Association between proton pump inhibitor use and the risk of myocardial infarction: A cross-sectional study based on NHANES 2007 to 2018

Proton pump inhibitors (PPIs) are among the most commonly prescribed medications in clinical practice. However, emerging evidence has raised concerns about a potential association between PPI use and the risk of myocardial infarction (MI), although the findings remain inconsistent. Given these uncertainties, this study aimed to explore the association between PPI use and the risk of MI in the general population. This retrospective analysis utilized data from 6 National Health and Nutrition Examination Survey cycles (2007-2018). Multivariable-adjusted weighted logistic regression analysis investigated the association between PPI use and the risk of MI. For comparative cohort balancing, multiple imputation and propensity score matching were employed to assess the association between PPI use and the risk of MI, adjusting for demographic, clinical, and lifestyle covariates. Subgroup analyses were conducted by sex, age, smoking, alcohol use, hypertension, diabetes, and aspirin use. This cross-sectional analysis identified 47,713 adults in the United States. In a multivariable weighted logistic regression model adjusted for potential confounders, PPI use was observed to be positively associated with the risk of MI (odds ratio=1.668; 95% confidence interval: 1.224-2.273; P<.001). Based on multiple imputation and propensity score matching analysis, this association remained consistent in the matched cohort (odds ratio=1.386, 95% confidence interval: 1.167-1.646; P=.002). Subgroup analyses showed that males and smokers were more susceptible to the risk of MI associated with PPI use. This study observed a significant association between PPI use and an increased risk of MI in the general adult population. The impact of PPI use on MI risk may differ across subgroups, highlighting the need for personalized approaches and careful risk-benefit assessment when prescribing PPIs.