Abstract
BackgroundThe 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.MethodsNew 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.ResultsThe 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.ConclusionOur 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.Electronic supplementary materialThe online version of this article (doi:10.1186/s12876-014-0205-y) contains supplementary material, which is available to authorized users.
Highlights
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
Women aged 50-59 years had a higher incidence of uncomplicated PUD (2.19 per 1000 personyears, 95% confidence interval (CI), 1.43-3.34) than men in the corresponding age group (1.16 per 1000 person-years, 95% CI, 0.77-1.76)
A higher incidence of uncomplicated PUD was observed in new users of ASA with a history of PUD (3.03 per 1000 person-years, 95% CI, 2.26-4.08) than in those without such a history (1.30 per 1000 person-years, 95% CI, 1.15-1.46)
Summary
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. Use of ASA has, been shown to increase the risk of gastrointestinal complications, including upper gastrointestinal bleeding [3] and uncomplicated peptic ulcer disease (PUD) [4]. Upper gastrointestinal symptoms have been shown to affect patients’ health-related quality of life [5] and may lead to discontinuation of ASA therapy [6,7,8,9], these additional risk factors have been studied for complicated PUD [3], data remain scarce for uncomplicated PUD. A similar incidence of uncomplicated PUD was reported in a population-based study in Denmark [13]
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