389 Are Proton Pump Inhibitors Associated With an Increased Risk in Developing Ischemic Heart Disease in Non-Cardiac Chest Pain Patients?

Abstract

INTRODUCTION: Non-cardiac chest pain (NCCP) is defined as chest pain that persists after cardiac etiologies have been excluded. Treatment of NCCP is targeted towards the underlying cause, most often GERD, which is commonly treated with proton pump inhibitors (PPI). It has been reported that long term PPI use is associated with increased risk for developing ischemic heart disease (IHD). We aim to determine whether PPI use is associated with an increased risk for IHD in NCCP patients, and thus alter the otherwise benign course of the disease. METHODS: Cohort analysis was performed using the multi-institutional database IBM Explorys. NCCP patients started on a PPI at least 1 day after diagnosis, and who developed IHD at least 30 days following PPI initiation were included. Identical parameters were used to acquire data on patients prescribed histamine H2 receptor antagonists (H2RA). Data analysis was controlled for 6 known confounding factors for IHD including hyperlipidemia, hypertension, obesity, smoking status, male gender, and diabetes mellitus. RESULTS: A total of 13,250 NCCP patients without preexisting IHD received PPI; 1,280 (9.66%) developed new IHD. Of these patients, 740 (57.8%) had ST-elevation MI (STEMI), 340 (26.5%) non-ST elevation MI (NSTEMI), and 200 (15.6%) ischemic cardiomyopathy (ICM). A total of 22,260 NCCP patients without preexisting IHD were never prescribed a PPI; 870 (3.91%) developed new IHD. Of these patients, 490 (56.3%) had STEMI, 210 (24.1%) NSTEMI, and 170 (19.5%) ICM. The unadjusted and adjusted odds ratios of developing IHD in NCCP patients while on PPI compared to not on PPI were 2.63 (95% CI 2.41-2.87), and 1.14 (95% CI 1.03-1.25, P-value 0.0093), respectively. A total of 3,050 NCCP patients without preexisting IHD received H2RA; 250 (8.19%) developed new IHD. Of these patients, 160 (64%) had STEMI, 70 (28%) NSTEMI, and 20 (8%) ICM. Overall, 22,070 NCCP patients without preexisting IHD received H2RA; 1,320 (5.98%) developed new IHD. Of these patients, 790 (59.8%) had STEMI, 350 (26.5%) NSTEMI, and 180 (13.6%) ICM. The unadjusted and adjusted odds ratios of developing IHD while on H2RA compared to not on H2RA were 1.40 (95% CI 1.22-1.62) and 0.90 (95% CI 0.77-1.06, P-value 0.2049), respectively. CONCLUSION: PPI use appears to confer a statistically significant, but marginally increased odds in developing IHD in NCCP patients. Thus, PPI use in NCCP only minimally alters the course of the disease. H2RA use does not statistically increase the risk for IHD in NCCP patients.