PPI’s do not raise cardiovascular risk, study says

Proton pump inhibitor therapy is not connected to an increased risk of cardiovascular disease, according to a study published in Alimentary Pharmacology & Therapeutics.
The FDA has discouraged using PPI’s with antiplatelet therapy clopidogrel because the drugs work with the same isoenzyme. “Inhibition of CYP2C19 by PPIs may reduce the bioavailability of the active metabolites of clopidogrel, and attenuate clopidogrel’s cardiovascular benefits,” wrote Danny Liew, MBBS, PhD, of the department of epidemiology and preventive medicine at Monash University in Melbourne, Australia. “It has been suggested that the observed risk of PPI use with antiplatelet therapy may be partly due to an increase in cardiovascular risk conferred by PPIs directly. To help address this theory, a systematic review and meta-analysis was conducted to explore the association between cardiovascular risk and PPIs independent of concomitant clopidogrel therapy.”

In their review of observational studies, Liew and colleagues found an increased risk for any adverse cardiovascular event with PPI monotherapy (RR = 1.25; 95% CI, 1.11-1.42; I² = 81%). However, their analysis of the eight randomized controlled trials found no increased risk (RR = 0.89; 95% CI, 0.34-2.33; I² = 0%).

“Given the limitations of observational data, these results may offer some reassurance when considering the cardiovascular safety of proton pump inhibitor monotherapy, in the context of emerging concerns about the general appropriateness of their widespread use,” Liew and colleagues wrote.

See the review article by Alex Young on Healio (free registration) here.

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