Systematic review with meta-analysis

risk of adverse cardiovascular events with proton pump inhibitors independent of clopidogrel

Research output: Contribution to journalReview ArticleResearchpeer-review

9 Citations (Scopus)

Abstract

Background: Clopidogrel's anti-platelet effects may be attenuated by a pharmacokinetic interaction with co-prescribed proton pump inhibitors, which inhibit oxidative pathways that convert clopidogrel into its active metabolites. Despite this, the impact of PPIs on cardiovascular risk in the absence of clopidogrel is not well defined. Aim: To report on a systematic review and meta-analysis of the association between PPIs and cardiovascular risk, independent of clopidogrel. Methods: The databases of MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Scopus, Web of Science, and ClinicalTrials.gov were systematically searched in October 2017. The primary outcome was association between PPI monotherapy and any adverse cardiovascular event. The secondary outcome was association between proton pump inhibitor monotherapy and acute myocardial infarction. Studies were excluded if they reported or did not adjust for concomitant anti-platelet therapy or involved participants aged less than 18 years. Results: A total of 22 studies were included in the systematic review. Data from 16 studies were included in the meta-analysis (involving 447 408 participants). Of these, eight were randomised controlled trials, seven were observational studies and one was a retrospective analysis of a randomised controlled trial. An increased risk of any adverse cardiovascular event with PPI monotherapy was observed using pooled data from observational studies (risk ratio 1.25, 95% CI 1.11-1.42, I2 81%, P < 0.001), but not from randomised controlled trials (risk ratio 0.89, 95% CI 0.34-2.33, I2 0%, P = 0.85). Conclusion: There is no clear evidence of an association between PPI monotherapy and increased cardiovascular risk.

Original languageEnglish
Pages (from-to)780-796
Number of pages17
JournalAlimentary Pharmacology and Therapeutics
Volume48
Issue number8
DOIs
Publication statusPublished - 1 Oct 2018

Cite this

@article{d75a891ff82f440389310c6594daae5d,
title = "Systematic review with meta-analysis: risk of adverse cardiovascular events with proton pump inhibitors independent of clopidogrel",
abstract = "Background: Clopidogrel's anti-platelet effects may be attenuated by a pharmacokinetic interaction with co-prescribed proton pump inhibitors, which inhibit oxidative pathways that convert clopidogrel into its active metabolites. Despite this, the impact of PPIs on cardiovascular risk in the absence of clopidogrel is not well defined. Aim: To report on a systematic review and meta-analysis of the association between PPIs and cardiovascular risk, independent of clopidogrel. Methods: The databases of MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Scopus, Web of Science, and ClinicalTrials.gov were systematically searched in October 2017. The primary outcome was association between PPI monotherapy and any adverse cardiovascular event. The secondary outcome was association between proton pump inhibitor monotherapy and acute myocardial infarction. Studies were excluded if they reported or did not adjust for concomitant anti-platelet therapy or involved participants aged less than 18 years. Results: A total of 22 studies were included in the systematic review. Data from 16 studies were included in the meta-analysis (involving 447 408 participants). Of these, eight were randomised controlled trials, seven were observational studies and one was a retrospective analysis of a randomised controlled trial. An increased risk of any adverse cardiovascular event with PPI monotherapy was observed using pooled data from observational studies (risk ratio 1.25, 95{\%} CI 1.11-1.42, I2 81{\%}, P < 0.001), but not from randomised controlled trials (risk ratio 0.89, 95{\%} CI 0.34-2.33, I2 0{\%}, P = 0.85). Conclusion: There is no clear evidence of an association between PPI monotherapy and increased cardiovascular risk.",
author = "Riley Batchelor and Radya Kumar and Gilmartin-Thomas, {Julia Fiona-Maree} and Hopper, {Ingrid Kate} and Kemp, {William Wilson} and Liew, {Danny Yearn Hian}",
year = "2018",
month = "10",
day = "1",
doi = "10.1111/apt.14955",
language = "English",
volume = "48",
pages = "780--796",
journal = "Alimentary Pharmacology and Therapeutics",
issn = "0269-2813",
publisher = "Wiley-Blackwell",
number = "8",

