Use of proton pump inhibitors and development of acute myocardial infarction (Q10-03)

Use of proton pump inhibitors and development of acute myocardial infarction (Q10-03)

Q10-03

Overview

What is the issue?
  • Proton pump inhibitors (PPIs), used to treat the symptoms of gastroesophageal reflux disease and peptic ulcer disease, are extensively used in Canada despite the lack of robust evidence regarding their cardiovascular risk.
  • Health Canada asked CNODES for advice on whether the observed associations of PPI with acute myocardial infarction (AMI) were likely to be causal and whether further analyses of CNODES data-sets would be informative.
What is the aim of the study?
  • We rapidly reviewed the existing literature to provide a synopsis of the evidence with respect to PPI use and the risk of AMI.
How was the study conducted?
  • This targeted rapid review focused on all X published randomized and observational studies, supplemented with undergoing Canadian studies investigating the association between PPI use and the risk AMI.
What did the study find?
  • The findings suggest that while PPIs were associated with an increased risk of cardiac events in many observational studies (both including and excluding clopidogrel), these associations were likely due to either protopathic or confounding biases.
  • The single meta-analysis of propensity score-matched or randomized trial participants showed no significant cardiovascular risk with PPIs (risk ratio for major cardiovascular events 1.07, 95%CI 0.90-1.28).
Implications
  • These findings do not rule out the possibility of PPI-specific effects, although a major cardiovascular effect seems unlikely.

Manuscripts

Presentations

Project Team

Site Investigator
Gary Teare DVM, MSc, PhD
Saskatchewan
Site Investigator
Brenda Hemmelgarn MD, PhD, FRCPC
Alberta
Site Investigator
Colin R. Dormuth ScD
British Columbia
Co-Site Investigator
Pierre Ernst MD, MSc, FRCPC
Quebec
Co-Site Investigator
Jacques LeLorier MD, MSc, FRCPC, FISPE
Quebec
Co-Site Investigator
Robert W. Platt PhD
Quebec
Co-Site Investigator
Samy Suissa PhD
Quebec
Co-Site Investigator
Michael Paterson MSc
Ontario
Co-Site Investigator
David Henry MBChB, MRCP, FRCP (Edin)
Ontario
Co-Site Investigator
Patricia Martens
Manitoba
Co-Site Investigator
Patricia Caetano PhD
Manitoba