GERD Drugs (PPI) Linked To Heart Attacks

haidut

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Notably, the older drugs form the class of H2 antagonists were not tied to heart risks. Some of those antihistamines have very beneficial effects unrelated to GERD. The PPI drugs powerfully deplete magnesium and calcium, and raise prolactin. So, the link to heart attacks is not surprising.

http://mobile.nytimes.com/blogs/well/20 ... t-attacks/

"...There was no association of heart attack with another class of drugs used to treat gastric reflux, H2 blockers like Zantac, Tagamet and Pepcid. The researchers suggest that P.P.I.’s promote inflammation and clots by interfering with the actions of protective enzymes. A significant limitation of the study, in PLOS One, is that P.P.I. usage may be a marker of a sicker patient population, more subject to heart disease in any case."
 

aguilaroja

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haidut said:
...The PPI drugs powerfully deplete magnesium and calcium, and raise prolactin. So, the link to heart attacks is not surprising...

Yes. Though the earlier "concern" was interaction between PPI's and Plavix/Clopidogrel, there has been accumulating evidence about the coronary risk of PPI's themselves, prior the new study.

Proton-pump inhibitors are associated with increased cardiovascular risk independent of clopidogrel use: a nationwide cohort study.
Charlot M1, Ahlehoff O, Norgaard ML, Jørgensen CH, Sørensen R, Abildstrøm SZ, Hansen PR, Madsen JK, Køber L, Torp-Pedersen C, Gislason G. Ann Intern Med. 2010 Sep 21;153(6):378-86. doi 10.7326/0003-4819-153-6-201009210-00005.

Proton pump inhibitor use represents an independent risk factor for myocardial infarction.
Shih CJ1, Chen YT2, Ou SM3, Li SY3, Chen TJ4, Wang SJ5. Int J Cardiol. 2014 Nov 15;177(1):292-7. doi: 10.1016/j.ijcard.2014.09.036. Epub 2014 Sep 28.
 

charlie

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"Take the purple pill."
 
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haidut

haidut

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aguilaroja said:
haidut said:
...The PPI drugs powerfully deplete magnesium and calcium, and raise prolactin. So, the link to heart attacks is not surprising...

Yes. Though the earlier "concern" was interaction between PPI's and Plavix/Clopidogrel, there has been accumulating evidence about the coronary risk of PPI's themselves, prior the new study.

Proton-pump inhibitors are associated with increased cardiovascular risk independent of clopidogrel use: a nationwide cohort study.
Charlot M1, Ahlehoff O, Norgaard ML, Jørgensen CH, Sørensen R, Abildstrøm SZ, Hansen PR, Madsen JK, Køber L, Torp-Pedersen C, Gislason G. Ann Intern Med. 2010 Sep 21;153(6):378-86. doi 10.7326/0003-4819-153-6-201009210-00005.

Proton pump inhibitor use represents an independent risk factor for myocardial infarction.
Shih CJ1, Chen YT2, Ou SM3, Li SY3, Chen TJ4, Wang SJ5. Int J Cardiol. 2014 Nov 15;177(1):292-7. doi: 10.1016/j.ijcard.2014.09.036. Epub 2014 Sep 28.

Thanks. Do you know what the proposed mechanism of action was in those studies? I am surprised that given their official FDA box warning for hypomagnesemia most doctors seem oblivious to the PPI potential for causing heart trouble.
 

Mariah143

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i dont know how to work this site i have a hernia severe cronic gerd. ive tried enzymes, aloe, applecider viniger nothing works. im allergic to alot of herbs but am will ing to try anything but note i take alot of rx perscribed meds too help need to get ridd of this heartburn
 
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Mariah143 said:
post 112007 i dont know how to work this site i have a hernia severe cronic gerd. ive tried enzymes, aloe, applecider viniger nothing works. im allergic to alot of herbs but am will ing to try anything but note i take alot of rx perscribed meds too help need to get ridd of this heartburn

Ask your doctor to do a Heidelberg acid test or the Betaine challenge test. Alternatively, a decent surrogate of acid levels if a blood test for chloride. These tests will determine if you indeed have high acid levels. Most people have low levels of stomach acid and the PPI drugs make the condition even worse. The symptoms of GERD can be caused by low acid too and most doctors conveniently forget about this fact until somebody is rude enough to remind them. If you have low acid level I think you need to seriously question your doctor about the need to take PPI and you should probably start looking at ways to improve metabolism as acid production depends mostly on thyroid function and proper nutrition.
 
