popular group of antacids known as proton
pump inhibitors, or PPIs, used to reduce
stomach acid and treat heartburn may increase
the risk of 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, M.D., 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, who had an endoscopy — a
procedure used to identify the causes of stomach pain
and indigestion. During nearly six years of follow up, 9,489
patients had an ischemic stroke for the first time in their
lives. Researchers determined if the stroke occurred while
patients were using one of four PPIs: omeprazole (Prilosec),
pantoprazole (Protonix), lansoprazole (Prevacid) and
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 four PPIs, 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
In comparison with non-users, PPI users were older and
had more health conditions, including atrial fibrillation at
baseline. The study accounted for age, gender and medical
factors, including high blood pressure, atrial fibrillation, heart
failure and the use of certain pain relievers that have been
linked to heart attack and stroke.
The authors believe that their findings, along with
previous studies, should encourage more cautious use of
PPIs. Sehested noted that most PPIs in the United States
are now available over the counter.
“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.”
Although their study did not find a link between H2
blockers and stroke, the authors could not say that this
group of drugs would be better for patients than PPIs.
Doctors prescribing PPIs, should carefully consider
whether their use is warranted and for how long: “We know
that from prior studies that a lot of individuals are using PPIs
for a much longer time than indicated, which is especially
true for elderly patients.”
Study limitations include its observational design,
which cannot establish cause and effect, and the fact that
nearly all the participants were white. Authors believe that
a randomized controlled trial of PPIs and cardiovascular
disease is warranted.
Popular heartburn medication may
increase ischemic stroke risk