Abstract
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.
Abbreviations and Acronyms:
ARIC (Atherosclerosis Risk in Communities), CHD (coronary heart disease), CVD (cardiovascular disease), HF (heart failure), HR (hazard ratio), ICD (International Classification of Diseases), PPI (proton pump inhibitor)To read this article in full you will need to make a payment
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Article info
Footnotes
For editorial comment, see page 2511
Grant Support: Dr Bell was supported by the NIH T32 Training Grant HL07111-40 and by Optum. Ms Rooney was supported by the NIH T32 Training Grant HL007779. The ARIC study was funded by the National Heart, Lung, and Blood Institute under contract numbers HHSN268201700001I, HHSN268201700002I, HHSN268201700003I, HHSN268201700004I, and HHSN268201700005I.
Potential Competing Interests: Dr Bell is currently an employee of Optum. AstraZeneca, Astellas, Celgene, EMD Serono, Novartis, and Sandoz have provided funding to Dr Bell for oncology studies, and Pfizer has provided funding to Dr Bell for a study on ulcerative colitis.
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Access this article on ScienceDirectLinked Article
- The Cardiovascular Risk of Proton Pump Inhibitors and the Dangers of PolypharmacyMayo Clinic ProceedingsVol. 96Issue 10
- PreviewProton pump inhibitors (PPIs) are among the most commonly prescribed medicines in the world and are used for a variety of indications, including peptic ulcer disease, gastroesophageal reflux disease, dyspepsia, and prevention of gastrointestinal bleed during antiplatelet therapy.1 A number of adverse effects, from Clostridium difficile infection2 to chronic kidney disease,3 have previously been observed with long-term use of PPIs. In addition, a link between long-term PPI use and increased cardiovascular risk has been suggested although not definitively established.
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