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Association of Proton Pump Inhibitors With Higher Risk of Cardiovascular Disease and Heart Failure
Elizabeth J Bell1, Suzette J Bielinski2, Jennifer L St Sauver2
1Department of Life Sciences, Optum, Eden Prairie, MN.
Insights
Long-term use of proton pump inhibitors (PPIs) was linked to a doubled risk of total cardiovascular disease (CVD) and heart failure (HF). This suggests caution is needed regarding PPI overuse.
Area of Science:
- Cardiovascular Medicine
- Pharmacology
Background:
- Proton pump inhibitors (PPIs) are widely prescribed for acid-related gastrointestinal disorders.
- Concerns exist regarding potential long-term adverse effects of PPIs, including cardiovascular risks.
Purpose of the Study:
- To investigate the association between cumulative proton pump inhibitor (PPI) exposure and the risk of total cardiovascular disease (CVD) and heart failure (HF).
Main Methods:
- A cohort study of White and African American participants from the Atherosclerosis Risk in Communities (ARIC) study was conducted.
- Cumulative PPI exposure was calculated based on pill bottle inspections from 1987 to 2013.
- Cox regression analysis was used to assess the association between PPI use and incident CVD and HF events through 2016.
Main Results:
- Participants with over 5.1 years of cumulative PPI exposure showed a 2.02-fold increased risk of total CVD.
- A cumulative PPI exposure exceeding 5.1 years was associated with a 2.21-fold higher risk of heart failure (HF).
Conclusions:
- Long-term proton pump inhibitor (PPI) use is associated with a significantly increased risk of total cardiovascular disease (CVD) and heart failure (HF).
- These findings highlight the importance of judicious PPI use and warrant further investigation into the underlying mechanisms.
- The results support existing research and emphasize the need for caution regarding PPI overuse.
Objective:
To examine associations of cumulative exposure to proton pump inhibitors (PPIs) with total cardiovascular disease (CVD; composed of stroke, coronary heart disease, and heart failure [HF]) and HF alone in a cohort study of White and African American participants of the Atherosclerosis Risk in Communities (ARIC) study.
Methods:
Use of PPIs was assessed by pill bottle inspection at visit 1 (January 1, 1987 to 1989) and up to 10 additional times before baseline (visit 5; 2011 to 2013). We calculated cumulative exposure to PPIs as days of use from visit 1 to baseline. Participants (n=4346 free of total CVD at visit 5; mean age, 75 years) were observed for incident total CVD and HF events through December 31, 2016. We used Cox regression to measure associations of PPIs with total CVD and HF.
Results:
After adjustment for potential confounding variables, participants with a cumulative exposure to PPIs of more than 5.1 years had a 2.02-fold higher risk of total CVD (95% CI, 1.50 to 2.72) and a 2.21-fold higher risk of HF (95% CI, 1.51 to 3.23) than nonusers.
Conclusion:
Long-term PPI use was associated with twice the risk of total CVD and HF compared with nonusers. Our findings are in concordance with other research and suggest another reason to be cautious of PPI overuse.
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