Proton Pump Inhibitor Exposure and Acute Myocardial Infarction Risk: A Nested Cohort Study


Background: Association of proton pump inhibitor (PPI) exposure with acute myocardial infarction (AMI) risk in the Caucasian population remains under debate. Here, we clarified whether PPI exposure might be related to an increased new-onset AMI risk in an Asian population. Method: Data of 27,624 patients with PPI exposure followed by new-onset AMI development were extracted from Taiwan National Health Insurance Research Database and age- and sex-matched with 27,624 controls with PPIs exposure, but without subsequent AMI and ischemic heart disease development. The amount of PPI exposure was calculated based on the cumulative defined daily dose (cDDD) during the follow-up period. Subsequent AMI risk was measured after adjustments of demographic data and indication of PPI use. Results: AMI risk increased with an increase in PPI exposure: with cDDD ≤ 30 as the reference, the odds ratios (95% confidence intervals) for cDDDs of > 365 was 1.56 (1.45–1.69). All five PPI categories, including pantoprazole, lansoprazole, omeprazole, esomeprazole, and rabeprazole, increased AMI risk. Conclusions: Our study demonstrated long-term or high-dose PPI exposure associated with increased new-onset AMI risk in patients without a history of any ischemic heart disease. The underlying mechanisms of PPI-related cardiovascular effects deserve more investigation.

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We thank Mr I-Fan Hu for his friendship and support.


The study was supported by a grant from Taipei Veterans General Hospital (V106B-020, V107B-010, V107C-181, V108B-012), Yen Tjing Ling Medical Foundation (CI-110-30), and Ministry of Science and Technology, Taiwan (107-2314-B-075-063-MY3, 108-2314-B-075-037). The funding source had no role in any process of our study. None of the aforementioned funding organizations had any role in the study design, data collection, analysis, interpretation of the result, writing of the report, and the ultimate decision to submit the paper for publication.

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Drs MHC, SJT, WCL, and YMB designed the study and wrote the protocol. Drs MHC and HJT drafted the manuscript. Dr CMC prepared the rebuttal letter and revised the manuscript. Drs CFT, TPS, SJT, WCL, YMB, and CTL reviewed and revised the manuscript paper. Drs MHC and TJC performed the statistical analysis. All authors reviewed the final manuscript and approved for publication.

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Correspondence to Mu-Hong Chen.

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Tseng, HJ., Cheng, CM., Tsai, SJ. et al. Proton Pump Inhibitor Exposure and Acute Myocardial Infarction Risk: A Nested Cohort Study. Cardiovasc Toxicol (2021).

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  • Proton pump inhibitor
  • Acute myocardial infarction
  • Cumulative defined daily dose