Proton-pump inhibitor use as a modifiable etiological factor for iron deficiency in heart failure
M Kutscher, H H Van Der Wal, A A Voors, P Van Der Meer, N Grote BeverborgAbstract
Background
Iron deficiency is highly prevalent in heart failure and associated with worse outcomes. Proton pump inhibitors (PPIs) are frequently prescribed to patients with heart failure and may contribute to iron deficiency through impaired iron uptake by gastric acid suppression, but evidence in heart failure populations is limited.
Purpose
To investigate the association between PPI use and iron deficiency in a large, well-characterized heart failure cohort.
Methods
We analyzed the combined BIOSTAT-CHF cohort comprising both index and validation populations. Iron parameters were measured in 4056 patients. We performed dose-response analyses and PPI subtype analyses.
Results
Iron deficiency was highly prevalent (59%) and 38% of patients were using a PPI. PPI users were older, had more comorbidities and showed a higher prevalence of iron deficiency (64% vs 56%, p<0.001). In multivariable analyses adjusting for age, sex, cohort, antiplatelet therapy, oral anticoagulants and established predictors of iron deficiency in heart failure, PPI use remained independently associated with iron deficiency (adjusted OR 1.31, 95% CI 1.10–1.57, p=0.003). A dose-response relationship was observed: each 10mg increase in omeprazole-equivalent dose was independently associated with iron deficiency (OR 1.10, 95% CI 1.03–1.16, p=0.002). PPI subtypes were not associated with the incidence of iron deficiency.
Conclusion
In patients with heart failure, proton pump inhibitor use is independently associated with iron deficiency in a dose-dependent manner.Forest plotFor image description, please refer to the figure legend and surrounding text.