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Acid suppressants use and risk of atherosclerotic cardiovascular disease in middle-aged and older adults

Ma, Yue ; Li, Shu ; Yang, Hongxi ; Zhang, Yuan ; Li, Huiping LU ; Zhou, Lihui ; Lin, Jing ; Chen, Yanchun ; Hou, Yabing and Zhang, Xinyu , et al. (2022) In Atherosclerosis 358. p.47-54
Abstract

Background and aims: Concerns regarding adverse events associated with the use of acid suppressants have increased. However, the impact of proton pump inhibitors (PPIs) and histamine‐2 receptor antagonists (H2RAs) on the risk of atherosclerotic cardiovascular disease (ASCVD) remains unknown. This study aimed to estimate the risk of ASCVD in association with the use of PPIs and H2RAs. Methods: This prospective cohort study included participants without cardiovascular diseases or anti-hypertensive treatment at baseline (2006–2010) in the UK Biobank. The outcomes were ASCVD and each subtype (coronary artery disease, myocardial infarction, peripheral artery disease, and ischemic stroke). The association was estimated by Cox... (More)

Background and aims: Concerns regarding adverse events associated with the use of acid suppressants have increased. However, the impact of proton pump inhibitors (PPIs) and histamine‐2 receptor antagonists (H2RAs) on the risk of atherosclerotic cardiovascular disease (ASCVD) remains unknown. This study aimed to estimate the risk of ASCVD in association with the use of PPIs and H2RAs. Methods: This prospective cohort study included participants without cardiovascular diseases or anti-hypertensive treatment at baseline (2006–2010) in the UK Biobank. The outcomes were ASCVD and each subtype (coronary artery disease, myocardial infarction, peripheral artery disease, and ischemic stroke). The association was estimated by Cox proportional-hazards models. Results: Among 316,730 individuals (aged 50–88 years), during a median of 12.5 years of follow-up, we documented 13,503 (4.3%) incident ASCVD. Regular PPIs use was associated with a higher risk of ASCVD (HR: 1.16, 95% CI: 1.09–1.23) and every subtype of ASCVD. Among each type of PPIs, omeprazole (HR: 1.19, 95% CI: 1.11–1.28), lansoprazole (HR: 1.11, 95% CI: 1.02–1.22), and pantoprazole (HR: 1.40, 95% CI: 1.00–1.97) were associated with a higher risk of ASCVD. Stratification analysis showed that PPIs use was associated with a higher risk of ASCVD among individuals without indications of medications for PPIs. In addition, use of H2RAs was not related to the risk of ASCVD (HR: 0.97, 95% CI: 0.85–1.11). Conclusions: PPIs were associated with increased risk of ASCVD, particularly amongst participants without indications for medication. Our findings are of important practical significance and suggest that clinicians should be cautious in prophylactic use of PPIs.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Atherosclerotic cardiovascular diseases, Cohort studies, Pharmacoepidemiology, Proton pump inhibitors
in
Atherosclerosis
volume
358
pages
8 pages
publisher
Elsevier
external identifiers
  • scopus:85137675373
  • pmid:36113328
ISSN
0021-9150
DOI
10.1016/j.atherosclerosis.2022.09.001
language
English
LU publication?
yes
id
b56c7080-3b43-4c58-b61b-6a5cc88cc56c
date added to LUP
2022-11-30 11:05:19
date last changed
2025-01-09 17:47:13
@article{b56c7080-3b43-4c58-b61b-6a5cc88cc56c,
  abstract     = {{<p>Background and aims: Concerns regarding adverse events associated with the use of acid suppressants have increased. However, the impact of proton pump inhibitors (PPIs) and histamine‐2 receptor antagonists (H2RAs) on the risk of atherosclerotic cardiovascular disease (ASCVD) remains unknown. This study aimed to estimate the risk of ASCVD in association with the use of PPIs and H2RAs. Methods: This prospective cohort study included participants without cardiovascular diseases or anti-hypertensive treatment at baseline (2006–2010) in the UK Biobank. The outcomes were ASCVD and each subtype (coronary artery disease, myocardial infarction, peripheral artery disease, and ischemic stroke). The association was estimated by Cox proportional-hazards models. Results: Among 316,730 individuals (aged 50–88 years), during a median of 12.5 years of follow-up, we documented 13,503 (4.3%) incident ASCVD. Regular PPIs use was associated with a higher risk of ASCVD (HR: 1.16, 95% CI: 1.09–1.23) and every subtype of ASCVD. Among each type of PPIs, omeprazole (HR: 1.19, 95% CI: 1.11–1.28), lansoprazole (HR: 1.11, 95% CI: 1.02–1.22), and pantoprazole (HR: 1.40, 95% CI: 1.00–1.97) were associated with a higher risk of ASCVD. Stratification analysis showed that PPIs use was associated with a higher risk of ASCVD among individuals without indications of medications for PPIs. In addition, use of H2RAs was not related to the risk of ASCVD (HR: 0.97, 95% CI: 0.85–1.11). Conclusions: PPIs were associated with increased risk of ASCVD, particularly amongst participants without indications for medication. Our findings are of important practical significance and suggest that clinicians should be cautious in prophylactic use of PPIs.</p>}},
  author       = {{Ma, Yue and Li, Shu and Yang, Hongxi and Zhang, Yuan and Li, Huiping and Zhou, Lihui and Lin, Jing and Chen, Yanchun and Hou, Yabing and Zhang, Xinyu and Liu, Tong and Zhou, Xin and Wang, Yaogang}},
  issn         = {{0021-9150}},
  keywords     = {{Atherosclerotic cardiovascular diseases; Cohort studies; Pharmacoepidemiology; Proton pump inhibitors}},
  language     = {{eng}},
  pages        = {{47--54}},
  publisher    = {{Elsevier}},
  series       = {{Atherosclerosis}},
  title        = {{Acid suppressants use and risk of atherosclerotic cardiovascular disease in middle-aged and older adults}},
  url          = {{http://dx.doi.org/10.1016/j.atherosclerosis.2022.09.001}},
  doi          = {{10.1016/j.atherosclerosis.2022.09.001}},
  volume       = {{358}},
  year         = {{2022}},
}