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PLoS One. 2017 Jan 19;12(1):e0169826. doi: 10.1371/journal.pone.0169826. eCollection 2017.

Use of Proton-Pump Inhibitors Predicts Heart Failure and Death in Patients with Coronary Artery Disease.

Author information

1
Department of Cardiology, IIS-Fundación Jiménez Díaz, Madrid, Spain.
2
Department of Cardiology, Hospital de Fuenlabrada, Madrid, Spain.
3
Rey Juan Carlos University, Alcorcón, Madrid, Spain.
4
Department of Cardiology, Hospital Universitario de Móstoles, Madrid, Spain.
5
Department of Cardiology, Hospital Universitario Fundación Alcorcón, Madrid, Spain.
6
Department of Cardiology, Hospital de Getafe, Madrid, Spain.
7
Autónoma University, Madrid, Spain.
8
Laboratory of Vascular Pathology, IIS-Fundación Jiménez Díaz, Madrid, Spain.
9
CIBERDEM, Madrid, Spain.

Abstract

OBJECTIVES:

Proton-pump inhibitors (PPIs) seem to increase the incidence of cardiovascular events in patients with coronary artery disease (CAD), mainly in those using clopidogrel. We analysed the impact of PPIs on the prognosis of patients with stable CAD.

METHODS:

We followed 706 patients with CAD. Primary outcome was the combination of secondary outcomes. Secondary outcomes were 1) acute ischaemic events (any acute coronary syndrome, stroke, or transient ischaemic attack) and 2) heart failure (HF) or death.

RESULTS:

Patients on PPIs were older [62.0 (53.0-73.0) vs. 58.0 (50.0-70.0) years; p = 0.003] and had a more frequent history of stroke (4.9% vs. 1.1%; p = 0.004) than those from the non-PPI group, and presented no differences in any other clinical variable, including cardiovascular risk factors, ejection fraction, and therapy with aspirin and clopidogrel. Follow-up was 2.2±0.99 years. Seventy-eight patients met the primary outcome, 53 developed acute ischaemic events, and 33 HF or death. PPI use was an independent predictor of the primary outcome [hazard ratio (HR) = 2.281 (1.244-4.183); p = 0.008], along with hypertension, body-mass index, glomerular filtration rate, atrial fibrillation, and nitrate use. PPI use was also an independent predictor of HF/death [HR = 5.713 (1.628-20.043); p = 0.007], but not of acute ischaemic events. A propensity score showed similar results.

CONCLUSIONS:

In patients with CAD, PPI use is independently associated with an increased incidence of HF and death but not with a high rate of acute ischaemic events. Further studies are needed to confirm these findings.

PMID:
28103324
PMCID:
PMC5245803
DOI:
10.1371/journal.pone.0169826
[Indexed for MEDLINE]
Free PMC Article

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