How May Proton Pump Inhibitors Impair Cardiovascular Health?

Sukhovershin, Roman; Cooke, John P.

doi:10.1007/s40256-016-0160-9

Cited by 38 publications

(42 citation statements)

References 90 publications

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“…35) Indeed, magnesium plays a key role in maintaining cardiovascular homeostasis; has vasodilator, anti-inflammatory, and antioxidative properties; reduces platelet activation; and regulates cardiac electric activity by modulating potassium and calcium channels. 41) In addition, hypomagnesemia is involved in many of the processes underlying atherosclerosis by promoting proatherogenic lipid profile, increased vascular calcification, im-paired insulin activity, and vascular chronic inflammation. 41) Current evidence has provided the molecular mechanisms for this association; therefore, careful consideration should be given to the prescription of PPIs.…”

Section: Discussionmentioning

confidence: 99%

Real-World Relationship Between Proton Pump Inhibitors and Cerebro-Cardiovascular Outcomes Independent of Clopidogrel

Liu

Chen

et al. 2019

Int. Heart J.

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Previous studies have provided established evidence on adverse outcomes of the coadministration of proton pump inhibitors (PPIs) and clopidogrel, whereas cerebro-cardiovascular outcomes of PPI use in the absence of clopidogrel therapy remain controversial. In this study, we aimed to assess the association between PPIs and cerebro-cardiovascular outcomes independent of clopidogrel. Systematic searches were conducted in the Cochrane Library, PubMed, and Embase databases for all relevant studies up to August 2018. Odds ratios (ORs) with its 95% confidence intervals (CIs) were abstracted and pooled using the random-effects model. A total of 14 observational studies (13 cohort studies and 1 case-control study) were identified. Compared with non-PPI users, PPI users experienced higher risks of stroke (

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Section: Discussionmentioning

confidence: 99%

Real-World Relationship Between Proton Pump Inhibitors and Cerebro-Cardiovascular Outcomes Independent of Clopidogrel

Liu

Chen

et al. 2019

Int. Heart J.

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“…Proton pump inhibitors (PPIs) were introduced to the market at the end of the 1980s [1] and are currently among the most widely prescribed treatments worldwide [2], with more than 60% of them prescribed for an unjustified indication [3] in US ambulatory settings. The chronic use of PPIs, the difficulty in stopping the treatment due to gastric acid rebound symptoms [4], their effectiveness and their very good short-term tolerance, leading to an estimated compliance of 71%, explain the magnitude of their prescription [5].…”

Section: Introductionmentioning

confidence: 99%

Snapshot of proton pump inhibitors prescriptions in a tertiary care hospital in Switzerland: less is more?

et al. 2019

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Background Proton pump inhibitors are among the most widely prescribed drugs in the world, but more than half of the indications for prescription are unjustified. The misuse of this therapeutic class has heavy consequences such as additional health costs, adverse drug reactions following long-term use and gastric acid rebound when the proton pump inhibitor is discontinued. Objective The overprescription of proton pump inhibitors is therefore becoming a public health problem, which led us to evaluate their use within the Geneva University Hospitals. Setting Patients hospitalized in two divisions of the department of internal medicine of the Geneva University Hospitals on a single day. Methods This is a register-based cross-sectional study and it collected data about the prescription pattern of proton pump inhibitors by consulting the electronic records of patients included. Main outcome measure To determine if the proton pump inhibitors prescription is made according to the market authorization and the available guidelines. Results Hundred-eighty patients were included. 54% of patients were on proton pump inhibitors, 29% of whom had their treatment initiated at hospital. Of the indications for treatment, 72% were not justified and 63% of the justified indications did not have an adequate dosage. Therefore, in all patients with a proton pump inhibitor at hospital, only 11% had a justified indication with an adequate dose. Finally, 87% of known home prescriptions were renewed on admission and among them, 71% did not have a justified or possibly justified indication according to the guidelines. Conclusion Indication for treatment inside the hospital was not justified in 72% of patients and only 11% had a justified indication with an adequate dosage. Precise guidelines with evidence-based indications and adequate daily doses would help to correctly prescribe proton pump inhibitors. Moreover, patients should benefit from a thorough evaluation of their treatment. Impact of findings on practice statements• Around 70% of the renewed prescriptions for proton pump inhibitors on admission did not have a justified indication. • As many as 72% of the hospitalised patients had an unjustified indication for a proton pump inhibitor.

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“…Namely, as a result of prolonged PPI administration, gastric hypoacidity ensues, resulting in the inhibition of the feedback mechanism initiated by antral mucosal acid sensors. Therefore, antral G-cell release of gastrin is not suppressed, which leads to chronic hypergastrinemia, gastric parietal, and ECL-cell hyperplasia (4,5). Among other consequences, hypergastrinemia will result in rebound gastric acid hypersecretion in 30-40% of patients following the abrupt PPI termination (1,5).…”

Section: Literature Overviewmentioning

confidence: 99%

“…Therefore, antral G-cell release of gastrin is not suppressed, which leads to chronic hypergastrinemia, gastric parietal, and ECL-cell hyperplasia (4,5). Among other consequences, hypergastrinemia will result in rebound gastric acid hypersecretion in 30-40% of patients following the abrupt PPI termination (1,5). Due to cell hyperplasia (which is not a short-time abnormality), rebound gastric acid oversecretion may last for weeks.…”

Section: Literature Overviewmentioning

confidence: 99%

“…This becomes even more important if we have in mind that PPIs are among the most widely used drugs worldwide, approximating US$13 billion in sales per year. Long-term usage of PPIs is not approved, but they became over-the-counter drugs in the USA, leading to the lack of efficient control in the PPI administration (5). Therefore, sudden PPI withdrawal occurs more often.…”

Section: Literature Overviewmentioning

confidence: 99%

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Rebound Phenomenon – Important and Ubiquitous in Pharmacotherapy

Koraćević¹,

Lalić²,

Nedeljković³

et al. 2018

AMM

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The rebound effect represents a common characteristic of the numerous classes of modern drugs and can result in serious and even fatal disorders. For example, prolonged administration of proton pump inhibitor (PPI) leads to moderate hypergastrinemia in 20-25%. This hypergastrinemia will result in rebound gastric acid hypersecretion in 30-40% of patients following the abrupt PPI discontinuation. PPIs are among the most widely used drugs worldwide.An abrupt cessation of chronic corticosteroid, beta blocker, or opioid treatment may also provoke rebound phenomenon. Even in heart failure patients, beta blocker withdrawal on admission resulted in a significant increase of the probability of in-hospital mortality. The incidence of a rebound phenomenon depends on numerous factors, including the intensity and duration of action of a particular drug and how long it has been applied; the susceptibility of an individual patient (regarding the comorbidities and the severity of the primary disease) and the related circumstances (e.g, co-therapy). The clinical importance of the rebound phenomenon varies from academic to lethal. Even rare rebounds found for some classes of drugs are becoming very important if the drug has been used often globally. Acta Medica Medianae 2018;57(4):148-152.

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How May Proton Pump Inhibitors Impair Cardiovascular Health?

Cited by 38 publications

References 90 publications

Real-World Relationship Between Proton Pump Inhibitors and Cerebro-Cardiovascular Outcomes Independent of Clopidogrel

Real-World Relationship Between Proton Pump Inhibitors and Cerebro-Cardiovascular Outcomes Independent of Clopidogrel

Snapshot of proton pump inhibitors prescriptions in a tertiary care hospital in Switzerland: less is more?

Rebound Phenomenon – Important and Ubiquitous in Pharmacotherapy

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