No association between acid suppressant use and risk of dementia: an updated meta-analysis.
Level 3 - non-randomized controlled study
Meta-analysis of observational studies reporting adjusted hazard ratios.
PubMed 34811582 · doi:10.1007/s00228-021-03248-0
What was done
A systematic review and random-effects meta-analysis was conducted across PubMed, EMBASE, and Cochrane Library databases through April 2021. Eligible studies reported adjusted hazard ratios (HR) and 95% confidence intervals (CI) evaluating the association between proton pump inhibitors (PPI) or histamine-2 receptor antagonists (H2RA) and dementia risk.
What was found
Across 17 included studies comprising 1,251,562 participants, PPI use was not associated with dementia risk compared to non-use (HR = 0.98, 95% CI: 0.85–1.13). Subgroup analyses by publication year, study location, mean age, PPI duration, and female proportion also showed no association. Similarly, H2RA use was not significantly associated with dementia risk (pooled HR = 1.20, 95% CI: 0.98–1.47).
Why it matters
These findings provide reassurance against prior observational concerns suggesting that common acid-suppressing medications increase the risk of cognitive decline and dementia.
Limits
The analysis relies entirely on observational studies subject to residual confounding, protopathic bias, and exposure misclassification. The abstract does not specify study-level heterogeneity metrics (e.g., I-squared) or the specific types of dementia evaluated.
Cited by
- contradicts Chronic use of NSAIDs or H2-blocking acid reducers is associated with a dramatic increased risk of dementia and stroke.