Use the labels in the right column to find what you want. Or you can go thru them one by one, there are only 33,991 posts. Searching is done in the search box in upper left corner. I blog on anything to do with stroke. DO NOT DO ANYTHING SUGGESTED HERE AS I AM NOT MEDICALLY TRAINED, YOUR DOCTOR IS, LISTEN TO THEM. BUT I BET THEY DON'T KNOW HOW TO GET YOU 100% RECOVERED. I DON'T EITHER BUT HAVE PLENTY OF QUESTIONS FOR YOUR DOCTOR TO ANSWER.
Changing stroke rehab and research worldwide now.Time is Brain!trillions and trillions of neuronsthatDIEeach day because there areNOeffective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.
What this blog is for:
My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.
Showing posts with label proton pump inhibitors. Show all posts
Showing posts with label proton pump inhibitors. Show all posts
Study adds to the ongoing discussion about proton pump inhibitors and cognition
by
Judy George, Deputy Managing Editor, MedPage Today
August 9, 2023
Cumulative use of proton pump inhibitors
(PPIs) -- drugs used to help control acid reflux and other
gastrointestinal disorders -- upped the risk of dementia, an analysis
of 5,700 older adults suggested.
Over a median follow-up of 5.5 years, people in the Atherosclerosis
Risk in Communities (ARIC) cohort who used prescribed PPIs for more than
4.4 years had a higher risk of dementia (adjusted HR 1.3, 95% CI
1.0-1.8) than those reporting no PPI use, said Kamakshi Lakshminarayan,
MD, PhD, of the University of Minnesota in Minneapolis, and co-authors.
Long-term use of PPIs has been linked in previous studies to a higher
risk of stroke, bone fractures, and chronic kidney disease,
Lakshminarayan and colleagues noted. Reports over the years have shown
mixed data about PPIs and cognition, however.
"I would be cautious about the study's conclusions that PPI use is
associated with risk of dementia," Chan said. "Importantly, most of
their analyses do not support a link. They find an association only in a
small subgroup of individuals without a clear linear relationship
between duration of use and risk."
The finding from the ARIC cohort could be due to confounding by other factors associated with the use of these drugs, Chan told MedPage Today.
"Taken together with evidence from our recent study that did not find
an association in a separate cohort, I think most patients can be
reassured that PPI use is not associated with dementia."
Lakshminarayan and co-authors studied 5,712 people who were
dementia-free at baseline, defined as visit 5 (2011-2013) in the ongoing
ARICopens in a new tab or window study. Mean baseline age was 75; 22% of participants were Black, and 58% were female.
During in-person ARIC study visits, participants were asked to bring
all over-the-counter and prescription medications used during the
preceding 2 weeks. PPI use also was ascertained through annual phone
calls. Cumulative PPI use included use from ARIC visit 1 through visit
5. Findings were adjusted for demographics, comorbid conditions, and
other medication use.
The researchers divided participants into four groups: those not
using PPIs, those using them for up to 2.8 years, those using them for
2.8 to 4.4 years, and those using them for more than 4.4 years.
Over-the-counter medications not prescribed by a doctor were excluded.
In
total, 1,490 participants used PPIs. Minimum cumulative PPI use was 112
days, and maximum use was 20.3 years. Median use was 3.8 years, and
mean use was 4.4 years.
Over a median of 5.5 years, 585 people -- roughly 10% of the
baseline population -- developed dementia. Participants using PPIs at
ARIC visit 5 did not have a higher risk of developing dementia than
those not using PPIs (adjusted HR 1.1, 95% CI 0.9-1.3). Only those
participants who used PPIs for more than 4.4 cumulative years before
visit 5 had a higher risk.
In a secondary analysis, Lakshminarayan and co-authors examined the
relationship between PPIs and dementia with histamine-2 receptor
antagonists (H2RAs) as an active comparator. Results were similar to
those of the main analyses: more than 4.4 cumulative years of exposure
to PPIs was associated with greater dementia risk compared with H2RAs,
but there was no association with use for shorter durations or current
use.
The
researchers attempted to adjust for anticholinergic medication use due
to reported associations between those drugs and cognitive impairment,
but were not able to due to small cell size. However, less than 2% of
the total sample used anticholinergics at visit 5, they noted. Despite
adjusting for many other variables, residual confounding may have
influenced results, they acknowledged.
Correction: The article has been updated to state that
over-the-counter medications not prescribed by a doctor were excluded
from the analysis.
