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We read with interest the article by Ghebremariam et al1 demonstrating that proton pump inhibitors (PPIs) reduce endogenous formation of nitric oxide (NO) and impair vascular reactivity.1 This deleterious effect of PPIs occurred through inhibition of the enzyme dimethylarginine dimethylaminohydrolase, which degrades asymmetrical diemethylarginine, an endogenous NO synthase inhibitor.1 The authors discuss this as a possible mechanism explaining the increased risk of adverse cardiovascular events with prolonged PPI treatment.2 We bring up another mechanism by which PPIs may alter vascular NO homeostasis, with possible added deleterious effects …

circulation

Letter by Montenegro and Lundberg Regarding Article, “Unexpected Effect of Proton Pump Inhibitors: Elevation of the Cardiovascular Risk Factor Asymmetric Dimethylarginine”