How PPIs affect your heart

In November 2023, we saw the publication of yet another scientific study suggesting a link between Proton Pump Inhibitors (PPIs) and serious illness. This was published in the International Journal of Cardiology. You can find the abstract here.

What did the study show?

In the study, scientists looked at nearly half a million people from the general population who were enrolled in the UK Biobank study between 2006 and 2010 and were then followed up until 2018. The risks of developing cardiovascular disease such as strokes, heart attacks and heart failure were then assessed and those taking PPIs compared with those who did not. Possible confounding factors such as lifestyle behaviours, the indications for taking the PPIs and demographics were calculated so that the true statistical risk of the PPIs being associated with cardio disease calculated.

The results suggests that for all the cardiovascular risks analysed PPIs were associated with increased risk. These weren’t enormous but were statistically significant ranging between 44% and 65% depending upon the specific condition. The authors concluded that “regular PPIs use was associated with higher risk of cardiovascular disease outcomes. Clinicians should therefore exercise caution when prescribing PPIs”.

This study is the latest of many published in recent years that suggest that taking PPIs long term is associated with increased risks of multiple conditions. These include dementia, renal failure, osteoporosis and bone fractures, stomach cancer, gastrointestinal infections and mineral malabsorption to name just a few.

What does this mean? Are PPIs harmful or even dangerous? Should everyone taking them be concerned or even stop them?

Moving into 2024, PPI usage and its effects will remain an important focus of our research and we look forward to publishing more content around this key subject. These are very important questions with major implications for millions of patients. While all medications carry risk and usually there is “no smoke without fire” these must always be balanced with their benefits. Many millions of people benefit from PPIs and take them without problem and much of the evidence regarding the potential harm they may cause is not strong. However, on the other hand PPIs are often prescribed without much thought and too many patients take them with little benefit and are rarely offered alternative treatments. There is also certainly increasing evidence that PPIs can affect the gut biome and as we learn more about the importance of this to our health it is likely to become an increasing focus of research. We have much to say on this subject.

Concerns about the consequences of taking PPIs long term are often quickly dismissed by clinicians. This is wrong and we’ll do our best to explain why in coming posts.