Judy George
covers neurology and neuroscience news for MedPage Today, writing about
brain aging, Alzheimer’s, dementia, MS, rare diseases, epilepsy,
autism, headache, stroke, Parkinson’s, ALS, concussion, CTE, sleep,
pain, and more. Follow
Disclosures
The ARIC study is supported by the NIH.
Lakshminarayan
receives NIH funding. Co-authors reported relationships with NIH,
Optum, Novartis, Incyte, AstraZeneca, EMD Serono, Sandoz, Celgene, and
Pfizer.
Chan has been a consultant for Bayer Pharma AG, Pfizer, and Boehringer Ingelheim.
Primary Source
Neurology
Source Reference: opens in a new tab or windowNorthuis
C, et al "Cumulative use of proton pump inhibitors and risk of
dementia: the Atherosclerosis Risk in Communities study" Neurology 2023;
DOI: 10.1212/WNL.0000000000207747.
You are already under high risk of getting dementia. What the fuck is your doctor EXACTLY doing to prevent that? This prevention is your doctor's responsibility, don't let them weasel out of it. You should get EXACT PROTOCOLS ON PREVENTION. Don't settle for crapola guidelines like the Mediterranean diet, that barely helps because there is no specificity to it.
Several pharmacoepidemiological studies indicate that
proton pump inhibitors (PPIs) significantly increase the risk of
dementia. Yet, the underlying mechanism is not known. Here, we report
the discovery of an unprecedented mode of action of PPIs that explains
how PPIs may increase the risk of dementia.
Methods
Advanced in silico docking analyses and
detailed enzymological assessments were performed on PPIs against the
core‐cholinergic enzyme, choline‐acetyltransferase (ChAT), responsible
for biosynthesis of acetylcholine (ACh).
Results
This report shows compelling evidence that PPIs act as
inhibitors of ChAT, with high selectivity and unprecedented potencies
that lie far below their in vivo plasma and brain concentrations.
Discussion
Given that accumulating evidence points at cholinergic
dysfunction as a driving force of major dementia disorders, our
findings mechanistically explain how prolonged use of PPIs may increase
incidence of dementia. This call for restrictions for prolonged use of
PPIs in elderly, and in patients with dementia or amyotrophic lateral
sclerosis.
1 INTRODUCTION
The cholinergic system is one of the oldest and the most
widely spread neuronal and non‐neuronal signaling systems in the body,
and in an evolutionary perspective has acquired regulatory functions in
diverse biological processes and organs. The cholinergic neurons and
their projections are identified by intracellular presence of the
acetylcholine (ACh) bio‐synthesizing enzyme, choline‐acetyltransferase
(ChAT). All other downstream neurons and non‐excitable cells which
express ACh‐receptors are cholinoceptive cells. The central cholinergic
system consists of four “ChAT‐containing” neuronal nuclei (Ch1–Ch4)
located in the basal forebrain.1
Ch1 and Ch2 innervate the hippocampal complex, Ch3 the olfactory bulb.
Ch4‐neurons are located in the nucleus basalis of Meynert (nbM), which
innervate the rest of cerebral cortex and amygdala.1
These cholinergic nuclei and their widespread projections throughout
the brain have recently been mapped in detail as a 3D whole‐brain atlas
together with the morphology and the connectivity of individual neurons
from the basal forebrain.2
In addition, extensive cholinergic neuronal projections, originated
from 13 cranial nerves (CN0 and I‐XII, constituting the parasympathetic
system3), reach throughout the body, thereby controlling autonomic function of diverse organs, muscles, and glands.4, 5
Another major neuronal system with extensive cholinergic circuitry is
the enteric nervous system (ENS), in which about 64% of the neurons are
cholinergic.6
I'm sure your responsible doctor will warn you of this stroke risk in the next week. But then your doctor already notified you of this other risk in Feb. 2016. Or is your doctor incompetent for not knowing about this OR not doing anything about this? Your choice of incompetency.
MedicalXpress Breaking News-and-Events | June 07, 2019
People who use common heartburn drugs for
months to years may face heightened risks of dying from heart disease,
kidney failure or stomach cancer, a new study suggests.
Advertisement
The study included more than 200,000 US veterans. It's the latest
to raise concerns over drugs called proton pump inhibitors (PPIs). They
include prescription and over-the-counter drugs like Prilosec
(omeprazole), Prevacid (lansoprazole) and Nexium (esomeprazole). And
they rank among the top-selling medications in the US.
