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Proton Pump Inhibitors (PPIs) Reduce Heartburn But May Increase Risk of Heart Attack


In a strange twist of fate, a class of drugs that help reduce the painful burning feeling in your chest caused by indigestion (if you suffer from a disease like gastroesophageal reflux disease) may also increase your risk of a heart attack. A new study conducted by a team of Stanford University researchers found a very strong correlation, but not causation, between the use of proton pump inhibitors and risk of heart attack. Further research on the subject is planned.

By Steven Fruitsmaak (Own work) [CC BY-SA 3.0 (], via Wikimedia Commons

X-ray of abdomen with severe reflux esophagitis. Radiocontrast can be seen moving through the entire esophagus.

This revelation about the possible dangers of proton pump inhibitors affects nearly 100 million people around the world who are prescribed the medications, and over 21 million Americans who reported using these drugs with a prescription in 2009. Some proton pump inhibitors are sold over the counter, and include brand names like Prilosec and Nexium. The drugs bring in over $13 billion in sales every year for pharmaceutical companies.

Experts recommend talking to your doctor before taking any proton pump inhibitors for heartburn as only two weeks of regular use could be very risky for individuals. The researchers theorize that these medications may inhibit the activity of nitric oxide, which may then increase vascular resistance within the heart, which could promote inflammation and thrombosis leading to an increased risk of heart attack.

Though this newfound potential association is important for patient safety, perhaps just as important is how the researchers came to their conclusion. The study utilized advanced data mining techniques to search over 16 million clinical documents belonging to approximately 2.9 million patients. These kinds of databases of anonymized medical records are becoming very useful for researchers – and are already proving their value to the scientific community (and notably, the pharmacovigilance community). By assembling these gigantic databases of patient information, curious researchers can discover previously unknown side effects of pharmaceutical drugs. This development benefits patient safety as well as general pharmaceutical research.

This kind of research is also far different than what pharmaceutical companies do before releasing a new drug. Most new drugs must undergo clinical testing through randomized trials before release to market, typically in a sample of a few thousand patients. New techniques like big data driven research addresses most, if not all, of the different types of patients the drugs will actually be given to – instead of the small sample of patients that the drug was actually studied in by the pharmaceutical company.

However, results from big data aren’t as easy to interpret as results from smaller studies. Some drug safety researchers believe that the results from this particular study may stem from the factors that cause usage of proton pump inhibitors in the first place, like alcohol use, smoking, and having a poor diet. Proton pump inhibitors also have known side effects, including kidney problems, osteoporosis, and low magnesium and vitamin B12 levels.

Despite the study’s lack of finding causation, it’s still important to consult with your doctor before adding any new drug to your regime, despite how benign it may appear.

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