Heartburn Drugs May Put Your Heart on the Line

The counter drugs like Prevacid and Prilosec may increase heart attack risk.

When acid indigestion makes life miserable, you can pick from plenty of over-the-counter medications. But the one you reach for to treat heartburn might put your actual heart at risk — even if you don’t have a history of heart problems.

That’s what researchers found in a new study published June 10 in the journal PLOS ONE. People who took drugs called proton pump inhibitors (PPIs) for acid indigestion had about a 16 percent higher risk of a heart attack than those not taking them.
Examples of PPIs include Prilosec (omeprazole), Prevacid (lansoprazole), Aciphex (rabeprazole), Protonix (pantoprazole), Nexium (esomeprazole), and Zegarid (omeprazole/sodium bicarbonate).
These differ from a group of heartburn medications called H2 blockers. The H2 blocker category includes drugs such as Tagamet (cimetidine), Pepcid (famotidine), Axid (nizatidine), and Zantac (ranitidine). Researchers did not find the same risk of heart attack with H2 blockers.

“These drugs [PPIs] were only approved for short-term use, but as over-the-counter medications, the duration of use is not being monitored adequately,” says John Cooke, MD, PhD, a study author and chair of the department of cardiovascular sciences at Houston Methodist Research Institute.

“Furthermore, these drugs should only be used when safer agent, such as H2 antagonists like Tagamet or Zantac, are not effective in treating symptoms.” Dr. Cooke suggests using PPIs only under a doctor’s direction.

Heart-Health Risks of PPI Heartburn Drugs
Past research studies in the United States and in Denmark had already shown that PPIs increase the risk of cardiovascular problems in people with coronary artery disease and those taking Plavix (clopidogrel), a blood thinner used to help prevent blood clots, stroke, or heart attacks. But the new study showed a risk in people without a history of heart problems.

“It is surprising that the apparent harm from PPIs is not limited to people with chronic illnesses or to the elderly, groups that would be considered high risk for heart problems under any conditions,” says Sarah Samaan, MD, a cardiologist at the Baylor Heart Hospital in Plano, Texas. Doctors often prescribe some kind of stomach acid blocker to patients taking blood thinners to reduce the risk of bleeding ulcers, she explains.

“While PPIs are incredibly effective, it may turn out that H2 blockers are the safer options,” Dr. Samaan says.

Both PPIs and H2 blockers limit how much acid the stomach can release, but they work in different ways. H2 blockers work faster but do not last as long while PPIs take more time to work but last longer, Samaan says.

This study could not prove that PPIs caused heart attacks, but the authors describe a way that is possible based on lab experiments. The drugs might interfere with production of a blood chemical called nitric oxide. This molecule helps dilate arteries and helps protect blood vessels from disease, according to Cooke and Samaan.

Heart Attack, Stroke, and Heart Failure Risks
Researchers in the most recent study gathered data by analyzing PPI use and heart-related incidents in the electronic medical records of nearly 3 million people in the general U.S. population.

Then they looked at data from tracking just over 1,500 individuals for around five years. They wanted to see if those taking PPIs were more likely to die from heart attacks, strokes, or heart failure.

It turns out they were. The electronic data showed that people taking PPIs for acid reflux (gastroesophageal reflux disease, or GERD) were 16 percent more likely to have a heart attack than those not taking PPIs.

The results from the study also showed that those taking PPIs were twice as likely to die from a serious heart-related incident than if they were not taking the drugs. The increased risk for heart attack with PPIs existed across all age groups and for those not taking blood thinners.

However, one problem with using data from electronic medical records is that the researchers do not know what other conditions the patients taking PPIs had, points out Nicole Weinberg, MD, a cardiologist at Providence Saint John’s Health Center in Santa Monica, California. If more patients taking PPIs have diabetes, for example, that could affect the results.

“This study is very thought-provoking although I am not sure that it would change my medical management at this time,” Dr. Weinberg says.

How Big is the Risk to Your Heart?
The overall risk of a heart attack in a person with few other risk factors is still small, and the increase from PPIs is not large. A previous study from Taiwan found that 4,357 people would need to take PPIs for two weeks for one of them to have a heart attack that would not otherwise have occurred.

“Before throwing away all your PPI drugs, consider the absolute risk for you as an individual before getting scared,” says Nigam Shah, PhD, a study author and assistant professor of medicine at Stanford School of Medicine. But he adds, “If you are taking PPIs long-term without telling your doctor, then please tell your doctor ASAP.”

Finally, consider reducing acid reflux with your diet, suggests Robert Greenfield, MD, medical director of non-invasive cardiology and cardiac rehabilitation at Orange Coast Memorial in Fountain Valley, California.

“Substances and foods such as aspirin, alcohol, cigarettes, pizza sauce, peppermint, caffeine, and very spicy foods should be avoided,” Dr. Greenfield says. “This and the combination of a good H2 blocker [which he says can be used long-term] may reduce the need for ongoing PPI usage.”