Inibidores de bomba de prótons e IAM: aumento do risco em 16%
Já vimos que os inibidores de bomba de prótons possuem efeitos colaterais bem documentados como diminuição da absorção de ferro, vitamina B12, Magnésio e Cálcio (com aumento de osteoporose e fraturas), aumento do risco de infecções intestinais, como por Clostridium, aumento do risco de pneumonia, nefrite intersticial e outros (postagem anterior: "Vamos renovar a receita do omeprazol?").
Entretanto, um recente artigo publicado no British Medical Journal demonstrou associação com aumento de risco de doença cardiovascular / infarto. Tal associação não foi evidenciada com Bloqueadores H2, como a ranitidina. Resta confirmação prospectiva, mas fica o alerta.
Cuidado com a prescrição em cascata! Tomar muitos remédios não é indicação de se fazer mais um, pois esse "para proteger o estômago" pode sair caro...
Primum non nocere.
Cuidado com a prescrição em cascata! Tomar muitos remédios não é indicação de se fazer mais um, pois esse "para proteger o estômago" pode sair caro...
Primum non nocere.
Vejam a descrição abaixo:
Is PPI Use Associated With Increased Cardiovascular Risk?
Information sourced from BMJ:
BMJ 2015;350:h3220
Research News
People taking proton pump inhibitors may have increased risk of myocardial infarction, study shows
Susan Mayor
London
People taking proton pump inhibitors have a 16% higher risk of myocardial infarction than people who don't, a large US data mining study indicates.1
Researchers used a novel approach to mine clinical pharmacovigilance data that used multiple data sources to assess whether there was any association between use of proton pump inhibitors and cardiovascular risk in the general population. They queried more than 16 million clinical documents, including patients' clinical notes, providing information on a total of 2.9 million people.
The results, reported in PLoS One, showed that, among patients with gastro-esophageal reflux disease, taking a proton pump inhibitor was associated with a 16% increased risk of myocardial infarction (adjusted odds ratio 1.16 (95% confidence interval 1.09 to 1.24)). There was no association with myocardial infarction for another class of agents commonly used to treat gastro-esophageal reflux disease, H2 antagonists (adjusted odds ratio 0.93 (0.86 to 1.02)).
A separate analysis in a prospective cohort showed that the risk of cardiovascular mortality in people taking proton pump inhibitors was nearly twice the risk in people not taking these drugs (hazard ratio 2.22 (1.07 to 3.78)).
"Our results demonstrate that PPIs [proton pump inhibitors] appear to be associated with elevated risk of MI in the general population and H2-blockers show no such association," wrote the researchers, led by Nigam Shah, assistant professor at the Stanford Center for Biomedical Informatics Research, California. Their result was consistent with previous findings that proton pump inhibitors may adversely affect vascular function, he said.
"These drugs may not be as safe as we think," said coauthor Nicholas Leeper, also from Stanford University. But he cautioned that the association between proton pump inhibitors and myocardial infarction seen in the study did not, in itself, prove causation. "This association needs to be tested in a large, prospective, randomized trial," he explained. "The truth will come out when we randomize several hundred people, give half of them PPIs and put the other half on H2 blockers, and see what happens."
References
01. Shah NH, LePendu P, Bauer-Mehren A, et al. Proton pump inhibitor usage and the risk of myocardial infarction in the general population. PLoS One 10 Jun 2015, doi:10.1371/journal.pone.0124653.
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