The use of lansoprazole increased the risk of ischemic stroke by 94%.
Proton pump inhibitors (PPIs) are commonly used medications that treat heartburn and reduce stomach acid. A recent study has found that these prescription and over-the-counter drugs may also increase the risk of ischemic stroke.
“PPIs have been associated with unhealthy vascular function, including heart attacks, kidney disease and dementia," said the study’s lead author Thomas Sehested, MD. “We wanted to see if PPIs also posed a risk for ischemic stroke, especially given their increasing use in the general population.”
Ischemic stroke is the most common type of stroke experienced, and is caused by clots blocking the brain’s blood supply. Symptoms include difficulties walking, speaking, understanding with numbness in the face, arm, or leg.
In the study, which was presented at the American Heart Association’s Scientific Sessions 2016, investigators examined the medical records of 244,679 patients who had an endoscopy, which is a procedure used to determine the cause of stomach pain and indigestion.
Patients who used PPIs were typically older and had more health conditions compared with patients who did not use the drugs. Investigators looked at factors such as age, gender, and medical factors such as high blood pressure, atrial fibrillation, heart failure, and use of pain relievers that have been linked to heart attack and stroke, according to the study.
During a 6-year follow up period, they found that 9489 patients experienced their first ischemic stroke. Investigators then determined if the stroke happened while the patients were taking 1 of the following PPIs: omeprazole (Prilosec), pantoprazole (Protonix), Iansoprazole (Prevacid) and esomeprazole (Nexium).
They discovered that stroke risk increased 21% when the patient was taking a PPI, but there was very little increased risk of stroke if the PPI was a low dose. At high doses, stroke risk increased from 30% when taking lansoprazole up to 94% when taking pantoprazole, according to the study.
Investigators did not find an increased risk of stroke associated with H2 blockers, which is another type of treatment to reduce stomach acid. Commonly prescribed H2 blockers include famotidine (Pepcid) and ranitidine (Zantac).
While there was no link established between H2 blockers and increased stroke risk, the investigators caution that these findings do not mean that the drugs are necessarily more beneficial.
Physicians should also be careful when determining whether or not to prescribe the drug and for how long. Pharmacists may play a role in reducing the use of PPIs as well.
“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,” Dr Sehested said.
As with most observational studies, their findings are limited since it cannot establish cause and effect. Randomized controlled clinical trials of PPIs and their link to heart disease is needed to determine how these drugs may affect the general population.
They believe their overall findings in conjunction with previous studies suggest that patients should use both prescribed and over-the-counter PPIs cautiously.
“At 1 time, PPIs were thought to be safe, without major side effects,” Dr Sehested concluded, “This study further questions the cardiovascular safety of these drugs.”