A popular group of antacids known as proton pump inhibitors, or PPIs, used to reduce stomach acid and treat heartburn may increase the risk of the most common form of stroke (“ischemic stroke”), according to preliminary research presented at the American Heart Association’s Scientific Sessions 2016.
“PPIs have been associated with unhealthy vascular function, including heart attacks, kidney disease and dementia,” said Thomas Sehested, MD, study lead author and a researcher at the Danish Heart Foundation in Copenhagen, Denmark. “We wanted to see if PPIs also posed a risk for ischemic stroke, especially given their increasing use in the general population.”
Researchers analyzed the records of 244,679 Danish patients, average age 57. During nearly six years of follow up, they assessed stroke rates while patients were using 1 of 4 PPIs: omeprazole (Prilosec), pantoprazole (Protonix), lansoprazole (Prevacid) and esomeprazole (Nexium)., all being obtainable over the counter in the U.S.A.
For ischemic stroke, researchers found:
- Overall stroke risk increased by 21 percent when patients were taking a PPI.
- At the lowest doses of the PPIs, there was slight or no increased stroke risk.
- At the highest dose for these 4 PPI’s, stroke risk increased from 30 percent for lansoprazole (Prevacid) to 94 percent for pantoprazole (Protonix).
- There was no increased risk of stroke associated with another group of acid–reducing medications known as H2 blockers, which include famotidine (Pepcid) and ranitidine (Zantac).
The study corrected for age, gender and medical factors, including high blood pressure, atrial fibrillation (irregular heart beat), heart failure and the use of certain pain relievers that have been linked to heart attack and stroke. The authors suggested that their findings, along with previous studies, should encourage more cautious use of PPIs. .
“At one time, PPIs were thought to be safe, without major side effects,” he said, “This study further questions the cardiovascular safety of these drugs.”
Since it was an observational design, this study could not definitively establish cause and effect between PPIs and strokes. For this reason, the authors believe that a randomized controlled trial of PPIs and cardiovascular disease is warranted.
In the meantime, how should each of us respond to this information? First, we should carefully consider whether use of PPIs is warranted at all, and for how long:
Given the relative safety of the H2 blockers such as Zantac and Pepcid, they should be tried first after ordinary antacids such as Mylanta, Di-Gel, Gelusil, etc. are tried and found wanting. Only then should we consider the PPIs, and used for as brief a period as possible.