Research in recent years has linked prolonged PPI use to increased risks of various diseases and premature death.
These latest findings point to the specific causes of death tied to the drugs, said lead researcher Dr. Ziyad Al-Aly.
He stressed that the excess risks were relatively small. For example,
over 10 years, 13% of PPI users died of a cardiovascular condition,
including heart disease or stroke. That compared with just over 11% of people who used H2 blockers, another class of heartburn drug.
When the researchers weighed other factors—such as patients' age and
chronic health conditions—PPI use was tied to a roughly 18% higher risk
of cardiovascular death.
However, based on patients' medical records, many of those with PPI prescriptions had no documented need for one.
"That's unsettling," said Al-Aly, an assistant professor at Washington University School of Medicine in St. Louis.
"It suggests a lot of people were using a PPI without actually
needing one," he said. "They could be taking a risk without deriving any
benefit."
But an expert not involved in the study said it's unclear whether PPIs, themselves, are responsible for the higher death rates.
Dr. Lawrence Kim is a member of the American Gastroenterological
Association's governing board. He said the current study, like others
before it, is "observational"—that is, it used medical records to track
patients' outcomes.
Those types of studies cannot prove cause and effect, Kim said. There
may be other explanations for the higher risks seen among PPI users.
In 2017, Kim said, the gastroenterological association published a review of the research into the issue.
"The report concluded that the evidence supporting all of these risks
was low- to very-low quality," he said. "Therefore, there's
insufficient evidence to conclude that these adverse outcomes are likely
to be an effect of the PPI therapy."
PPIs work by blocking the enzyme system that creates stomach acid. They are commonly prescribed for gastroesophageal reflux disease (GERD), where stomach acid chronically escapes into the esophagus (the tube connecting the mouth and stomach).
Many people with GERD can take a PPI for just a short time, Al-Aly
said. That allows damaged tissue in the esophagus to heal. Then patients
can switch to a different treatment, like an H2 blocker. Those
medications include drugs such as Tagamet (cimetidine), Pepcid
(famotidine) and Zantac (ranitidine).
"Most people don't need to be on a PPI for months or years," Al-Aly said.
In this study, the risks linked to PPIs rose with prolonged use. The
odds of death over 10 years were 63% to 71% higher among patients who'd
used the drugs for at least a year, vs those who'd used them for a few
months.
However, some GERD patients do need long-term PPI treatment, Al-Aly
and Kim said. That includes people with recurrent stomach ulcers or
Barrett's esophagus—serious damage to the esophageal lining that can
raise the risk of cancer.
Before you start a PPI, Al-Aly said, be sure you actually need one.
The drugs are available over the counter, but they should not be used
for more than a couple weeks without talking to a doctor, he said.
If you've used a PPI for a long time, Kim said, talk to your doctor about whether you need to continue.
According to the study, more than 15 million Americans have PPI
prescriptions. And millions more buy them over the counter without a
doctor's knowledge.
The findings were published recently in the journal BMJ. The veterans in the study—mostly older men—started on a PPI or H2 blocker between 2002 and 2004.
Over the next 10 years, 38% of PPI users died, as did nearly 36% of those on H2 blockers.
If PPIs contribute to deaths, it's unclear why. According to Al-Aly,
lab research has hinted the drugs may cause dysfunction in the lining of
the blood vessels, or disrupt the gut's immune function and normal
bacterial makeup.
A popular group of antacids known
as proton pump inhibitors, or PPIs, used to reduce stomach acid and
treat heartburn may increase the risk of ischemic stroke, according to
preliminary research presented at the American Heart Association's
Scientific Sessions 2016.
"PPIs have been
associated with unhealthy vascular function, including heart attacks,
kidney disease and dementia," said Thomas Sehested, M.D., study lead
author and a researcher at the Danish Heart Foundation in Copenhagen,
Denmark. "We wanted to see if PPIs also posed a risk for ischemic stroke, especially given their increasing use in the general population."
Ischemic stroke, the most common type of stroke, is caused by clots blocking blood flow to or in the brain.
Researchers analyzed the records of 244,679 Danish patients,
average age 57, who had an endoscopy—a procedure used to identify the
causes of stomach pain and indigestion. During nearly six years of
follow up, 9,489 patients had an ischemic stroke for the first time in
their lives. Researchers determined if the stroke occurred while
patients were using 1 of 4 PPIs: omeprazole (Prilosec), pantoprazole
(Protonix), lansoprazole (Prevacid) and esomeprazole (Nexium).
