Proton Pump Inhibitor Usage and the Risk of Myocardial Infarction in the General Population

Shah, Nigam H.; LePendu, Paea; Bauer-Mehren, Anna; Ghebremariam, Yohannes T.; Iyer, Srinivasan; Marcus, Jake R.; Nead, Kevin T.; Cooke, John P.; Leeper, Nicholas J.

doi:10.1371/journal.pone.0124653

Cited by 291 publications

(234 citation statements)

References 43 publications

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“…37 Although other mechanisms have been proposed, 38 the effects of PPIs on the microbiota could affect lipid metabolism and an thereby an individual's subsequent risk of cardiovascular events. 9,12 The effects of commonly used medication and the effects on the host metabolism therefore warrant further investigation.…”

Section: Bmi and Lipid Metabolismmentioning

confidence: 99%

The influence of proton pump inhibitors and other commonly used medication on the gut microbiota

et al. 2017

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Proton pump inhibitors (PPIs), used to treat gastro-esophageal reflux and prevent gastric ulcers, are among the most widely used drugs in the world. The use of PPIs is associated with an increased risk of enteric infections. Since the gut microbiota can, depending on composition, increase or decrease the risk of enteric infections, we investigated the effect of PPI-use on the gut microbiota. We discovered profound differences in the gut microbiota of PPI users: 20% of their bacterial taxa were statistically significantly altered compared with those of non-users. Moreover, we found that it is not only PPIs, but also antibiotics, antidepressants, statins and other commonly used medication were associated with distinct gut microbiota signatures. As a consequence, commonly used medications could affect how the gut microbiota resist enteric infections, promote or ameliorate gut inflammation, or change the host's metabolism. More studies are clearly needed to understand the role of commonly used medication in altering the gut microbiota as well as the subsequent health consequences.KEYWORDS gut microbiota; medication; proton pump inhibitors Proton pump inhibitors affect the gut microbiotaProton pump inhibitors (PPIs), used to treat gastroesophageal reflux and to prevent gastric ulcers, are among the most commonly used drugs in the world.1,2 In the Netherlands, one PPI alone (omeprazole) was the fourth most prescribed drug in 2015. In observational studies, the use of PPIs has been associated with an increased risk of enteric infections caused by Clostridium difficile, Salmonella spp., Shigella spp and Campylobacter spp. [3][4][5] Since the gut microbiota can, depending on composition, increase or decrease the risk of enteric infections, we investigated the effect of PPI use on the gut microbiota. 6 Using the 16S rRNA sequences of stool samples from 1815 individuals spanning 3 independent cohorts, we observed profound changes in the gut microbiota of PPI users. In PPI users the relative abundance of 20% of the bacterial taxa, whereof 18 bacterial families, was statistically significantly different (either increased or decreased) compared with abundances in samples from non-users. 6 Concurrently with our research, other research groups were also investigating the influence of PPIs on the gut microbiota. A small intervention study was published a few months before ours and a similar observational study was published in the same issue of Gut. 7,8 In Table 1, the bacterial alterations associated with PPI use from all 3 studies are presented at the family level. There are many similarities between the results of all 3 studies and, when associations at different taxonomical levels are taken into account (e.g. the decrease of order Clostridiales and increases of class Gammaproteobacteria and order Actinomycetales), a consistent profile of alterations in gut microbiota associated with PPI use emerges. Other commonly used drugs and the gut microbiotaTo ensure that our observed alterations in gut microbiota associated wi...

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Section: Bmi and Lipid Metabolismmentioning

confidence: 99%

The influence of proton pump inhibitors and other commonly used medication on the gut microbiota

et al. 2017

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“…This tool has several disadvantages, including the incorporation of approaches to modifying the bleeding risk that are not empirically proven in a patients without known CVD and insufficient external validation to confirm its readiness for clinical application (21,(28)(29).…”

Section: Antiplatelet Therapy In Primary Prevention Of Cardiovascularmentioning

confidence: 99%

Update of Antiplatelet Therapy in Patients Without Known Cardiovascular Disease

Tomasević

Aleksandric

Stojković

2018

Serbian Journal of Experimental and Clinical Research

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Platelet activation and aggregation play a critical role in thrombosis, a fundamental pathophysiologic event responsible for the acute clinical manifestations of atherothrombotic events such as acute coronary syndrome, myocardial infarction, ischemic stroke/transient ischemic attack and peripheral artery disease. Dual antiplatelet therapy (low-dose aspirin plus ADP-P2Y12 receptor blockers) has become the cornerstone of therapy SAŽETAK Aktivacija i adhezija trombocita imaju glavnu ulogu u procesu tromboze koja predstavlja osnovni patofi ziološki događaj odgovoran za razvoj akutnih kliničkih manifestacija aterosklerotske bolesti arterija, kao što su akutni koronarni sindrom, infarkt miokarda, ishemijski moždani udar/tranzitorni ishemijski atak ili periferna arterijska bolest. Dvojna antitrombocitna terapija (aspirin plus blokatori trombocitnih ADP-P2Y12 receptora) predstavlja kamen temeljac u lečenju bolesnika sa akutnim i hroničnim oblicima ishemijske bolesti srca, kao i u prevenciji neželjenih ishemijskih kardiovaskularnih događaja

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“…105 To date, cimetidine is the only H2RA known to interact with clopidogrel. 27 Recently a retrospective study, 106 analyzing 2.9 million patient data, has been published suggesting that PPIs therapies are associated with an increased risk of myocardial infarction in the general population.…”

Section: Interaction Between Proton Pump Inhibitors and Other Drugsmentioning

confidence: 99%

Proton pump inhibitors overuse: only inappropriate prescriptions or further iatrogenic damage?

Visconti¹

2015

Ital J Med

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Proton pump inhibitors (PPIs) are the most potent drugs for reducing gastric acid secretion; so, since their release in the late 1980s, they have been recommended as the first therapeutic choice for many gastroesophageal diseases, risk reduction in or healing of non-steroidal anti-inflammatory drugs-associated ulcer disease and stress ulcer prophylaxis in intensive care unit patients. Thus PPIs account for a significant proportion of pharmaceutical health-care expenditure. Much of this high expenditure results from overuse of PPIs in account of inappropriate indications or prolongation of therapies for excessive time compared to real need. PPIs overutilization occurs in all medical care settings: in the majority of hospitalized patients with low risks for gastrointestinal bleeding, in patients healed at discharge from hospital, in outpatients in ambulatory practice. However potential adverse effects associated with PPIs therapy have been described, including enteric (especially by Clostridium difficile in elderly patients) and pneumonia infections, nutritional deficiencies, rebound acid hypersecretion, acute interstitial nephritis, gastric neoplasms, bone fractures. Caution is required for some coprescription, particularly with clopidogrel.

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Proton Pump Inhibitor Usage and the Risk of Myocardial Infarction in the General Population

Cited by 291 publications

References 43 publications

The influence of proton pump inhibitors and other commonly used medication on the gut microbiota

The influence of proton pump inhibitors and other commonly used medication on the gut microbiota

Update of Antiplatelet Therapy in Patients Without Known Cardiovascular Disease

Proton pump inhibitors overuse: only inappropriate prescriptions or further iatrogenic damage?

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