In a prospective cohort study recently published in PLoS One, use of proton pump inhibitors (or PPIs) was associated with increased risk for heart failure and death in patients with coronary artery disease (CAD). The Cardiology Advisor explains that CAD patients are often treated with PPIs as prevention or treatment of GI complications to chronic antiplatelet therapy.
PPI use has been linked to pneumonia, micronutrient deficiencies, bone fractures, and risk of infection. Studies have also linked long-term use of the acid-reducing drugs to decreased cognitive function, chronic kidney disease and kidney failure as well as cardiovascular events.
The researchers analyzed follow-up data and blood samples of 706 patients, 431 were treated with PPIs. Of those in the study being treated with PPIs, most were taking omeprazole, or Prilosec. A goal of the study was to examine the possibility cardiovascular events might be caused by PPI use inhibiting the antiplatelet effect of aspirin and clopidogrel. Most of the patients were taking clopidogrel and aspirin, with approximately two-thirds of the 706 participants taking clopidogrel, and more than 90 percent taking aspirin.
“The present work shows that PPI use is an independent predictor of [heart failure] or death. Although there are no previous studies reporting this association, it is known that pantoprazole may exert negative inotropic effects on isolated myocardium from humans and rabbits,” the researchers wrote.
In this study the researchers did not find an association with PPIs and acute ischemic events, however the study authors wrote that more studies are needed. Other research has linked PPIs to ischemic events.
In the preliminary findings of one study presented at an American Heart Association conference in New Orleans last November stroke risk was found for those on PPIs, with increased risk at high doses, and the risk was also was present to varying degrees depending on which drug was being taken: 33 percent for Prilosec and Prevacid patients, 50 percent for Nexium patients, and 79 percent for Protonix patients. No increased stroke risk was found for patients who were taking alterative acid-reducers H2 blockers.
“We wanted to see if PPIs also posed a risk for ischemic stroke, especially given their increasing use in the general population,” said Dr. Thomas Sehested, that study’s lead author and a researcher at the Danish Heart Foundation. “At one time, PPIs were thought to be safe, without major side effects. This study further questions the cardiovascular safety of these drugs,” he said.