Abstract Title:

Proton pump inhibitors and the risk of severe adverse events - a cardiovascular bomb?

Abstract Source:

Rev Port Cardiol. 2018 May 24. Epub 2018 May 24. PMID: 29804887

Abstract Author(s):

Nelson Cunha, António Pedro Machado

Article Affiliation:

Nelson Cunha


Proton pump inhibitors are currently one of the most prescribed pharmacological classes in developed countries, given their effectiveness and safety profile previously considered favourable. However, over the last few years, several papers have been published that associate prolonged use of these drugs with a wide range of adverse effects, posing doubts about their safety. Among the adverse effects described, one should emphasize the increased risk of cardiovascular events. This relationship was first described in subjects after acute coronary syndrome by the interference of proton pump inhibitors in cytochrome P450 2C19 and the conversion of clopidogrel to active metabolite. However, more recent studies describe this relationship also with the use of antiplatelet agents that do not depend on cytochrome P450 2C19 activation. The proposed mechanism is by inhibiting dimethylarginine dimethylaminohydrolase, a physiological inhibitor of asymmetric dimethylarginine, thus increasing the plasma concentrations of the latter enzyme and in turn translating into lower levels of nitric oxide. The authors reviewing in this article the relationship between the use of proton pump inhibitors and the increased risk of cardio and cerebrovascular events, are intended to alert the scientific community to the potentially harmful effects of these drugs and recommend the setting of a moratorium on their prolonged use.

Study Type : Review
Additional Links
Adverse Pharmacological Actions : Cardiotoxic : CK(1000) : AC(164)

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