28 Jan PPIs Linked to Increased Risk of Heart Disease and Death in Type 2 Diabetes

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MedicalResearch.com Interview with:
Tingting Geng PhD
Department of Nutrition and Food Hygiene
Hubei Key Laboratory of Food Nutrition and Safety
Ministry of Education Key Lab of Environment and Health
State Key Laboratory of Environment Health (Incubating)
School of Public Health, Tongji Medical College
Huazhong University of Science and Technology
Wuhan, China

MedicalResearch.com: What is the background for this study?

Response: Previous studies have suggested that proton pump inhibitors (PPIs) may lead to an increase in cardiovascular events due to the drug-drug interactions between PPIs and clopidogrel and gut microbiota dysbiosis. Patients with Type 2 Diabetes (T2D) are at more than three times higher prevalence of using PPIs, and two- to fourfold higher risk of developing cardiovascular complications and premature death than general populations. However, evidence regarding the influence of PPI use on subsequent risks of cardiovascular disease and mortality among patients with T2D is scarce.

We conducted a prospective study using the UK Biobank study to examine the association of PPI use with risks of coronary artery disease, myocardial infarction, heart failure, stroke and mortality among patients with T2D. Using multivariable-adjusted Cox regression models and a propensity score-matched cohort, researchers found robust results that PPIs use was associated with a higher risk of coronary artery disease (adjusted HR=1.27), myocardial infarction (adjusted HR=1.34), heart failure (adjusted HR=1.35), and mortality (adjusted HR=1.30).

MedicalResearch.com: What are the main findings?

Response:  In this prospective study of 19,229 patients with type 2 diabetes (T2D), Proton pump inhibitors (PPIs) use was associated with a 27% higher risk of coronary artery disease, 34% higher risk of myocardial infarction, 35% higher risk of heart failure, and 30% higher risk of mortality. The results were consistent between different agents (omeprazole, lansoprazole, esomeprazole and others) and outcomes.

MedicalResearch.com: What should readers take away from your report?

Response: Patients with type 2 diabetes under PPIs therapy are a high-risk group to target for risk-factor modifications for cardiovascular complications and death prevention. These findings suggest that the clinical benefits of PPI use against the excess risks of cardiovascular events and mortality should be taken into consideration among patients with T2D. Physicians should enhance monitoring of cardiovascular phenotypes among patients with T2D during the therapy of PPIs. 

MedicalResearch.com: What recommendations do you have for future research as a results of this study?

Response: We did not observe significant associations of PPI use with risk of stroke and CVD mortality, which might be explained by low statistical power due to the modest number of stroke cases and CVD deaths.

MedicalResearch.com: Is there anything else you would like to add? Any disclosures?

Response: In this study, information on frequency, duration and dosage of PPIs use was not collected; hence, future studies are needed to further clarify the relationship between these characteristics and adverse outcomes among patients with T2D.  

Citation:

Tingting Geng, Jun-Xiang Chen, Yan-Feng Zhou, Qi Lu, Zhenzhen Wan, Liegang Liu, An Pan, Gang Liu, Proton Pump Inhibitor Use and Risks of Cardiovascular Disease and Mortality in Patients With Type 2 Diabetes, The Journal of Clinical Endocrinology & Metabolism, 2022;, dgac750, https://doi.org/10.1210/clinem/dgac750

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Last Updated on January 28, 2023 by Marie Benz MD FAAD