Proton pump inhibitor use and all-cause mortality in stroke survivors on antiplatelet therapy: An NHANES analysis

Introduction: Stroke is a leading cause of death and disability worldwide. Antiplatelet therapy is essential for preventing ischemic stroke recurrence, but it carries a risk of gastrointestinal (GI) bleeding. Proton pump inhibitors (PPIs) are often prescribed to mitigate this risk, but their long-term use has been linked to increased allcause mortality. Limited research exists on the impact of PPI use on mortality in stroke survivors receiving antiplatelet therapy. This study aims to evaluate the association between PPI use and all-cause mortality in this population. Methods: Data from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018 were used. A total of 335 stroke survivors on antiplatelet therapy were included and classified based on PPI use. Allcause mortality was determined by linkage to the National Death Index. Weighted Cox regression models were used to assess the association between PPI use and all-cause mortality, adjusting for key covariates such as age, sex, race, socioeconomic status, and comorbidities. Results: Among 335 participants, 78 used PPIs. No significant association was found between PPI use and allcause mortality across all models (HR 0.98, 95 % CI 0.67-1.42, p = 0.95). Subgroup analysis indicated that PPIs use was not associated with all-cause mortality risk in any of the subgroups. Kaplan-Meier curves showed no significant difference in survival between PPI and non-PPI groups (p = 0.79). Conclusion: PPI use in stroke survivors on antiplatelet therapy was not associated with increased all-cause mortality. The decision to use PPIs should involve a careful evaluation of the potential benefits and risks.