+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

No Increase in Risk of Acute Myocardial Infarction in Privately Insured Adults Prescribed Proton Pump Inhibitors vs Histamine-2 Receptor Antagonists (2002-2014)

No Increase in Risk of Acute Myocardial Infarction in Privately Insured Adults Prescribed Proton Pump Inhibitors vs Histamine-2 Receptor Antagonists (2002-2014)

Gastroenterology 154(4): 861-873.E6

Proton pump inhibitors (PPIs) are commonly used medications. Recent studies reported an increased risk of acute myocardial infarction (MI) in PPI users vs non-users. We evaluated MI risk associated with PPIs compared with histamine-2 receptor antagonists (H2RAs) in privately insured adults in the United States. Using administrative claims from commercial and Medicare Supplemental plans (2001-2014), we compared risk of MI in patients who started a new prescription for PPIs vs H2RAs. Enrollees were followed from their first prescription until MI, medication discontinuation, plan disenrollment, or December 31, 2014. MI was defined using hospital diagnosis codes. Risk differences (RD), risk ratios, and 95% confidence intervals (CIs) were estimated using Kaplan-Meier methods at 3, 12, and 36 months after treatment initiation. Standardized morbidity ratio weights were used to control measured confounding. Analyses were stratified by plan type (commercial vs Medicare Supplemental). We identified more than 5 million new users of prescription PPIs and H2RAs. Median follow-up time was 60 days for patients with commercial insurance and 96 days in patients with Medicare Supplemental insurance. The 12-month weighted risk of MI was low overall (approximately 2 cases per 1000 among patients in commercial plans; 8 per 1000 among patients in Medicare Supplemental plans). In the RD analysis, we found no significant differences in MI risk between patients who started PPIs vs H2RAs for the first 12 months, either in the commercial population (weighted RD per 1000, -0.08; 95% CI, -0.51 to 0.36) or the Medicare Supplemental population (weighted RD per 1000, -0.45; 95% CI, -1.53 to 0.58). In an analysis of administrative claims from commercial and Medicare Supplemental plans, we found no evidence that prescription PPIs increase risk of MI compared with prescription H2RAs. Physicians and patients should not avoid starting a PPI because of concerns related to MI risk.

Please choose payment method:

(PDF emailed within 0-6 h: $19.90)

Accession: 060021945

Download citation: RISBibTeXText

PMID: 29122546

DOI: 10.1053/j.gastro.2017.10.042

Related references

Proton Pump Inhibitors versus Histamine-2 Receptor Antagonists and Risk of Pneumonia in Patients with Acute Stroke. Journal of Stroke and Cerebrovascular Diseases 25(5): 1035-1040, 2016

Characteristics of children and adolescents first prescribed proton pump inhibitors or histamine-2-receptor antagonists: an observational cohort study. Current Medical Research and Opinion 33(12): 2251-2259, 2017

Prevention of stress induced ulcers: histamine-2 receptor antagonists or proton pump inhibitors? - gastric hemorrhage occur more often under proton pump inhibitors. DeutscheMedizinischeWochenschrift139(25-26):1338, 2014

Proton pump inhibitors and histamine-2 receptor antagonists are associated with hip fractures among at-risk patients. Gastroenterology 139(1): 93, 2010

Do proton pump inhibitors increase the risk of myocardial infarction?. Gastroenterologia Y Hepatologia 39(6): 365-368, 2017

Proton pump inhibitors, histamine H2 receptor antagonists, and other antacid medications and the risk of fracture. Calcified Tissue International 79(2): 76-83, 2006

Proton Pump Inhibitors, Histamine-2 Receptor Antagonists, and Hip Fracture Risk among Patients on Hemodialysis. Clinical Journal of the American Society of Nephrology 13(10): 1534-1541, 2018

Do proton pump inhibitors increase the incidence of nosocomial pneumonia and related infectious complications when compared with histamine-2 receptor antagonists in critically ill trauma patients?. Current Surgery 61(5): 452-458, 2004

Fracture risk of young adults receiving proton-pump inhibitors and H2-receptor antagonists. International Journal of Clinical Practice 73(5): E13339, 2019

Renal Transplant Acute Rejection with Lower Mycophenolate Mofetil Dosing and Proton Pump Inhibitors or Histamine-2 Receptor Antagonists. PharmacoTherapy 37(12): 1507-1515, 2017

Lack of incremental effect of histamine receptor antagonists over proton pump inhibitors on the risk of neoplastic progression in patients with Barrett's esophagus: a cohort study. Journal of Digestive Diseases 18(3): 143-150, 2017

Histamine 2 Receptor Antagonists and Proton Pump Inhibitors. Dermatitis 27(3): 100-109, 2018

Revising the link between proton-pump inhibitors and risk of acute myocardial infarction-a case-crossover analysis. European Journal of Clinical Pharmacology 71(1): 125-129, 2015

Do histamine-2 receptor antagonists and proton pump inhibitors really have no effect on the gastric emptying rate?. Journal of Neurogastroenterology and Motility 17(4): 434; Author Reply 435, 2011

Treatment of peptic ulcer in the elderly. Proton pump inhibitors and histamine H2 receptor antagonists. Drugs and Aging 9(4): 251-261, 1996