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July 01, 2015

Reflux Medications Linked to Heart Attacks: Not as Bad as You Think

In June 2015, media reported a link between heart attacks and taking a certain class of reflux medications known as proton pump inhibitors (PPI). Such medications include nexium, prilosec, prevacid, etc and are very common to treat heartburn. This reported link was due to a paper published in PLOS One which you can read here.

How high is the risk? The research suggested an increased risk of 16%. Although this may sound high, this translates into one heart attack for every 4000 patients treated.

Keep in mind that untreated reflux is also associated with esophageal cancer which also has a risk of death. (10-15% of patients suffering from reflux develop Barrett's esophagus of which 1% go on to develop cancer.)

And although this particular research suggested H2 blockers like pepcid and zantac are safe, these meds are associated with possible rare risk of prolonged QT syndrome which may lead to cardiac death. [link]

As such, if you suffer from reflux that does not respond to lifestyle/dietary changes, it is perfectly appropriate and "safe" to take reflux medications. It is what is considered an acceptable risk given the downsides if you do not treat. Of course, one can always consider surgical options in order to avoid medications... but than surgery is also associated with risks as well.

I should also mention that common antibiotics like z-pack and levaquin have also been associated with heart attacks. So too with benadryl and sudafed. More info here on these other drugs.

How does risk of heart attack from taking PPI compare to other risks that people accept on a regular basis?

Dying on the road over 50 years of driving1 in 85
Dying from any cause in the next year1 in 100
Annual risk of death from smoking 10 cigarettes per day1 in 200
ER treatment in the next year after being injured by a can, bottle, or jar1 in 1,000
ER treatment in the next year after being injured by a bed mattress or pillow1 in 2,000
Risk of Heart Attack from Taking PPI Reflux Medication1 in 4000
Death by an accident at home1 in 7,100
Death by an accident at work1 in 40,000
Death playing soccer1 in 50,000
Death by murder1 in 100,000
Being hit in your home by a crashing aeroplane1 in 250,000
Death by rail accident1 in 500,000
Being struck by lightning1 in 10,000,000
Death from a nuclear power accident1 in 10,000,000

Let's consider other popular drugs that also has an increased risk of death, though not necessarily from a cardiac trigger.

• ALL antibiotics due to a severe anaphylactic allergic reaction - Take Penicillin for example... about 300 die annually from penicillin allergic reaction in the US
• Tylenol causes liver failure - About 400 deaths per year in the US
• Ibuprofen causes internal bleeding - About 15,000 - 20,000 die per year in the US
• Alcohol related deaths - 75,000 deaths per year in the US
• Smoking related deaths - 443,000 deaths per year (one in five deaths) in the US

Never mind deaths from driving a car, accidental gunfire, drowning in a swimming pool, etc.

Life in general in the United States has a risk of death.


Source:
Heartburn Drugs Linked to Heart Attacks. New York Times 6/10/15

Reference:
Proton Pump Inhibitor Usage and the Risk of Myocardial Infarction in the General Population. PLoS ONE 10(6): e0124653. doi:10.1371/journal.pone.0124653


Fauquier blog
Fauquier ENT

Dr. Christopher Chang is a private practice otolaryngology, head & neck surgeon specializing in the treatment of problems related to the ear, nose, and throat. Located in Warrenton, VA about 45 minutes west of Washington DC, he also provides inhalant allergy testing/treatment, hearing tests, and dispenses hearing aids. Google+ Christopher Chang, MD Bio

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