Data out of Stanford University suggest that Proton Pump Inhibitors (PPI’s) such as Prilosec, Prevacid, and Nexium are associated with a higher risk of heart attack. Published in the journal PLOS One online, researchers looked over 2.9 million patients over a several year period to determine if patients who took PPI’s for gastro esophageal reflux had an increased risk for myocardial infarction than patients who did not. Concern was raised when scientists discovered that PPI’s potentially reduced the antiplatelet effect of clopidogrel, a drug use to prevent clotting after a heart attack or stroke. The clopidogrel is used after heart attack to prevent clotting which could lead another heart attack. They were concerned that if heart attack was raised in this population, it could extend to lower risk patients.
The study showed that patients taking PPI’s had a 16% increased risk of heart attack. H2 Blockers, such as Zantac and Pepcid were not associated with an increase risk. Perhaps more importantly, the risk was not just associated with high risk categories such as having had a previous heart attack, the elderly or taking clopidogrel. It was applicable to all ages and risk groups.
The study has several limitations including the attempt to look back at charts and determine what medications are being taken. Often patients will take over the counter PPI’s and may not be accurately reporting it to their physician. Also, retrospective analyses like this are subject to certain biases and are not as valuable as preplanned double-blind clinical trials. However, the large number of patients reviewed does give the study significant credence.
PPI’s are one the most commonly used medications in the United States and around the world, with over 113 million prescriptions filled globally each year. PPI’s are used to treat stomach and intestinal ulcers and heartburn, as well as to prevent gastrointestinal bleeding from NSAID’s in higher risk populations. NSAID’s have been associated with a number of serious complications in addition to bleeding ulcers including kidney and liver issues, fluid retention with swelling in the legs, elevated blood pressure and possibly increasing the risk of heart attack.
Medications that are often used to treat or prevent the side effects of another medication create a potentially vicious cycle for patients who will ultimately end up taking more and more medications to manage an illness. The risk of adverse events increases with the number of medications prescribed, and the number of medications prescribed increases with age.
The avoidance of polypharmacy and therefore reducing the risk of dangerous medication side effects is crucial for patients and providers. Alternative therapies, such as FDA regulated medical foods, which by definition must be on the FDA GRAS list (generally recognized as safe), may have similar efficacy to standard pharmaceuticals but without the side effects. Understanding the risks and benefits of medications is an important part of being a patient and a healthcare provider. Exploring the medication options that may be better tolerated is something every patient and physician should do.