Can Long Term Use of PPI's Like the "Purple Pill" Harm Your Arteries? Maybe

Proton pump inhibitors (PPIs) are widely used drugs for gastric acid–related diseases and may affect the gut microbiome. Prior studies have raised the question of whether the risk of heart attack is elevated in long-term users of PPIs. Other studies have suggested endothelial damage to arteries from the same class of medications used long term. Therefore, a new research study aimed to evaluate the associations of PPI use with risks of cardiovascular disease (CVD) and all-cause mortality in patients with type 2 diabetes (T2D).

METHODS

The scientists analyzed the associations of PPI use with risks of coronary artery disease (CAD), myocardial infarction (MI), heart failure (HF), stroke, and all-cause mortality in 19,229 adults with T2D using data from the UK Biobank study.

RESULTS

During a median follow-up of 11 years, there were documented 2971 CAD, 1827 MI, 1192 HF, and 738 stroke cases, along with 2297 total deaths.

PPI use was significantly associated with higher risks of CAD, MI, HF, and all-cause mortality, and raised the risk by 30-40% range for each outcome.

No statistically significant association was observed between PPI use and stroke.

The results were consistent in the subgroup analyses stratified by factors including indications of PPI, antidiabetic medication use, and antiplatelet drug use. 

CONCLUSIONS

The data, added to prior studies, suggest that PPI use is associated with higher risks of CVD events and mortality among patients with T2D.

The benefits and risks of PPI use should be carefully balanced among patients with T2D, and monitoring of adverse CVD events during PPI therapy should be enhanced.  If diet changes, weight loss, other medications like H2 receptor blockers like famotidine, or natural approaches can be instituted, avoiding chronic PPIs should be a consideration. 

Author
Dr. Joel Kahn

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