% vs 1.3%
p-value: p=<0.001
In patients taking low-dose acetylsalicylic acid for secondary cardiovascular prevention, the incidence of uncomplicated peptic ulcer disease is 1.41 per 1000 person-years, with risk significantly elevated by prior PUD, smoking, and concurrent use of NSAIDs or steroids.
Prior PUD history flags higher uncomplicated PUD risk on low-dose ASA; leaves open whether gastroprotection improves outcomes in secondary prevention.
BACKGROUND: The aim of this study was to analyse the risk of uncomplicated peptic ulcer disease (PUD) in a cohort of new users of low-dose acetylsalicylic acid (ASA) for secondary prevention of cardiovascular events in a UK primary care setting. METHODS: New users of low-dose ASA for secondary prevention of cardiovascular events, aged 50-84 years in 2000-2007, were identified from The Health Improvement Network. Among those 38,975 individuals, 309 patients were considered to be incident cases of uncomplicated PUD. Incidence of uncomplicated PUD was calculated and a nested case-control analysis adjusted for potential confounding factors was performed to calculate the odds ratios (ORs) for the association of potential risk factors with uncomplicated PUD. RESULTS: The crude incidence of uncomplicated PUD was 1.41 per 1000 person-years (95% confidence interval [CI], 1.26-1.58). Individuals with a history of PUD were more likely to develop uncomplicated PUD than those without such a history (hazard ratio [HR], 2.22, 95% CI, 1.60-3.09). In nested case-control analyses, the risk of uncomplicated PUD was associated with current use of non-steroidal anti-inflammatory drugs, oral steroids or acid suppressants. Other risk factors for developing uncomplicated PUD included smoking, stress, depression, anaemia and social deprivation. CONCLUSION: Our results indicate that several risk factors significantly increase the risk of development of uncomplicated PUD in new users of low-dose ASA. Therefore, physicians should monitor ASA users for gastrointestinal symptoms and signs of ulcer, particularly if they have additional risk factors.
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Ruigómez et al. (2014) conducted a cohort in Secondary prevention of cardiovascular events (n=38,975). History of peptic ulcer disease vs. No history of peptic ulcer disease was evaluated on Incident uncomplicated peptic ulcer disease (HR 2.22, 95% CI 1.60-3.09, p=<0.001). A history of peptic ulcer disease increased the risk of developing uncomplicated peptic ulcer disease by over twofold (HR 2.22) in a cohort of new users of low-dose ASA for secondary prevention of cardiovascular events.
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