Newspaper comment - PPI link to MI disputed

Press/Media: Expert Comment

Period16 Jun 2015

Media contributions


Media contributions

  • TitlePPI link to MI disputed
    Degree of recognitionNational
    Media name/outletMedical observer
    Media typePrint
    Duration/Length/Size300 words
    DescriptionAUSTRALIAN experts are unimpressed with a study that suggests proton-pump inhibitors (PPIs) are associated with an increased risk of myocardial infarction (MI).

    Researchers from the US analysed electronic medical records for 2.9 million patients using data mining and found the odds of having an MI were 1.16 times higher in PPI users compared with non-users.

    The association was similar when data was restricted to patients not on clopidogrel, and the risks extended to patients younger than 55, the authors say. The researchers found H2 blockers had no association with MI.
    A survival analysis comprising 1500 patients prospectively followed for five years found results that were concordant with the data-mining study, the researchers say.

    However, Associate Professor Geoff Hebbard, director of gastroenterology at Royal Melbourne Hospital, says the research should “have no effect on clinical practice”.

    “It’s quite a small effect, and in a study where you haven’t been able to adjust for confounders, 1.16 looks particularly weak,” he says.

    “The number needed to harm in their study is 4000, so if someone has a good reason to be on a PPI, they should be on it.”

    Professor Hebbard also raises concerns about the potential conflicts of interest disclosed by the authors and their suggestion that H2 blockers achieve a similar change in gastric pH as PPIs.

    “It’s just not true… It’s why PPIs are so much more effective in reflux than H2 receptor antagonists,” he says.

    Dr Ingrid Hopper, clinical pharmacologist and researcher at Monash University, says caution is needed when interpreting data-mining studies.

    “Causality cannot be established with this technique,” she says.

    The non-systematic approach to data collection makes it difficult to correct for confounding factors, Dr Hopper adds.

    Sydney gastroenterologist Dr Katie Ellard, a member of the Council of the Gastroenterological Society of Australia, says that although the study findings appear “fairly preliminary”, it may serve as a prompt for PPI review in patients.

    PLoS One 2015; online 10 June

    Producer/AuthorKristen Ochs
    PersonsIngrid Hopper