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PPI and the risks of heart attack and kidney disease

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Professor Lovat
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Following the previous article on the association between proton pump inhibitors (PPIs) and dementia (click here), we will discuss further some medical correlations between PPIs and common diseases: first, myocardial infarctions (heart attacks).

PPIs and Heart Attacks

PPIs are primarily used for the treated of gastro-oesophageal reflux disease and are prescribed to about 21 million people in the USA, around 5 million people in the UK, and 113 million people globally.

Myocardial infarction (MI), or heart attacks, arise when there is an insufficient blood supply (and hence oxygen supply) to an area of the heart, resulting in damage to the heart muscle. If the blood supply is not returned within several minutes, the heart cells will die and be replaced by scar tissue. The scar tissue increases a person’s risk of developing arrhythmias (abnormal heart rhythms) and heart failure.

A study published in 2015, in the journal PLOS ONE, investigated the correlation between PPI usage and risk of developing cardiovascular problems. The authors examined over 16 million sets of clinical documents from a patient-population of 2.9 million. They found that patients with gastroesophageal reflux disease, on a treatment-course of PPI, had a 1.16-fold increased risk of developing an MI compared to the general population. They also found that patients on PPIs had a 2-fold increased risk of dying from a cardiovascular related disease.

According to the study, 4000 individuals would need to be prescribed PPIs before one patient was harmed.

Although there is an obvious concern over taking PPIs, it is important to consider the risks versus benefits of such a drug. There is a fairly weak correlation between PPI-use and cardiovascular disease, and, as such, there is no real urge to stop using PPIs in patients who need them. It does, however, support the notion of not using PPIs in patients who do not necessarily need them.

PPIs and Kidney Disease

The second disease we will consider is kidney disease.

Chronic kidney disease is a long-term condition that reduces the functioning of the kidney. It is associated with a reduced quality of life and elevated risk of cardiovascular disease and death. A study published in JAMA Internal medicine considered 10,482 patients from the “Atherosclerosis Risk in Communities” study. The authors found that individuals who took PPIs had a relative risk of 1.45 of developing chronic kidney disease compared with those who did not take PPIs. When this value was adjusted for demographics, clinical factors and socioeconomic factors the relative risk was calculated to be 1.50.

The authors of the paper stated “we note that our study is observational and does not provide evidence of causality” hence acknowledging that the study findings should not be used to stop the use of PPIs immediately. However, they did comment that as “25% of long-term PPI users could discontinue therapy without developing symptoms” their findings do suggest that PPI prescriptions should be avoided in patients who do not absolutely require them.

In fact, the study also examined the correlation between a similar type of drug called a histamine antagonist and chronic kidney disease and found no link. As histamine (H2) antagonists are often prescribed for the same clinical indications as PPIs, suggesting that H2 antagonists could be used as a suitable, and effective, alternative.

At the London Gastroenterology centre we specialise in the use of PPI therapy for stomach conditions. We recognise the importance of getting a clear diagnosis. Our expert consultant gastroenterologists are amongst the best in the country and can offer you an endoscopy or other tests to determine whether you need these medicines or not. Please call our helpful secretaries on 020 7183 7965 to make your initial private consultation.

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