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Acid reflux and heart attacks

June 10, 2015 | John Murray

Does fighting acid reflux with a popular class of drugs called proton pump inhibitors lead to an increased risk of heart attack? Research based on mining massive amounts of health data, published y in the journal PLOS One, suggests there is a connection.

As reported in the Washington Post, “the research theorizes that proton pump inhibitors may reduce production of nitric oxide from cells that line the inside of the circulatory system, including the heart. Lower levels of nitric oxide have long been associated with cardiovascular problems.”

The research examined patterns found in a database of 2.9 million patients.

Keep taking PPIs...for now

Despite the headlines, experts say patients should not unilaterally decide to stop taking drugs like Nexium, Prevacid and Prilosec, which work by blocking the stomach’s acid production.

“I would advise against patients making any drastic changes in the use of PPIs until they speak with their physicians,” says Dr. Pranav Patel, chief of UCI Health Cardiology Services, noting that both patients and physicians may need take pause in individuals who are at high risk of having a heart attack and who use PPIs chronically.

“There seems to be a possible association with PPI use and heart attack, although this association is weak,” he says. “The results deserve further investigation.”

Link is not a new one

Dr. Gregory Albers, a gastroenterologist at the H.H. Chao Comprehensive Digestive Disease Center, agrees, and says the possible correlation between PPIs and cardiovascular issues is not new.

“I think people will be alarmed by this study, but they shouldn’t be,” he says.

Albers points to a 2013 study that concluded PPIs may be associated with a short-term risk of adverse cardiac events, but that such observations do not represent a cause-and-effect connection.

He says changing the way physicians manage GERD will require a much more rigorous conclusion than is possible from data mining, a type of statistical analysis of trends and patterns found in large quantities of data.

Data mining and medical research

The promise that diving deeply into big data can yield healthcare wisdom has become an article of faith in some corners of Silicon Valley. Last year, Google’s CEO told the New York Times, “… we don’t data-mine health care data. If we did we’d probably save 100,000 lives next year.”

While the Washington Post highlighted the PLOS One study’s connection between PPIs and heart attacks, just eight months ago the same newspaper cautioned against viewing data mining health records as a cure-all.

Albers says it is not possible for this type of analysis to truly associate an outcome with its causes. In short, data mining has not — and cannot — replace the randomized controlled trial as the gold standard for research.

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