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jaakkima

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When you are hospitalized they try to give you PPIs as a matter of routine whether you've ever had GERD or not. So infuriating.
 

denise

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This is only slightly related, but I wanted to throw it out there. I was in a meeting with one of our trainers (I work for a medical device company), and she was giving another coworker a lecture about chronic use of heartburn medication, because since they merely mask symptoms, many people (it seems men, especially) will use OTC meds for years, then get a PPI from their GP and use that for years, and then only after they've been masking/avoiding the root issue for a decade or so do they get referred to a gastroenterologist, who finds that they've developed Barrett's esophagus (which can, in some cases, lead to esophageal cancer). Moral of her story: if you've got chronic GERD [and, I would add, you've determined that it's not actually caused by low acid], get scoped to find out what's going on in there rather than just hiding behind antacids.
 
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haidut

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This is only slightly related, but I wanted to throw it out there. I was in a meeting with one of our trainers (I work for a medical device company), and she was giving another coworker a lecture about chronic use of heartburn medication, because since they merely mask symptoms, many people (it seems men, especially) will use OTC meds for years, then get a PPI from their GP and use that for years, and then only after they've been masking/avoiding the root issue for a decade or so do they get referred to a gastroenterologist, who finds that they've developed Barrett's esophagus (which can, in some cases, lead to esophageal cancer). Moral of her story: if you've got chronic GERD [and, I would add, you've determined that it's not actually caused by low acid], get scoped to find out what's going on in there rather than just hiding behind antacids.

Unfortunately, getting scoped won't do much for your GERD or Barrets either. It will just confirm or reject whether you have Barrets. Even if confirmed there is no treatment other than the PPIs, which as you mentioned is not a treatment, and most doctors will readily tell you PPI will NOT prevent developing esophageal cancer. The only "therapy" that is done for this condition is surgical ablation, which also does NOT prevent developing cancer later on.
GERD is probably an inflammatory condition as discussed in this other post, and as such is likely to respond better to NSADI therapy, especially aspirin.
https://raypeatforum.com/community/...aused-by-inflammation-not-stomach-acid.11110/

Finally, given that gastric acid production depends on metabolism and that declines with age, most people have LOW and not HIGH acid production. Low stomach acid can also cause the symptoms of GERD as the food is sitting undigested and the duodenal sphincter won't open until it is digested. So, in the meantime food has only one way to go - up. So, a saner approach would be to actually test for acid production and only then prescribe PPI. I don't know of a single doctor who does that btw, even though they are aware of the needed tests.
Finally, the only people with legitimate acid conditions that may truly need anti-acid drugs areones with the so-called Zolinger-Ellison syndrome.
Zollinger–Ellison syndrome - Wikipedia

That condition is rather rare, and prescribing of PPI without testing for actual acid production is absolutely insane/criminal.
 

michael94

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I once had a doctor tell me it's impossible to have too little stomach acid. Literally he said impossible. LOL
 

michael94

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I think in some instances however stomach acid is lowered naturally due to the stomach mucosa not being able to handle it. Betaine HCL caps would be one way to test if low stomach acid is protective or caused by roadblock/metabolism.
 
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I once had a doctor tell me it's impossible to have too little stomach acid. Literally he said impossible. LOL

Ask that doctor if he/she has ever heard of "atrophic gastritis". And if the answer is no, then you need a new doctor. The PPI drugs are known to cause atrophic gastritis and gastric cancer down the line. If you look at the animal data, it shows it in the very first stages of trials. FDA also knows it but considers the risk "low".
 

denise

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Unfortunately, getting scoped won't do much for your GERD or Barrets either. It will just confirm or reject whether you have Barrets. Even if confirmed there is no treatment other than the PPIs, which as you mentioned is not a treatment, and most doctors will readily tell you PPI will NOT prevent developing esophageal cancer. The only "therapy" that is done for this condition is surgical ablation, which also does NOT prevent developing cancer later on.
GERD is probably an inflammatory condition as discussed in this other post, and as such is likely to respond better to NSADI therapy, especially aspirin.
GERD (acid Reflux) Is Caused By Inflammation, Not Stomach Acid

