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Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
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Proton pump inhibitors and vascular function: A prospective cross-over pilot study.

Yohannes T Ghebremariam1, John P Cooke1, Fouzia Khan2

  • 1Department of Cardiovascular Sciences, Houston Methodist Research Institute, Houston, TX, USA.

Vascular Medicine (London, England)
|April 4, 2015
PubMed
Summary

Proton pump inhibitors (PPIs) did not significantly impact vascular function in a pilot study of healthy individuals and those with cardiovascular disease. Further research is needed to understand the link between PPI use and cardiovascular risk.

Keywords:
asymmetric dimethylargininecardiovascular risk factorsdimethylarginine dimethylaminohydrolasenitric oxideproton pump inhibitors

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Area of Science:

  • Cardiology
  • Pharmacology

Background:

  • Proton pump inhibitors (PPIs) are widely prescribed for gastric reflux.
  • Retrospective studies suggest a link between PPI use and increased cardiovascular (CV) risk.
  • Prospective evidence directly linking PPIs to CV harm is lacking.

Purpose of the Study:

  • To prospectively evaluate the direct impact of PPIs on vascular endothelial function.
  • To investigate the association between PPI use, asymmetric dimethylarginine (ADMA) levels, and cardiovascular health.

Main Methods:

  • A controlled, open-label, cross-over pilot study involving 21 adults (healthy and with established CV disease).
  • Participants received a PPI (Prevacid) or placebo for 4 weeks, followed by a 2-week washout and then the alternate treatment.
  • Vascular function (EndoPAT) and plasma ADMA levels were assessed before and after each treatment interval.

Main Results:

  • A marginal inverse correlation was observed between vascular function scores and ADMA levels.
  • While PPI use showed a trend towards worsening ADMA levels, particularly in those with vascular disease, this did not reach statistical significance.
  • PPI use was not associated with significant impairment in flow-mediated vasodilation.

Conclusions:

  • In this pilot study, PPI use did not significantly affect vascular endothelial function in healthy individuals or patients with coronary disease.
  • Larger, long-term, and blinded trials are necessary to clarify the relationship between PPIs and adverse cardiovascular outcomes observed in previous studies.