Proton pump inhibitors and statins: a possible interaction that favors low-density lipoprotein cholesterol reduction?
BACKGROUND
Proton pump inhibitors (PPIs) might influence the metabolism of cholesterol and statins in the liver.


OBJECTIVE
The impact of PPIs on low-density lipoprotein cholesterol (LDL-C) levels in statin-treated patients.


METHODS
Retrospective observational study including consecutive statin-treated individuals followed for ≥3 years in a university hospital lipid clinic. Demographic characteristics as well as clinical and laboratory data were recorded at baseline and the most recent visit. High, moderate and low-intensity statin therapy was defined according to the expected LDL-C reduction (≥50%, 30-50%, and <30%, respectively). We compared the LDL-C reduction in subjects receiving statin + PPI with those on statin alone and assessed the overall effect of PPI administration on LDL-C lowering.


RESULTS
Of 648 statin-treated subjects, 7% were also taking a PPI. There was no difference between PPI vs. non-PPI group regarding baseline characteristics and intensity of lipid-lowering therapy. Stepwise linear regression analysis showed that PPI use was significantly associated with LDL-C reduction (b =0.104, p =0.005) along with baseline LDL-C levels (b =0.482, p <0.001), treatment with ezetimibe (b =0.198, p <0.001), presence of diabetes (b =0.168, p <0.001), compliance with treatment (b =0.205, p <0.001), intensity of statin treatment (b =0.101, p =0.005) and cardiovascular risk (b =0.082, p =0.049). Subjects receiving statin + PPI had a higher LDL-C reduction by 6.4% compared with those taking a statin alone (fully adjusted p =0.005).


CONCLUSIONS
PPIs may modestly boost the statin-mediated LDL-C reduction. This effect should be confirmed by prospective clinical studies. Hippokratia 2015; 19 (4): 332-337.
Department of Internal Medicine, School of Medicine, University Hospital of Ioannina, Ioannina, Greece.
F
F
Barkas
Department of Internal Medicine, School of Medicine, University Hospital of Ioannina, Ioannina, Greece.
M
M
Elisaf
Department of Internal Medicine, School of Medicine, University Hospital of Ioannina, Ioannina, Greece.
C V
CV
Rizos
Department of Internal Medicine, School of Medicine, University Hospital of Ioannina, Ioannina, Greece.
E
E
Klouras
Clinical Pharmacology Unit, Addenbrooke's Hospital Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
M S
MS
Kostapanos
Department of Internal Medicine, School of Medicine, University Hospital of Ioannina, Ioannina, Greece.
E
E
Liberopoulos
cholesterol; cytochrome; interaction; proton pump inhibitors; statin
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