title: Use of Proton-Pump Inhibitors Predicts Heart Failure and Death in Patients with Coronary Artery Disease.
abstract: OBJECTIVE
  Proton-pump inhibitors (PPIs) seem to increase the incidence of cardiovascular events in patients with coronary artery disease (CAD), mainly in those using clopidogrel. We analysed the impact of PPIs on the prognosis of patients with stable CAD.
  
  
  METHODS
  We followed 706 patients with CAD. Primary outcome was the combination of secondary outcomes. Secondary outcomes were 1) acute ischaemic events (any acute coronary syndrome, stroke, or transient ischaemic attack) and 2) heart failure (HF) or death.
  
  
  RESULTS
  Patients on PPIs were older [62.0 (53.0-73.0) vs. 58.0 (50.0-70.0) years; p = 0.003] and had a more frequent history of stroke (4.9% vs. 1.1%; p = 0.004) than those from the non-PPI group, and presented no differences in any other clinical variable, including cardiovascular risk factors, ejection fraction, and therapy with aspirin and clopidogrel. Follow-up was 2.2±0.99 years. Seventy-eight patients met the primary outcome, 53 developed acute ischaemic events, and 33 HF or death. PPI use was an independent predictor of the primary outcome [hazard ratio (HR) = 2.281 (1.244-4.183); p = 0.008], along with hypertension, body-mass index, glomerular filtration rate, atrial fibrillation, and nitrate use. PPI use was also an independent predictor of HF/death [HR = 5.713 (1.628-20.043); p = 0.007], but not of acute ischaemic events. A propensity score showed similar results.
  
  
  CONCLUSIONS
  In patients with CAD, PPI use is independently associated with an increased incidence of HF and death but not with a high rate of acute ischaemic events. Further studies are needed to confirm these findings.
authors.affiliation: Department of Cardiology, IIS-Fundación Jiménez Díaz, Madrid, Spain.
authors.forename: Ana María
authors.initials: AM
authors.lastname: Pello Lázaro
authors.affiliation: Department of Cardiology, Hospital de Fuenlabrada, Madrid, Spain.|Rey Juan Carlos University, Alcorcón, Madrid, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Cristóbal
authors.affiliation: Department of Cardiology, IIS-Fundación Jiménez Díaz, Madrid, Spain.
authors.forename: Juan Antonio
authors.initials: JA
authors.lastname: Franco-Peláez
authors.affiliation: Department of Cardiology, Hospital Universitario de Móstoles, Madrid, Spain.
authors.forename: Nieves
authors.initials: N
authors.lastname: Tarín
authors.affiliation: Department of Cardiology, IIS-Fundación Jiménez Díaz, Madrid, Spain.
authors.forename: Álvaro
authors.initials: Á
authors.lastname: Aceña
authors.affiliation: Department of Cardiology, IIS-Fundación Jiménez Díaz, Madrid, Spain.
authors.forename: Rocío
authors.initials: R
authors.lastname: Carda
authors.affiliation: Department of Cardiology, Hospital Universitario Fundación Alcorcón, Madrid, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Huelmos
authors.affiliation: Department of Cardiology, IIS-Fundación Jiménez Díaz, Madrid, Spain.
authors.forename: María Luisa
authors.initials: ML
authors.lastname: Martín-Mariscal
authors.affiliation: Department of Cardiology, IIS-Fundación Jiménez Díaz, Madrid, Spain.
authors.forename: Jesús
authors.initials: J
authors.lastname: Fuentes-Antras
authors.affiliation: Department of Cardiology, IIS-Fundación Jiménez Díaz, Madrid, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Martínez-Millá
authors.affiliation: Rey Juan Carlos University, Alcorcón, Madrid, Spain.|Department of Cardiology, Hospital de Getafe, Madrid, Spain.
authors.forename: Joaquín
authors.initials: J
authors.lastname: Alonso
authors.affiliation: Autónoma University, Madrid, Spain.|Laboratory of Vascular Pathology, IIS-Fundación Jiménez Díaz, Madrid, Spain.
authors.forename: Óscar
authors.initials: Ó
authors.lastname: Lorenzo
authors.affiliation: Autónoma University, Madrid, Spain.|Laboratory of Vascular Pathology, IIS-Fundación Jiménez Díaz, Madrid, Spain.|CIBERDEM, Madrid, Spain.
authors.forename: Jesús
authors.initials: J
authors.lastname: Egido
authors.affiliation: Rey Juan Carlos University, Alcorcón, Madrid, Spain.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: López-Bescós
authors.affiliation: Department of Cardiology, IIS-Fundación Jiménez Díaz, Madrid, Spain.|Autónoma University, Madrid, Spain.|Laboratory of Vascular Pathology, IIS-Fundación Jiménez Díaz, Madrid, Spain.
authors.forename: José
authors.initials: J
authors.lastname: Tuñón
mesh_terms: D054058:Acute Coronary Syndrome / Q000139:chemically induced / Q000209:etiology / Q000401:mortality; D000368:Aged; D016022:Case-Control Studies; D003327:Coronary Disease / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D005260:Female; D006333:Heart Failure / Q000139:chemically induced / Q000209:etiology* / Q000401:mortality; D006801:Humans; D002546:Ischemic Attack, Transient / Q000139:chemically induced / Q000209:etiology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D054328:Proton Pump Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D012307:Risk Factors; D000072657:ST Elevation Myocardial Infarction / Q000139:chemically induced / Q000209:etiology / Q000401:mortality; D020521:Stroke / Q000139:chemically induced / Q000209:etiology / Q000401:mortality
chemical_list: D054328:Proton Pump Inhibitors