Proton pump inhibitor use tied to CVD and mortality in type 2 diabetes patients

"The risks and benefits of PPI use should be balanced carefully in type 2 diabetes (T2D) patients, and there should be an enhancement of monitoring of adverse CVD events during PPI therapy," the researchers wrote. The study showed that PPI use was significantly linked with a 35% relative increase in heart failure, a 34% relative increase in myocardial infarction, and a 30% relative increase in all-cause death.

Proton pump inhibitors are a medication class used widely in prescription and over-the-counter formulations to reduce the stomach's acid production and treat gastroesophageal reflux disease and other acid-related disorders. PPIs include agents as omeprazole (Prilosec), lansoprazole (Prevacid), and esomeprazole (Nexium).

PPIs are a medication class widely used in over-the-counter and prescription formulations to reduce acid production in the stomach and treat gastroesophageal reflux disease and other acid-related disorders. The PPI class includes such widely used agents as esomeprazole (Nexium), lansoprazole (Prevacid), and omeprazole (Prilosec).

Tingting Geng from Huazhong University of Science and Technology in Wuhan, China, and colleagues aimed to investigate the associations of PPI use with risks of cardiovascular disease (CVD) and all-cause mortality in type 2 diabetes patients.

They analyzed the association of PPI use with risks of myocardial infarction (MI), coronary artery disease (CAD), stroke, heart failure (HF), and all-cause mortality in 19 229 adults with type 2 diabetes using data from the UK Biobank study.

The authors reported the following findings:

• During a median follow-up of 10.9 to 11.2 years, 2971 CAD, 1827 MI, 1192 HF, and 738 stroke cases were documented, along with 2297 total deaths.
• PPI use was significantly associated with higher risks of CAD (hazard ratio [HR], 1.27), MI (HR, 1.34), HF (HR, 1.35), and all-cause mortality (HR, 1.30).
• No statistically significant association was observed between PPI use and stroke (HR, 1.11).
• The results were consistent in the subgroup analyses stratified by factors including indications of PPI, antidiabetic medication use, and antiplatelet drug use.
• Analyses in a 1:1 propensity score-matched cohort of PPI users vs nonusers yielded similar results.

"Our data indicate that use of proton pump inhibitors is associated with a higher risk of mortality and CVD events in patients with type 2 diabetes," the researchers concluded.

The findings were consistent in various sensitivity analyses, including a propensity-score matched analysis and after adjusting for the use of histamine type-2 receptor antagonists (H2RAs), a drug class having similar indications as that of PPIs.

Reference:

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