}

TY - JOUR

T1 - Systematic review with meta-analysis

T2 - risk of adverse cardiovascular events with proton pump inhibitors independent of clopidogrel

AU - Batchelor, Riley

AU - Kumar, Radya

AU - Gilmartin-Thomas, Julia Fiona-Maree

AU - Hopper, Ingrid Kate

AU - Kemp, William Wilson

AU - Liew, Danny Yearn Hian

PY - 2018/10/1

Y1 - 2018/10/1

N2 - Background: Clopidogrel's anti-platelet effects may be attenuated by a pharmacokinetic interaction with co-prescribed proton pump inhibitors, which inhibit oxidative pathways that convert clopidogrel into its active metabolites. Despite this, the impact of PPIs on cardiovascular risk in the absence of clopidogrel is not well defined. Aim: To report on a systematic review and meta-analysis of the association between PPIs and cardiovascular risk, independent of clopidogrel. Methods: The databases of MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Scopus, Web of Science, and ClinicalTrials.gov were systematically searched in October 2017. The primary outcome was association between PPI monotherapy and any adverse cardiovascular event. The secondary outcome was association between proton pump inhibitor monotherapy and acute myocardial infarction. Studies were excluded if they reported or did not adjust for concomitant anti-platelet therapy or involved participants aged less than 18 years. Results: A total of 22 studies were included in the systematic review. Data from 16 studies were included in the meta-analysis (involving 447 408 participants). Of these, eight were randomised controlled trials, seven were observational studies and one was a retrospective analysis of a randomised controlled trial. An increased risk of any adverse cardiovascular event with PPI monotherapy was observed using pooled data from observational studies (risk ratio 1.25, 95% CI 1.11-1.42, I2 81%, P < 0.001), but not from randomised controlled trials (risk ratio 0.89, 95% CI 0.34-2.33, I2 0%, P = 0.85). Conclusion: There is no clear evidence of an association between PPI monotherapy and increased cardiovascular risk.

AB - Background: Clopidogrel's anti-platelet effects may be attenuated by a pharmacokinetic interaction with co-prescribed proton pump inhibitors, which inhibit oxidative pathways that convert clopidogrel into its active metabolites. Despite this, the impact of PPIs on cardiovascular risk in the absence of clopidogrel is not well defined. Aim: To report on a systematic review and meta-analysis of the association between PPIs and cardiovascular risk, independent of clopidogrel. Methods: The databases of MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Scopus, Web of Science, and ClinicalTrials.gov were systematically searched in October 2017. The primary outcome was association between PPI monotherapy and any adverse cardiovascular event. The secondary outcome was association between proton pump inhibitor monotherapy and acute myocardial infarction. Studies were excluded if they reported or did not adjust for concomitant anti-platelet therapy or involved participants aged less than 18 years. Results: A total of 22 studies were included in the systematic review. Data from 16 studies were included in the meta-analysis (involving 447 408 participants). Of these, eight were randomised controlled trials, seven were observational studies and one was a retrospective analysis of a randomised controlled trial. An increased risk of any adverse cardiovascular event with PPI monotherapy was observed using pooled data from observational studies (risk ratio 1.25, 95% CI 1.11-1.42, I2 81%, P < 0.001), but not from randomised controlled trials (risk ratio 0.89, 95% CI 0.34-2.33, I2 0%, P = 0.85). Conclusion: There is no clear evidence of an association between PPI monotherapy and increased cardiovascular risk.

UR - http://www.scopus.com/inward/record.url?scp=85053237591&partnerID=8YFLogxK

U2 - 10.1111/apt.14955

DO - 10.1111/apt.14955

M3 - Review Article

VL - 48

SP - 780

EP - 796

JO - Alimentary Pharmacology and Therapeutics

JF - Alimentary Pharmacology and Therapeutics

SN - 0269-2813

IS - 8

ER -