When Heartburn Gets Serious

Heart attack risk may increase with proton pump inhibitor use

(RxWiki News) It may be easy to pop a pill for heartburn for the convenience of not having to stop eating spicy and acidic foods, but this convenience may come at the price of good health.

A new study found that adults who take antacids, known as proton pump inhibitors, may have a higher risk of heart attack than non-users — regardless of age and heart health.

"Our report raises concerns that these drugs — which are available over the counter and are among the most commonly prescribed drugs in the world — may not be as safe as we previously assumed," said lead study author Nicholas J. Leeper, MD, of Stanford University, in a press release.

Proton pump inhibitors (PPIs) — such as omeprazole and lansoprazole (brand names Prilosec and Prevacid) — are prescribed for various gastrointestinal disorders, such as gastroesophageal reflux disease (GERD) and Barrett's esophagus.

An estimated 113 million PPI prescriptions are filled worldwide each year, bringing yearly global sales to more than $13 billion, according to this study. These drugs are also available over the counter.

Dr. Leeper and team looked at data on nearly 3 million patients who used one of two types of antacid medication — PPIs and H2 blockers.

H2 blockers — such as cimetidine and ranitidine (brand names Zantac and Tagamet) — are antacid drugs that have similar effects to PPIs.

These researchers looked for a link between the drugs and heart health in patients with no history of heart disease. Dr. Leeper and team found that PPIs increased heart attack risk by 16 to 21 percent, while H2 blockers did not.

Past research found that PPIs reduced the effectiveness of clopidogrel (brand name Plavix) — a drug used to treat patients with a history of acute coronary disease (heart disease). According to Dr. Leeper and team, this risk may extend to patients without any history of heart disease.

"Our earlier work identified that the PPIs can adversely affect the endothelium, the Teflon-like lining of the blood vessels," said study author John P. Cooke MD, PhD, of the Houston Methodist Research Institute, in the release. "That observation led us to hypothesize that anyone taking PPIs may be at greater risk for heart attack."

Dr. Leeper and team noted that PPI usage may be a marker of a sicker patient population. In some cases, antacids may have been prescribed for heart problems that were mistaken for heartburn.

"However, the observation that alternative heartburn medications such as H2 blockers were not associated with harm lends support to the concept that PPIs may specifically promote risk," said study author Nigam H. Shah, PhD, of Stanford University, in the release.

This study was published June 10 in the journal PLOS ONE.

The National Institutes of Health, the American Heart Association, Apixio Inc., and the Stanford SPARK Transnational Research Program funded this research. Two of the authors disclosed ties to Altitude Pharma.


Review Date: 
June 10, 2015