Reactions 1680, p9 - 2 Dec 2017 Increased risk of myocardial infarction with PPIs? There is no evidence that prescribing proton pump inhibitors (PPIs) increases the risk of myocardial infarction (MI) compared with prescribing histamine-2 receptor antagonists (H2RAs), according to study results reported in Gastroenterology, and "physicians and patients should not avoid starting a PPI because of concerns related to MI risk". The observational cohort study used the US Truven Health Analytics MarketScan Research Database. Claims from eligible adults who started new prescriptions for PPIs or H2RAs in 2001–2014 were identified. The Commercial Claims and Encounters database included 3675 120 patients who received PPIs and 829 441 patients who received H2RAs, while the Medicare Supplemental database identified 894 821 patients who received PPIs and 192 607 patients who received H2RAs. The primary outcome was hospitalised MI. In the commercial claims cohort, the crude MI risk increased over the time of the study. The 3-month risk for PPI compared with H2RA recipients was "essentially null," note the authors (weighted risk ratio [RR] 1.00; 95% CI 0.87, 1.16), and remained approximately null for other timepoints. At 12 months, there was a slight but insignificantly decreased risk of MI per 1000 PPI recipients (weighted risk difference [RD] –0.08; –0.51, 0.36). This had reversed by 36 months (RD 1.21; 1.07, 1.37). Similarly, the MI risk increased over time in the Medicare Supplemental cohort; the mean as-treated follow-up duration was longer for PPI compared with H2RA recipients (241 vs 147 days). Relative risks were different at 3 months (RR 0.87; 0.76, 0.99) and 12 months (RR 0.99; 0.84, 1.17). There were small risk differences per 1000 patients between 3 months (RD –0.35; –0.72, –0.02) and 12 months (RD –0.33; –4.40, 3.46). The authors conclude that "for U.S. patients enrolled in privately insured plans with no previous history of MI, prescription PPI utilization does not appear to pose a short-term risk for MI over the utilization of prescription H2RAs, a drug similarly recommended to treat gastrointestinal conditions like GERD". Landi SN, et al. No Increase in Risk of Acute Myocardial Infarction in Privately Insured Adults Prescribed Proton Pump Inhibitors vs Histamine-2 Receptor Antagonists (2002-2014). Gastroenterology : 6 Nov 2017. Available from: URL: http://doi.org/10.1053/j.gastro.2017.10.042 803284961 0114-9954/17/1680-0001/$14.95 Adis © 2017 Springer International Publishing AG. All rights reserved Reactions 2 Dec 2017 No. 1680
Reactions Weekly – Springer Journals
Published: Dec 2, 2017
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