Proton pump inhibitor use and risk of adverse cardiovascular events in aspirin treated patients with first time myocardial infarction: nationwide propensity score matched study

We read with interest the article "Proton pump inhibitor use and risk
of adverse cardiovascular
events in aspirin treated patients with first time myocardial infarction:
nationwide propensity score matched study" by Charlot el al (1). The
authors note that they did not observe an increased risk associated with
treatment using H2 receptor blockers. In this regard, it is important to
mention that if one choose H2 receptor blockers for gastroprotection, not
all H2 receptor blockers are equal. Ranitidine can prevent duodenal
ulceration in patients taking nonsteroidal antiinflammatory drugs (NSAID)
for arthritis but is relatively ineffective in preventing NSAID-associated
gastric ulceration (2). In a study of patients with rheumatoid arthritis
or osteoarthritis who had been receiving standard doses of an NSAID, high
doses of famotidine (40 mg of famotidine twice daily ) were effective in
preventing both gastric and duodenal ulcers (3). In another recent study
(4), famotidine (20 mg twice daily) was also effective in the prevention
of gastric and duodenal ulcers in patients with diabetes or cardiovascular
disease taking low-dose aspirin.

1. Charlot M, Grove EL, Hansen PR, Olesen JB, Ahlehoff O, Selmer C,
et al. Proton pump inhibitor use and risk of adverse cardiovascular events
in aspirin treated patients with first time myocardial infarction:
nationwide propensity score matched study. BMJ 2011;342:d2690

2. Ehsanullah RSB, Page MC, Tildesley G, Wood JR. Prevention of
gastroduodenal damage induced by non-steroidal anti-inflammatory drugs:
controlled trial of ranitidine. BMJ 1988;297:1017-21.

3. Taha AS, Hudson N, Hawkey CJ, Swannell AJ, Trye PN, Cottrell J, et
al. Famotidine for the prevention of gastric and duodenal ulcers caused
by nonsteroidal antiinflammatory drugs. N Engl J Med 1996;334:1435-9.

4. Taha AS, McCloskey C, Prasad R, Bezlyak V. Famotidine for the
prevention of peptic ulcers and oesophagitis in patients taking low-dose
aspirin (FAMOUS): a phase III, randomised, double-blind, placebo-
controlled trial. Lancet 2009; 374: 119-25.