Finally, given that gastric acid production depends on metabolism and that declines with age, most people have LOW and not HIGH acid production. Low stomach acid can also cause the symptoms of GERD as the food is sitting undigested and the duodenal sphincter won't open until it is digested. So, in the meantime food has only one way to go - up. So, a saner approach would be to actually test for acid production and only then prescribe PPI. I don't know of a single doctor who does that btw, even though they are aware of the needed tests.
Finally, the only people with legitimate acid conditions that may truly need anti-acid drugs areones with the so-called Zolinger-Ellison syndrome.
Zollinger–Ellison syndrome - Wikipedia

That condition is rather rare, and prescribing of PPI without testing for actual acid production is absolutely insane/criminal.
I did wonder at the time what scoping got you (aside from a good look for a diagnosis) but since this is, thank heavens, one problem I don't have, I didn't care enough to follow up. I think I'll mention this to my coworker though. If nothing else, it'd be a lot cheaper to test for low acid than to get scoped.
On a side note, a while ago this same coworker overheard me talking about thyroid stuff and how great your TyroMix is for rats, and he was interested for his wife's sake. I haven't followed up to see if she's tried it for her rat yet. I hope so. She sounds quite miserable. If she's trying it, this will be the third coworker (or coworker's spouse's rat) that I've gotten to try it!
 
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I did wonder at the time what scoping got you (aside from a good look for a diagnosis) but since this is, thank heavens, one problem I don't have, I didn't care enough to follow up. I think I'll mention this to my coworker though. If nothing else, it'd be a lot cheaper to test for low acid than to get scoped.
On a side note, a while ago this same coworker overheard me talking about thyroid stuff and how great your TyroMix is for rats, and he was interested for his wife's sake. I haven't followed up to see if she's tried it for her rat yet. I hope so. She sounds quite miserable. If she's trying it, this will be the third coworker (or coworker's spouse's rat) that I've gotten to try it!

Awesome, thanks for the referrals and please keep me posted on how the rats feel.
 

aguilaroja

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...The PPI drugs powerfully deplete magnesium and calcium, and raise prolactin. So, the link to heart attacks is not surprising.
http://mobile.nytimes.com/blogs/well/20 ... t-attacks/
"... The researchers suggest that P.P.I.’s promote inflammation and clots by interfering with the actions of protective enzymes...."

Proton pump inhibitor monotherapy and the risk of cardiovascular events in patients with gastro-esophageal reflux disease: a meta-analysis. - PubMed - NCBI
“…the use of PPIs was associated with a 70% increased cardiovascular risk (RR=1.70…). Furthermore, higher risks of adverse cardiovascular events in the omeprazole subgroup (RR=3.17…) and long-term treatment subgroup (RR=2.33…) were found.”
“PPI monotherapy can be a risk factor for cardiovascular adverse events. Omeprazole could significantly increase the risk of cardiovascular events and, so, should be used carefully.”
 
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Proton pump inhibitor monotherapy and the risk of cardiovascular events in patients with gastro-esophageal reflux disease: a meta-analysis. - PubMed - NCBI
“…the use of PPIs was associated with a 70% increased cardiovascular risk (RR=1.70…). Furthermore, higher risks of adverse cardiovascular events in the omeprazole subgroup (RR=3.17…) and long-term treatment subgroup (RR=2.33…) were found.”
“PPI monotherapy can be a risk factor for cardiovascular adverse events. Omeprazole could significantly increase the risk of cardiovascular events and, so, should be used carefully.”

Thanks, and btw famotidine was recently found to actually benefit heart failure and CVD so it becomes a no-brainer to use instead of PPI. I wonder if the H2 antagonists will get pulled from market or get re-approved for different conditions and thus become again prescription-only...
Histamine H2 receptor activation exacerbates myocardial ischemia/reperfusion injury by disturbing mitochondrial and endothelial function. - PubMed - NCBI
Blockade of histamine H2 receptors protects the heart against ischemia and reperfusion injury in dogs. - PubMed - NCBI
Histamine-2 receptor antagonist famotidine modulates cardiac stem cell characteristics in hypertensive heart disease. - PubMed - NCBI
"...DISCUSSION: As anticipated, CSCs from SHRs were functionally impaired. Stem cell attributes of famotidine-treated SHRs was comparable to that of Wistar rats. Therefore, in addition to being cardioprotective, the histamine 2 receptor antagonist modulated cardiac stem cells characteristics. Restoration of stem cell efficiency by famotidine is possibly mediated by reduction of oxidative stress as the expression of H2R was unaffected by the treatment. Maintenance of healthy stem cell population is suggested as a possible mechanism underlying the cardioprotective effect of famotidine."
 

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