A recent retrospective study has suggested a link between a class of over the counter heartburn medications and a an increased risk of heart attacks according to Dr. Steven Reisman, the Director of The New York Cardiac Diagnostic Center. This class of medications called proton pump inhibitors (PPI) include Prevacid, Prilosec, and Nexium. They work by potently decreasing the acid in the stomach. Those who are using these medications may have a 16-21% increase in the rate of heart attacks compared to those who have acid reflux and do not take these medications. This study is retrospective and thus may be limited in its ability to establish a cause and effect relationship. It is estimated that approximately 21 million people in the United States use PPI medications yearly.
The mechanism of association with heart attack risk may be related to several possibilities. It is possible that some individuals who have acid reflux “heartburn” may in fact have cardiac related angina or chest pain that independently puts them at risk for a heart attack. In addition, it has also been suggested that these PPI medications may decrease the amount of nitrous oxide in the blood vessel walls causing endothelial dysfunction which may increase the risk of heart attack.
Any individuals on PPI medications should consult their physician to see if this is appropriate according to Dr. Steven Reisman, a Cardiologist in Manhattan. In addition, other causes of heart attack risk should also be evaluated including stress testing and testing for endothelial dysfunction by using EndoPAT testing. Another class of drugs call H2 blockers may be more appropriate in certain patients who have acid reflux.