Adverse cardiovascular effects associated with proton pump inhibitors

  • The study described here provides no definitive answer to the question whether PPIs do indeed cause an elevated cardiac risk.
  • The study shows that there is an increased risk of stroke and myocardial infarction when PPIs are used for more than 84 days, within six months after endoscopy.
  • The study also found a dosage-related effect, with only the use of medium and high dosages being associated with elevated risks of stroke and myocardial infarction.
  • It makes sense to be reticent about prescribing PPIs in high doses for over three months, in view of the elevated risks of stroke and myocardial infarction.
  • Such an association with elevated risk has not been found for H2 antagonists, so if long-term treatment is required, H2 antagonists could be preferable.
  • If future research finds the elevated risk to be real, much damage could be prevented by a restrictive prescribing policy.
  • This research once more underlines the importance of a periodic re-evaluation of chronic medication, in this case of PPIs.

  1. Stichting Farmaceutische Kengetallen. Aantal gebruikers maagmedicatie stijgt naar ruim drie miljoen. Pharm Weekbl 2017; 152(39): 7. Via: www.sfk.nl/publicaties/PW/2017/gebruikers-maagmedicatie-stijgt-naar-ruim-3-miljoen.
  2. Lazarus B, Chen Y, Wilson FP, Sang Y, Chang AR, Coresh J, et al. Proton Pump Inhibitor Use and the Risk of Chronic Kidney Disease. JAMA Intern Med. 2016 Feb;176(2):238-46.
  3. Xie Y, Bowe B, Li T, Xian H, Yan Y, Al-Aly Z. Risk of death among users of Proton Pump Inhibitors: a longitudinal observational cohort study of United States veterans. BMJ Open. 2017 Jul 4;7(6):e015735.
  4. Sehested TSG, Gerds TA, Fosbøl EL, Hansen PW, Charlot MG, Carlson N, et al. Long-term use of proton pump inhibitors, dose-response relationship and associated risk of ischemic stroke and myocardial infarction. J Intern Med. 2018 Mar;283(3):268-281.
  5. Yepuri G, Sukhovershin R, Nazari-Shafti TZ, Petrascheck M, Ghebre YT, Cooke JP. Proton Pump Inhibitors Accelerate Endothelial Senescence. Circ Res. 2016 Jun 10;118(12):e36-42.

The literature refers to the Dutch text

Authors

  • Prof. dr O.M. Dekkers