Heartburn Drugs May Raise Your Heart Attack Risk

Proton pump inhibitors, popular medications often sold over the counter that can stop acid indigestion (heartburn), aren't risk-free. Here's what you should know.

Drugs known as proton pump inhibitors (PPIs), sold both over the counter (OTC) since 2003 and in prescription form for even longer, are some of the most popular medications on the planet.

If you are concerned about your heart or kidneys, however, talk to your doctors about alternatives. The best strategy is to use PPIs for only short periods, not regularly for years.

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Why you might use a proton pump inhibitor

These medications include Prilosec, Nexium, Prevacid, and Aciphex. They relieve pain and discomfort from chronic, severe heartburn and gastroesophageal reflux disease (GERD), which causes stomach contents to rise up into the esophagus.

PPIs are also frequently prescribed to treat other upper gastrointestinal woes, including inflammation of the esophagus, stomach ulcers, and the pre-cancerous complication of GERD known as Barrett's esophagus.

Unlike other drugs that neutralize acid to bring some relief, PPIs block acid secretion in the stomach. The result is rapid soothing of symptoms and healing of the esophagus, which often starts within days of taking the medication.

Although long hailed by most doctors as extremely safe drugs, the U.S. Food and Drug Administration has noted that they may be linked to serious diarrhea, increases in fractures, and low magnesium levels. The drugs may be linked to kidney disease, as well.  

Your doctors also need to watch for interactions with other drugs, so it’s important to tell them if you’ve been using a PPI on your own.

PPIs and your heart

PPIs may increase your chance of a heart attack. One study from the Mayo Clinic found that people who used PPIs for more than five years had twice the risk of a cardiovascular event (including strokes) and more than twice the risk of heart failure. The key may be how long you use the drugs.

The Mayo Clinic research supported earlier research at Houston Methodist Hospital and Stanford University suggesting that adults who use PPIs are between 16 and 21 percent more likely to have a heart attack than people who skip the medications.  

The team was following up on an earlier study that suggested PPIs might impact the heart on a molecular level and cause heart disease. Their exhaustive study, which looked at 16 million clinical documents representing data on almost three million patients, found a clear and significant link between taking PPIs and the chances of having a heart attack, according to the research team.

Yet other research has focused on mortality and found no link to PPIs. A large study, evaluating more than 440,000 residents of the United Kingdom, concluded there was no evidence that people who used PPIs were likely to die in the next two years. The study of mortality was conducted because of conflicting earlier results.

In a study of U.S. veterans using PPIs, for example, researchers did find a small increase in deaths from heart disease, kidney disease, and upper gastrointestinal cancer. But a larger study of nearly 2 million U.S. seniors didn’t find that PPIs increased mortality.

What you can do

There is a clear alternative to PPIs: H2 blockers (the H stands for “histamine”), which include famotidine (Pepcid), cimetidine (Tagamet), ranitidine (Zantac), and others sold OTC.  

“Our results demonstrate that PPIs appear to be associated with elevated risk of heart attack in the general population, and H2 blockers show no such association," said Stanford researcher Nigam H. Shah, PhD.

H2 blockers work by decreasing stomach acid but, unlike PPIs, they don’t block acid from being secreted in the first place. Although H2 blockers give fast relief to many people with heartburn and GERD, their effects are not as strong or long-lasting as those of PPIs for most people.

Talk to your doctor about what’s best for you. Your doctor might suggest lifestyle strategies, including weight loss and diet changes, to help relieve heartburn and GERD symptoms. You can also ask about H2 blockers.

If PPIs are strongly indicated for your condition, make sure you control other areas of your life to lower your heart disease risk — for example, exercise regularly and keep your weight under control.

Don’t stop taking PPIs cold turkey

Researchers have found that stopping these drugs abruptly can bring back heartburn pain that is worse than ever. Tapering off the drugs slowly and using other types of antacids to control your symptoms can reduce that rebound effect.

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