By Bas ten Elzen
Proton pump inhibitors (PPIs) are one of the most commonly prescribed drugs worldwide, accounting for an annual turnover of about 10 billion euros. In most countries, like in the US, these drugs are obtainable without a prescription, and are even sold in regular shops like supermarkets. Now, however, the easy availabilty of these drugs might be something to be concerned about..
Admittedly, PPIs are very effective in treating a wide range of diseases; including gastro-oesophageal reflux disease (GERD), gastric ulcers, Barrett’s oesophagus and Zollinger-Ellison syndrome. Yet, more caution in prescribing (and using) these drugs is recommended. This is because scientists from Houston Methodist and Stanford University reported approximately a 16-21% increased risk of myocardial infarction (MI) in PPI users.
The precise pathophysiological mechanism behind this correlation has not yet been clarified. The authors hypothesised that it might relate to formerly reported data demonstrating that PPIs inhibit an important enzyme that promotes cardiovascular health. This enzyme (DDAH) metabolises an essential competitive inhibitor of nitric oxide synthase. So an increase in DDAH indirectly causes impaired endothelium-dependent vasodilatation in important vessels, resulting in increased cardiovascular risk.
So, are these groundbreaking findings going to cause a revolution in drug prescription?
Future research will tell..
Shah et all., plosone 2015 10;10(6):e0124653