Cardiovascular Compatibility of Proton Pump Inhibitors: Practice Recommendations

Figures

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  Fig. 1. Association between cardiac and GI disorders. This figure illustrates the strong association between cardiac and GI disorders. The consensus level among participants was 100%, with 62% strongly agreeing and 38% agreeing with some reservations. GI gastrointestinal

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  Fig. 2. Consequences of increased GI bleeding with respect to cardiovascular events, mortality, and hospitalization. The figure illustrates the association between increased GI bleeding and its consequences, including cardiovascular events, mortality, and prolonged hospitalization. The consensus level reached 100% agreement. GI gastrointestinal

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  Fig. 3. Polypharmacy and DDI burden in cardiac patients. The figure highlights a significant consensus level (100%) regarding the burden of polypharmacy and DDI in cardiac patients, with 62% strongly agreeing and 38% agreeing with some reservations. DDI drug–drug interaction

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  Fig. 4. Aspirin and aspirin + clopidogrel—common medications in cardiac patients. The figure summarizes the common medications used in cardiac patient care, including aspirin as the single drug and the combination of aspirin + clopidogrel. The consensus level was 100%, with 87% strongly agreeing and 13% agreeing with some reservations

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  Fig. 5. PPI recommendations for gastroprotection in patients with CAD. The figure highlights the recommendations for PPIs in providing gastroprotection for patients with CAD, with a consensus level of 100%, including 87% strongly agreeing and 13% agreeing with some reservations. CAD coronary artery disease, PPI proton pump inhibitor

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  Fig. 6. Influence of PPIs on DAPT effectiveness in cardiac patients. The figure highlights how PPIs influence the effectiveness of DAPT in cardiac patients, with a consensus level of 100%, agreeing with some reservations. PPI proton pump inhibitor, DAPT dual antiplatelet therapy

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  Fig. 7. PPIs and antiplatelet drugs share a common cytochrome P450 metabolic pathway. This figure highlights the common cytochrome P450 metabolic pathway shared by PPIs and antiplatelet drugs, with a consensus level of 100%, including 38% strongly agreeing and 62% agreeing with some reservations. PPI proton pump inhibitor

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  Fig. 8. Major metabolic pathways for the PPIs and the CYP 450 enzymes involved. The contribution of each isoenzyme is represented by the thickness of the arrow (thick arrows indicate the dominant pathway; thin arrows indicate the non-dominant pathway). PPI proton pump inhibitor. Note: Adapted from Sugimoto et al. Proton pump inhibitor therapy before and after endoscopic submucosal dissection: A review. Diagn Ther Endosc. 2012; 791873. https://doi.org/10.1155/2012/791873. Copyright © 2012 Sugimoto et al. This is an open access article, licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0)

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  Fig. 9. Not all PPIs are metabolized predominantly by the CYP450 pathway. The figure illustrates that not all PPIs are predominantly metabolized by the CYP450 pathway. The consensus level among participants was 100%, with 25% strongly agreeing and 75% agreeing with some reservations. PPI proton pump inhibitor

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  Fig. 10. PPIs with minimal DDI should be preferred. The figure shows that a PPI with minimal DDI should be preferred, especially in patients requiring clopidogrel or polypharmacy. The consensus level among participants was 100%, with 100% strongly agreeing. PPI proton pump inhibitor, DDI drug–drug interaction

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  Fig. 11. Rabeprazole does not interact with clopidogrel to the same extent as other PPIs. The figure illustrates that rabeprazole does not interact with clopidogrel to the same extent as other PPIs. The consensus level among participants was 100%, with 100% strongly agreeing. PPIs proton pump inhibitors

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  Fig. 12. Rabeprazole prevents recurrence of peptic ulcers in patients on low-dose aspirin treatment. The figure illustrates that rabeprazole prevents recurrence of peptic ulcers in patients on low-dose aspirin treatment. The consensus level among participants was 100%, with 75% strongly agreeing and 25% agreeing with some reservations