Geng Tingting, Chen Jun-Xiang, Zhou Yan-Feng, Lu Qi, Wan Zhenzhen, Liu Liegang, Pan An, Liu Gang
Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety (Huazhong University of Science and Technology), Ministry of Education Key Lab of Environment and Health, and State Key Laboratory of Environment Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 430030 Wuhan, China.
Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 430030 Wuhan, China.
J Clin Endocrinol Metab. 2023 May 17;108(6):e216-e222. doi: 10.1210/clinem/dgac750.
Proton pump inhibitors (PPIs) are widely used drugs for gastric acid-related diseases and may affect the gut microbiome.
We aimed to evaluate the associations of PPI use with risks of cardiovascular disease (CVD) and all-cause mortality in patients with type 2 diabetes (T2D).
We analyzed the associations of PPI use with risks of coronary artery disease (CAD), myocardial infarction (MI), heart failure (HF), stroke, and all-cause mortality in 19 229 adults with T2D using data from the UK Biobank study.
During a median follow-up of 10.9 to 11.2 years, we documented 2971 CAD, 1827 MI, 1192 HF, and 738 stroke cases, along with 2297 total deaths. PPI use was significantly associated with higher risks of CAD (hazard ratio [HR], 1.27; 95% CI, 1.15-1.40), MI (HR, 1.34; 95% CI, 1.18-1.52), HF (HR, 1.35; 95% CI, 1.16-1.57), and all-cause mortality (HR, 1.30; 95% CI, 1.16-1.45). No statistically significant association was observed between PPI use and stroke (HR, 1.11; 95% CI, 0.90-1.36). The results were consistent in the subgroup analyses stratified by factors including indications of PPI, antidiabetic medication use, and antiplatelet drug use. Analyses in a 1:1 propensity score-matched cohort of PPI users vs nonusers yielded similar results.
Our data suggest that PPI use is associated with higher risks of CVD events and mortality among patients with T2D. The benefits and risks of PPI use should be carefully balanced among patients with T2D, and monitoring of adverse CVD events during PPI therapy should be enhanced.
质子泵抑制剂（PPIs）是治疗胃酸相关疾病的常用药物，可能会影响肠道微生物群。
我们旨在评估使用PPIs与2型糖尿病（T2D）患者心血管疾病（CVD）风险和全因死亡率之间的关联。
我们使用英国生物银行研究的数据，分析了19229名T2D成人中使用PPIs与冠状动脉疾病（CAD）、心肌梗死（MI）、心力衰竭（HF）、中风和全因死亡率风险之间的关联。
在中位随访10.9至11.2年期间，我们记录了2971例CAD、1827例MI、1192例HF和738例中风病例，以及2297例全因死亡。使用PPIs与CAD风险较高（风险比[HR]，1.27；95%CI，1.15-1.40）、MI（HR，1.34；95%CI，1.18-1.52）、HF（HR，1.35；95%CI，1.16-1.57）和全因死亡率（HR，1.30；95%CI，1.16-1.45）显著相关。未观察到使用PPIs与中风之间存在统计学显著关联（HR，1.11；95%CI，0.90-1.36）。在按PPIs适应症、抗糖尿病药物使用和抗血小板药物使用等因素分层的亚组分析中，结果一致。在PPIs使用者与非使用者的1:1倾向评分匹配队列分析中得出了类似结果。
我们的数据表明，在T2D患者中，使用PPIs与CVD事件和死亡风险较高相关。在T2D患者中应仔细权衡使用PPIs的益处和风险，并应加强在PPIs治疗期间对不良CVD事件的监测。
