Everyday Medications that Increase the Risk of Heart Attack

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.

 

Published by

David Silver M.D.

Dr. Silver currently serves as the Chief Medical Officer at Targeted Medical Pharma. He is a practicing board certified rheumatologist and internist with privileges at Cedars-Sinai Medical Center in Los Angeles, California and served as clinical chief of rheumatology at Cedars Sinai from October 2000 to September 2004. Since June 1993, Dr. Silver has taught at the University of California at Los Angeles School of Medicine in various capacities and in July 2004 was named an associate clinical professor. From December 1994 to October 2008, Dr. Silver served as the director of the Chronic Pain Rehabilitation Program at Cedars-Sinai Medical Center and, since January 1993, Dr. Silver has served as associate medical director of the Osteoporosis Medical Center, a non-profit research corporation in Beverly Hills, California. From May 2003 to April 2006, Dr. Silver served as member of the scientific advisory committee of the American College of Rheumatology and, from May 2000 to April 2002, he served as a member of the awards and grants committee. Dr. Silver has written a book entitled Playing Through Arthritis: How to Conquer Pain and Enjoy Your Favorite Sports and Activities. Dr. Silver has also been granted several research grants to study osteoarthritis, osteoporosis, fibromyalgia, rheumatoid arthritis and epicondylitis. Dr. Silver is the author of numerous publications in peer-reviewed journals and has regularly accepted speaking engagements on various topics in rheumatology. Dr. Silver also serves as peer reviewer for Arthritis and Rheumatism, Clinical Rheumatology, Osteoporosis International, Journal of Osteoporosis and American Journal of Managed Care. Dr. Silver received a Bachelor of Arts degree in medical sciences with a minor in economics from Boston University and a medical degree from the Boston University School of Medicine. He did his residency training in internal medical at Northwestern University School of Medicine and his fellowship in Rheumatology at Cedars Sinai Medical Center.

Leave a Reply