Clinical Summary

Proton Pump Inhibitors Raise the Risk of CVD and Mortality in T2D

Vinod Rane, BS Pharm | Disclosures

Takeaway

In patients with type 2 diabetes (T2D), proton pump inhibitor use was associated with an increased risk of cardiovascular disease (CVD), such as coronary artery disease, myocardial infarction and heart failure, and all-cause mortality.
There was no significant association between the proton pump inhibitor use and stroke risk.

Findings suggest that clinicians should consider benefit-risk assessments before prescribing proton pump inhibitors to patients with T2D.

This was a large prospective cohort study that included 19,229 patients (age, 37-73 years) with T2D from the UK Biobank (2006-2010).
Primary outcomes: coronary artery disease, myocardial infarction, stroke, and heart failure.
Secondary outcome: all-cause mortality.
Funding: None disclosed.

During a median follow-up of 10.9-11.2 years, 2971 cases of coronary artery disease, 1827 cases of myocardial infarction, 1192 cases of heart failure, 738 cases of stroke and 2297 deaths were reported.
Proton pump inhibitor users vs non-users had higher risks of (adjusted HR [aHR]; 95% CI):
- coronary artery disease (1.27; 1.15 to 1.40);
- myocardial infarction (1.34; 1.18 to 1.52);
- heart failure (1.35; 1.16 to 1.57); and
- all-cause mortality (1.30; 1.16 to 1.45).
No significant association was seen between proton pump inhibitor use and stroke risk (aHR 1.11; 95% CI 0.90 to 1.36).
These results were consistent in the subgroup analyses stratified by indications for proton pump inhibitors, anti-diabetic medication use and antiplatelet drug use.