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Commonly Prescribed Antacids Increase Risk Of Heart Attack Up To 21 Percent, Study Finds

by — 2015-07-26 in Drugs & Medications
The link between the class of medications known as proton pump inhibitors and the risk of heart attack is so strong that many people should not take them, a new study says.

For some of us, treating heartburn can lead to heart attack, recently reported research reveals.

A novel "data mining" study by researchers at Houston Methodist Hospital and Stanford University has found that the antacid medications known as proton inhibitors increases the risk of a heart attack by 16 to 21 percent. Dr. Nicholas J. Leeper, an assistant professor of cardiovascular medicine and vascular surgery at the Stanford medical school, and one of the authors of the study, says the risk is not limited to the elderly, and is so strong that doctors need to take it into account when prescribing medications such as the "little purple pill," Nexium. The study did not find increased heart dangers from another kind of medication for gastroesophageal reflux disease and chronic heartburn that includes Axid, Pepcid, Tagamet, and Zantac.

What Are The Proton Pump Inhibitors?

Proton pump inhibitors, also known as H2 inhibitors, are a group of drugs that reduce stomach acid production by disabling the "proton pump" that releases hydrogen ions from the lining of the stomach to make its contents acidic. These medications do not have any effect until they are absorbed into the lining of the stomach, where they permanently disable acid production. The H2 inhibitors reduce the amount of acid in the stomach and also in the duodenum, the first section of the small intestine.
 
Proton pump inhibitors come in many formulations under many brand names. Some of the most popular brands of this $13 billion a year drug classification include:
  • Dexlansoprazol (Dexilant, Kapidex).
  • Esomeprazole (Esotrex, Nexium).
  • Lansoprazole (Prevacid, Zoton, Inhibitol).
  • Omeprazole, which is currently available over the counter in the United States (Prilosec, Gasec, Losec, Zegerid, Ocid, Lomac, Omepral, Omez, Omepep, UlcerGard, GastroGard, Altose).
  • Pantoprazole (Controloc, Protonix, Pantoloc, Pantozol, Pantomed, Zurcal, Zentro,Tecta, and others).
  • Rabeprazole (Aciphex, Dorafem, Nzole-D, and many others).
In the United States and Canada, the bestsellers of this group are Nexium, Pepcid, and Prilosec, although there are many competing medications. They begin to work in as little as 30 minutes, and they continue to work for up to three days, even if a dose of the medication is skipped, until the lining of the stomach grows new acid-producing cells.

Millions Of People Use Proton Pump Inhibitors

An astonishingly large number of people use proton pump inhibitors to control heartburn. In the United States, about one out of every fourteen people, over twenty-two million people in all, take a proton pump inhibitor such as Nexium, Prilosec, or Prevacid. These medications are most commonly prescribed for GERD (gastroesophageal reflux disease, or chronic heartburn), but they are also prescribed for Helicobacter pylori infections, peptic ulcers, duodenal ulcers, and Barrett's esophagus, a complication of chronic GERD in which the lining of the lower throat turns into tissue that resembles the lining of the intestine. Barrett's esophagus increases the likelihood of developing esophageal cancer.

READ How Much Do You Know About Heart Attack?

Over a lifetime of use, these medications attribute to an addition two to three million heart attacks in the United States alone. The additional danger from taking them in any given year is not particularly high, but the lifetime risk of using these medications adds up, enough that anyone who otherwise has high risk factors for heart disease probably should avoid them.

If You Can't Take Proton Pump Inhibitors, What Should You Do?

There is no single best treatment for acid reflux, but PPIs come close. Many people rely on proton pump inhibitors for acid reflux treatment, but if you are someone who should not use these medications because of heart risk, there are still a number of alternative acid reflux remedies, both medical and natural.
 
PPIs are the most effective form of heartburn treatment, but they are not the only drugs for the condition. The H2-receptor antagonists stop the release of stomach acid at a different point in the process. These medications shut down the ability of the lining of the stomach to respond to histamine (the same chemical that causes burning eyes and itching in allergies), so globe cells in the lining of the stomach never get the signal to release acid. They are not, as in the case with medications like Nexium, Prevacid, and Prilosec, "paralyzed." They just don't get a signal to release acid. Because the stomach can start generating acid again as soon as H2-receptor agonists wear off, they are not as effective in fighting heartburn, and their effects are more temporary.
 
 
These heart-safe alternative medications include:
  • Axid (nizatidine),
  • Pepcid (famotidine),
  • Tagamet (cimetidine), and
  • Zantac (ranitidine).
Many people who have both gastroesophageal reflux disease and heart disease already take these medications instead of the more dangerous acid blockers because they take Plavix (clopidogrel), the blood thinner, which is not compatible with PPIs. The problem with the H2 blockers is that the body builds up resistance to them, and they can cause tachyphylaxis, a sudden decrease in responsiveness to the medication. Essentially, they will work for a few months or a few years, and then suddenly they will have no effect at all.
 
A more "natural" approach to heartburn is deglycyrrhizinated licorice, also known as DGL. Certain compounds in the licorice root soothe stomach irritation. However, the whole herb contains glycyrrhizin, which can be dangerous for people who already have high blood pressure or kidney disease. It can cause excessive accumulation of potassium. Deglycyrrhizinated licorice removes the potentially heart-threatening component of the herb and simply relieves acidity. It is most effective in cases of Helicobacter pylori infection and associated peptic and duodenal ulcers.
 
It also helps not to put pressure on the stomach that drives acid upward. Losing weight reduces the symptoms of GERD. Avoiding tight-fitting shirts, blouses, and belts reduces stomach acid, and so does eating smaller meals. The less one eats, the more quickly it passes through the stomach, and the less time there is for stomach acid to come up. Gastric motility, the speed at which food passes through the stomach, can also be increased with drugs like Reglan (metoclopramide) or digestive enzymes such as bromelain and papain. Sometimes over the counter, natural enzyme preparations can make a big difference in acid reflux.
 
Oddly enough, there are occasions that increasing the production of stomach acid reduces the uprising of stomach acid. In many parts of Europe, it is customary to drink a bitter apertif, such as gentian, or to eat a small salad of bitter herbs, such as endive and/or radicchio, before eating fatty meat. Fat ordinarily stays longer in the stomach, but the bitter taste activates a reflex that releases stomach acid and accelerates the passage of the digested fat and protein out of the stomach. Increasing acid sometimes reduces the amount of acid coming back into the throat.

READ Raising GERD Awareness: Be Aware of Heartburn

Managing GERD and related conditions is harder without PPIs, but it is not impossible. If you have any risk for heart disease, ask your doctor about the most appropriate medication and lifestyle changes for your symptoms.

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