title: Risk of uncomplicated peptic ulcer disease in a cohort of new users of low-dose acetylsalicylic acid for secondary prevention of cardiovascular events.
abstract: BACKGROUND
  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.
  
  
  METHODS
  New 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.
  
  
  RESULTS
  The 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.
  
  
  CONCLUSIONS
  Our 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.
authors.affiliation: Spanish Centre for Pharmacoepidemiologic Research (CEIFE), Almirante 28-2, E 28004, Madrid, Spain. aruigomez@ceife.es.
authors.forename: Ana
authors.initials: A
authors.lastname: Ruigómez
authors.affiliation: AstraZeneca R&D, Pepparedsleden 1, Mölndal, SE-431 83, Sweden. Saga.Johansson@astrazeneca.com.
authors.forename: Saga
authors.initials: S
authors.lastname: Johansson
authors.affiliation: AstraZeneca R&D, Pepparedsleden 1, Mölndal, SE-431 83, Sweden. Peter.Nagy@astrazeneca.com.
authors.forename: Péter
authors.initials: P
authors.lastname: Nagy
authors.affiliation: Spanish Centre for Pharmacoepidemiologic Research (CEIFE), Almirante 28-2, E 28004, Madrid, Spain. mar.martinpe@gmail.com.
authors.forename: Mar
authors.initials: M
authors.lastname: Martín-Pérez
authors.affiliation: Spanish Centre for Pharmacoepidemiologic Research (CEIFE), Almirante 28-2, E 28004, Madrid, Spain. lagarcia@ceife.es.
authors.forename: Luis A García
authors.initials: LA
authors.lastname: Rodríguez
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000009:adverse effects*; D001241:Aspirin / Q000008:administration & dosage / Q000009:adverse effects*; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010437:Peptic Ulcer / Q000139:chemically induced* / Q000453:epidemiology*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D055502:Secondary Prevention
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D001241:Aspirin