Data out of Stanford University suggests 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 scientist 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% increase in risk of heart attack and the risk was statistically significant. H2 Blockers, such as Zantac and Pepcid were not associated with an increase risk. Perhaps more importantly, the risk extended out of the high risk categories such as having had a previous heart attack, the elderly or taking clopidogrel. It was in all age and risk groups.

PPI’s are one the most commonly used medication 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 risk of heart attack.

Medications are often used to treat or prevent the side effects of another medication. This creates a potentially vicious cycle of taking more and more medication, each with its own side effect profile just to eliminate the negative effects of another medication. Understanding the risks and benefits of medication is crucial, and exploring the options that may be better tolerated is something every patient and physician should do.