Proton pump inhibitors and risk for recurrent ischemic events or death in outpatients with symptomatic artery disease

Abstract Bagkground and aims The influence of proton pump inhibitors (PPIs) on outcome in patients with symptomatic artery disease remains controversial. Methods FRENA is a prospective registry of consecutive outpatients with symptomatic coronary (CAD), cerebrovascular (CVD) or peripheral artery disease (PAD). We compared the risk for subsequent ischemic events or death according to the use of PPIs. Results As of December 2016, 5170 patients were recruited: 1793 (35%) had CAD, 1530 (30%) CVD and 1847 (35%) had PAD. Overall, 2289 patients (44%) were regularly using PPIs. During a median follow-up of 36 months, 172 patients suffered a recurrent myocardial infarction, 139 had ischemic stroke, 71 underwent limb amputation and 267 died (cardiovascular death, 109). On multivariable analysis, patients using PPIs were at a lower risk for subsequent limb amputation (hazard ratio [HR]: 0.53; 95%CI: 0.30–0.94), a similar risk for myocardial infarction (HR: 0.78; 95%CI: 0.55–1.10) or stroke (HR: 0.93; 95%CI: 0.64–1.35) and at a higher risk of death (HR: 1.37; 95%CI: 1.04–1.79). Conclusions Among stable outpatients with symptomatic artery disease, the use of PPIs was associated with a lower risk for subsequent ischemic events but a higher risk for death.