title: Prolonged utilization of proton pump inhibitors in patients with ischemic and valvular heart disease is associated with surgical treatments, weight loss and aggravates anemia.
abstract: BACKGROUND
  Proton pump inhibitors (PPIs) are among the commonest drugs used nowadays. The aim of our study was to analyze prolonged utilization of proton pump inhibitors in medical therapy of patients with ischemic and valvular heart disease. Secondly, profile of utilization was scrutinized to patient characteristics and type of cardiovascular treatments.
  
  
  METHODS
  The study included consecutive patients scheduled for cardiovascular rehabilitation 2-6months after index cardiovascular treatment.
  
  
  RESULTS
  Two hundred ninety-four patients (n=294/604; 48.7%) have been using proton pump inhibitor in their therapy after index cardiovascular treatment. Cardiovascular treatments were powerfully connected with utilization of PPIs; surgery 5.77 (95%-confidence intervals [CI]: 4.05-8.22; p<0.001) and PCI 0.15 (CI: 0.10-0.22; p<0.001). The odds for having proton pump inhibitor in their chronic therapy were increased for atrial fibrillation 1.87 (CI: 1.08-3.23; p=0.025) and decreased for obesity 0.65 (CI: 0.45-0.96; p=0.035); surviving myocardial infarction 0.49 (CI: 0.29-0.83; p=0.035). Multinomial logistic regression controlled for existence of chronic renal disease found no significant association of renal dysfunction and PPI therapy. The existence of anemia was significantly increased in patients taking PPIs than controls; 6.00 (CI: 3.85-9.33; p<0.001). The use of PPI was also associated with worsening of metabolic profile, in part due to decreased utilization of ACE-inhibitors and statins. PPI consumption correlated with age of patients (Rho=0.216; p<0.001).
  
  
  CONCLUSIONS
  High proportion of cardiovascular, particularly surgical patients with ischemic and valvular heart disease utilized proton pump inhibitor in prolonged courses. Prolonged courses of PPIs were connected with existence and worsening of red blood count indexes, older age, lesser weight of patients and underutilization of cardioprotective drugs.
authors.affiliation: Department of Cardiology, University hospital "Thalassotherapia Opatija", Medical Faculty, University of Rijeka, Croatia; Department of Internal Medicine, Medical Faculty "J.J. Strossmayer", University of Osijek, Croatia. Electronic address: marcoboban@yahoo.com.
authors.forename: Marko
authors.initials: M
authors.lastname: Boban
authors.affiliation: Department of Internal Medicine, Medical Faculty "J.J. Strossmayer", University of Osijek, Croatia.
authors.forename: Marinko
authors.initials: M
authors.lastname: Zulj
authors.affiliation: Department of Cardiology, University hospital "Thalassotherapia Opatija", Medical Faculty, University of Rijeka, Croatia; Department of Internal Medicine, Medical Faculty "J.J. Strossmayer", University of Osijek, Croatia.
authors.forename: Viktor
authors.initials: V
authors.lastname: Persic
authors.affiliation: Department of Cardiac Surgery, Medical Faculty, University of Zagreb, University hospital centre "Zagreb", Croatia.
authors.forename: Igor
authors.initials: I
authors.lastname: Medved
authors.affiliation: Department of Cardiology, University hospital "Thalassotherapia Opatija", Medical Faculty, University of Rijeka, Croatia; Department of Internal Medicine, Medical Faculty "J.J. Strossmayer", University of Osijek, Croatia.
authors.forename: Drazen
authors.initials: D
authors.lastname: Zekanovic
authors.affiliation: Department of Internal Medicine, Medical Faculty "J.J. Strossmayer", University of Osijek, Croatia.
authors.forename: Aleksandar
authors.initials: A
authors.lastname: Vcev
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000139:chemically induced* / Q000175:diagnosis; D015331:Cohort Studies; D004334:Drug Administration Schedule; D005260:Female; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery*; D054328:Proton Pump Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D013997:Time Factors; D016896:Treatment Outcome; D015431:Weight Loss / Q000187:drug effects* / Q000502:physiology; D055815:Young Adult
chemical_list: D054328:Proton Pump Inhibitors
keywords: Anemia; Ischemic heart disease; Proton pump inhibitor (PPI); Valvular heart disease; Weight loss