Abstract
ObjectiveGastroesophageal reflux disease (GERD) is a common disease which can cause troublesome symptoms and affect quality of life. In addition to esophageal complications, GERD may also be a risk factor for extra-esophageal complications. Both GERD and coronary artery disease (CAD) can cause chest pain and frequently co-exist. However, the association between GERD and acute myocardial infarction (AMI) remain unclear. The purpose of the study was to compare the incidence of acute myocardial infarction in GERD patients with an age-, gender-, and comorbidity matched population free of GERD. We also examine the association of the risk of AMI and the use of acid suppressing agents in GERD patients.MethodsWe identified patients with GERD from the Taiwan National Health Insurance Research Database. The study cohort comprised 54,422 newly diagnosed GERD patients; 269,572 randomly selected age-, gender-, comorbidity-matched subjects comprised the comparison cohort. Patients with any prior CAD, AMI or peripheral arterial disease were excluded. Incidence of new AMI was studied in both groups.ResultsA total 1,236 (0.5%) of the patients from the control group and 371 (0.7%) patients from the GERD group experienced AMI during a mean follow-up period of 3.3 years. Based on Cox proportional-hazard model analysis, GERD was independently associated with increased risk of developing AMI (hazard ratio (HR) = 1.48; 95% confidence interval (CI): 1.31–1.66, P < 0.001). Within the GERD group, patients who were prescribed proton pump inhibitors (PPIs) for more than one year had slightly decreased the risk of developing AMI, compared with those without taking PPIs (HR = 0.57; 95% CI: 0.31–1.04, P = 0.066).ConclusionsThis large population-based study demonstrates an association between GERD and future development of AMI, however, PPIs use only achieved marginal significance in reducing the occurrence of AMI in GERD patients. Further prospective studies are needed to evaluate whether anti-reflux medication may reduce the occurrence of acute ischemic event in GERD patients.
Highlights
Gastroesophageal reflux disease (GERD) is a common disorder which can cause troublesome reflux symptoms and potential serious complications, and has a negative impact on the quality of life [1]
Based on Cox proportional-hazard model analysis, GERD was independently associated with increased risk of developing acute myocardial infarction (AMI) (hazard ratio (HR) = 1.48; 95% confidence interval (CI): 1.31–1.66, P < 0.001)
Within the GERD group, patients who were prescribed proton pump inhibitors (PPIs) for more than one year had slightly decreased the risk of developing AMI, compared with those without taking PPIs (HR = 0.57; 95% CI: 0.31–1.04, P = 0.066)
Summary
Gastroesophageal reflux disease (GERD) is a common disorder which can cause troublesome reflux symptoms and potential serious complications, and has a negative impact on the quality of life [1]. In addition to esophageal complications, GERD may be a risk factor for extraesophageal complications including laryngeal, pulmonary, and cardiovascular diseases [2]. GERD more frequently causes chest pain than other esophageal motility disorders [3], implying that GERD symptoms may be misclassified as coronary artery disease (CAD). As both GERD and CAD are prevalent diseases in the population, they frequently co-exist; frequently making a differential diagnosis of chest pain more difficult. Evaluating the symptoms is not sufficient to diagnose the underlying disease
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