For ischemic stroke, researchers found:
Overall stroke risk increased by 21 percent when patients were taking a PPI.
At the lowest doses of the PPIs, there was slight or no increased stroke risk.
At the highest dose for these 4 PPI's, stroke risk increased from 30 percent for lansoprazole (Prevacid) to 94 percent for pantoprazole (Protonix).
There
was no increased risk of stroke associated with another group of
acid-reducing medications known as H2 blockers, which include famotidine
(Pepcid) and ranitidine (Zantac).
In comparison with non-users, PPI users were older and had more
health conditions, including atrial fibrillation at baseline (3.4 vs.
3.8 percent). The study accounted for age, gender and medical factors,
including high blood pressure, atrial fibrillation (irregular heart beat), heart failure and the use of certain pain relievers that have been linked to heart attack and stroke.
Authors believe that their findings, along with previous studies,
should encourage more cautious use of PPIs. Sehested noted that most
PPIs in the United States are now available over the counter.
"At one time, PPIs were thought to be safe, without major side
effects," he said, "This study further questions the cardiovascular
safety of these drugs."
Although their study did not find a link between H2 blockers and
stroke, the authors could not say that this group of drugs would be
better for patients than PPIs.
Doctors prescribing PPIs, should carefully consider whether their use
is warranted and for how long: "We know that from prior studies that a
lot of individuals are using PPIs for a much longer time than indicated,
which is especially true for elderly patients."
Study limitations include its observational design, which cannot
establish cause and effect, and the fact that nearly all the
participants were white. Authors believe that a randomized controlled trial of PPIs and cardiovascular disease is warranted.
I know this is just correlation not necessarily cause but what is your doctor doing to answer the question for sure? http://www.cbsnews.com/news/heartburn-drugs-ppi-prilosec-nexium-prevacid-risk-of-dementia/
A popular class of heartburn medications might raise a senior's risk of dementia, a new study suggests.
Called proton pump inhibitors (PPIs), this group of drugs includes Prilosec, Nexium and Prevacid. They work by lowering the amount of acid produced by the stomach.
But German researchers found that people 75 or older who regularly take the medications had a 44 percent increased risk of dementia, compared with seniors not using the drugs. The study only found an association, however, and not a cause-and-effect link.
"To evaluate cause-and-effect relationships between long-term PPI use and possible effects on cognition in the elderly, randomized, prospective clinical trials are needed," said corresponding author Britta Haenisch, from the German Center for Neurodegenerative Diseases in Bonn.
In the meantime, "Clinicians should follow guidelines for PPI prescription, to avoid overprescribing PPIs and inappropriate use," Haenisch said.
The report was published Feb. 15 in the journal JAMA Neurology.
The results are surprising enough that at least one leading expert on aging, Dr. Malaz Boustani, plans to share the findings with older patients who are using PPIs.
Boustani said earlier studies have linked another type of antacid, H2 blockers, with an increased risk of dementia. Up to now, he's recommended that patients use PPIs to treat acid reflux and steer clear of H2 blockers like Tagamet, Pepcid and Zantac.
"I'm going to disclose the finding to my patients and then let them decide whether they will take the risk or not," said Boustani, a professor of medicine with the Indiana University Center for Aging Research and a spokesman for the American Federation for Aging Research. "On Monday I have clinic, and if I have patients taking a PPI or an H2 blocker I will tell them exactly what I'm telling you, and then they can decide."
More than 15 million Americans used prescription PPIs in 2013, at a total cost of more than $10 billion, according to a report by the IMS Institute for Healthcare Informatics. Several popular PPIs -- Prilosec, Prevacid and Zegerid -- also are available over-the counter, further boosting their use.
Concern has been increasing that Americans might be overusing PPIs to treat minor cases of heartburn or acid reflux.
As many as 70 percent of PPI prescriptions in the United States have been inappropriately handed out by doctors, and 25 percent of long-term users could stop taking the medication without suffering increased heartburn or acid reflux, according to a study published in January in the journal JAMA Internal Medicine.
Overuse of PPIs could have drastic effects on health, that study found. For example, the medications have been linked to a 20 percent to 50 percent higher risk of chronic kidney disease.
And now the German researchers report there also is some evidence that PPI use might affect a person's ability to reason.
PPIs appear to effect levels of amyloid beta and tau, which are proteins associated with Alzheimer's disease, the German authors said. PPI use can also lead to vitamin B12 deficiency, which has been associated with cognitive decline.
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