Connections between nutritional status and proton pump inhibitor therapy in patients scheduled for cardiovascular rehabilitation after treatment for ischaemic and valvular heart disease

Abstract

A b s t r a c t Background:Multiple and yet uncertain connections exist between cardiovascular diseases and the nutritional status of patients, particularly in relation to cardiovascular treatments. Proton pump inhibitors (PPI) are among the most commonly used group of drugs. Aim:To analyse utilisation of PPI in association with nutritional risk of patients scheduled for rehabilitation after treatment for ischaemic and valvular heart disease. Methods:Retrospective analyses on a consecutive sample of patients, which included drug utilisation of PPI and nutritional risk screening, using a standardised NRS-2002 tool. The patients (n = 536) were divided into groups based on previous cardiovascular treatments and use of PPI.Results: Nearly half of the patients (244, 46.1%) had PPI in their chronic therapy despite the clinically negligible prevalence of conditions that are their fundamental indications. The odds for using PPI in patients with increased nutritional risk, estimated by logistic regression, were 3.34 (95% confidence intervals [CI] 2.26-4.94), p < 0.001. Receiver operating curve analyses also revealed significant differences of PPI utilisation in connection with NRS-2002 > 3: positive likelihood-ratio (LR) 2.35 (95% CI 2.10-2.60); negative LR 0.46 (95% CI 0.4-0.6); area under the curve (AUC) 0.720; p < 0.001; as well as the percentage weigh loss history > 6.36% (positive LR 2.22 [95% CI 2.00-2.50]; negative LR 0.41 [95% CI 0.30-0.50]; AUC 0.707; p < 0.001).Conclusions: Utilisation of PPI was found to be of relatively high prevalence and significantly associated with parameters of nutritional risk screening. Furthermore, it was in correlation with the age of patients and the existence of chronic kidney disease, which are well-established predispositions for poor nutritional status. Nutritional risk seems to be additionally negatively challenged by utilisation of PPI due to gastric malabsorption and anaemia.

Effect of Long-Term Proton Pump Inhibitor Therapy on Nutritional Status in Elderly Hospitalized Patients

“…The number of female patients was higher than male patients, as with PPI therapy. Our results differed from a previous study in which patients had higher BMIs and there was a higher number of men than women (16). Although, there was no difference in daily intake, FOIS and FIM were significantly different between the presence and absence of PPI therapy.…”

Nutritional Considerations of Cardiovascular Diseases and Treatments

“…56 Despite the fact that proton pump inhibitors (PPIs) are not drugs for the treatment of CVD, they are often prescribed in these patients, especially in elderly and are significantly associated with parameters of NRS. 76 According to some studies, 25% to 86% of elderly patients have been overprescribed with PPIs, mostly because of the antiaggregation therapy commonly used by cardiovascular patients. [76][77][78] In addition, in cardiovascular patients, PPIs seem to be negatively connected with nutritional risk, mostly due to increase in gastric malabsorption and anemia.…”

“…76 According to some studies, 25% to 86% of elderly patients have been overprescribed with PPIs, mostly because of the antiaggregation therapy commonly used by cardiovascular patients. [76][77][78] In addition, in cardiovascular patients, PPIs seem to be negatively connected with nutritional risk, mostly due to increase in gastric malabsorption and anemia. 76 While, as mentioned above, ACE inhibitors may have protective role on nutritional risk, PPIs and loop diuretics might be associated with increased nutritional risk and unintentional weight loss.…”

“…[76][77][78] In addition, in cardiovascular patients, PPIs seem to be negatively connected with nutritional risk, mostly due to increase in gastric malabsorption and anemia. 76 While, as mentioned above, ACE inhibitors may have protective role on nutritional risk, PPIs and loop diuretics might be associated with increased nutritional risk and unintentional weight loss. 79…”

“…137 Poorer nutritional risk in patients with CVD scheduled for CR can also be related to overuse of PPI and consequent malabsorption and anemia. 76…”