Sometimes, Solving One Problem Only Creates Another

Millions of Americans take proton pump inhibitors to treat acid reflux and heartburn.  Known as PPIs, they are among the most prescribed drugs in the United States and are widely available over the counter.  But according to preliminary research presented at the American Heart Association conference in New Orleans, these medications may also increase the risk of ischemic stroke.

Ischemic strokes are the most common type of stroke, according to the Centers for Disease Control and Prevention.  They occur when a blood clot cuts off blood flow to the brain.  The research was conducted in Denmark among a quarter-million patients who suffered from stomach pain and indigestion, and were taking one of four PPIs: Prilosec, Protonix, Prevacidor Nexium.

Overall stroke risk increased 21% among patients who were taking a PPI, according to the study.  At the lowest doses, the authors found either no or minimal increased risk of stroke.  At the highest doses, they found that stroke risk increased 33% for Prilosec and Prevacid patients, 50% for Nexium patients and 79% for Protonix patients.

H2 receptor antagonists such as Pepcid and Zantac showed no association with stroke risk.

There has been a growing body of evidence that have been suggesting some evidence questioning the cardiovascular safety of PPIs. PPIs reduce the production of nitric oxide leading to cell dysfunction, and several observational clinical studies have linked their use to cardiovascular disease.

An interesting question also however arises if PPIs are most likely a marker of increased risk rather than a direct cause of cardiovascular or neurovascular adverse outcomes.  All the evidence suggesting cardiovascular harm with PPIs has come from observational studies.

This is still an observational study, and due to the possibility of residual confounders, this association by no means indicates a causative effect.  Further studies are indicated to study this association.  An important point of this study and other observational studies of PPI use and adverse cardiovascular events is that patients should not be taking PPIs without a clear indication. canlı bahis

The evidence is not yet strong enough to support stopping use of PPI drugs if they are needed.  Patients should not take these drugs unless there is a clear indication for them.  Many people are taking them unnecessarily or they are continuing to take them long-term when they don’t need to.  I would urge doctors to review their patients on PPIs and look at why they are taking these drugs and consider whether they really need them or if they could take a lower dose.

PPIs are available over the counter in many countries and many patients take them off label, which is a concern.

In April, another study published in the Journal of the American Society of Nephrologyfound that patients who took PPIs had a 96% increased risk of kidney failure and a 28% increased risk of kidney disease, compared with those who were prescribed alternative medications.

The majority of people who suffer from acid reflux or heartburn could drastically or completely reduce their discomfort by making a few lifestyle changes: quit smoking, lose weight and cut back on spicy and fatty foods.

If your doctor determines that you do need pills for your problem, starting with an antacid, such as Tums, Rolaids or Maalox may be a good choice.  Antacids usually would help if you have less than one incident a week.

Antacids provide quick relief, but only for a short amount of time. If you’re pregnant, you should avoid sodium bicarbonate and magnesium trisilicate.  Patients with kidney disease should avoid antacids that contain aluminum.

For longer-lasting relief, H2 antagonist medications(also called H2 blockers) are also an option, but they can take a few hours to kick in.

As always, you should talk to your doctor before starting or stopping any medication — prescribed or over the counter.

For more information on stroke, log on to bursa evden eve nakliyat
deneme bonusu deneme bonusu veren siteler